AUTHOR=Yang Seokhun , Choi Gilwoo , Zhang Jinlong , Lee Joo Myung , Hwang Doyeon , Doh Joon-Hyung , Nam Chang-Wook , Shin Eun-Seok , Cho Young-Seok , Choi Su-Yeon , Chun Eun Ju , Nørgaard Bjarne L. , Nieman Koen , Otake Hiromasa , Penicka Martin , Bruyne Bernard De , Kubo Takashi , Akasaka Takashi , Taylor Charles A. , Koo Bon-Kwon 

TITLE=Association Among Local Hemodynamic Parameters Derived From CT Angiography and Their Comparable Implications in Development of Acute Coronary Syndrome

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=8

YEAR=2021

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2021.713835

DOI=10.3389/fcvm.2021.713835

ISSN=2297-055X

ABSTRACT=<p><bold>Background:</bold> Association among local hemodynamic parameters and their implications in development of acute coronary syndrome (ACS) have not been fully investigated.</p><p><bold>Methods:</bold> A total of 216 lesions in ACS patients undergoing coronary CT angiography (CCTA) before 1–24 months from ACS event were analyzed. High-risk plaque on CCTA was defined as a plaque with ≥2 of low-attenuation plaque, positive remodeling, spotty calcification, and napkin-ring sign. With the use of computational fluid dynamics analysis, fractional flow reserve (FFR) derived from CCTA (FFR<sub>CT</sub>) and local hemodynamic parameters including wall shear stress (WSS), axial plaque stress (APS), pressure gradient (PG) across the lesion, and delta FFR<sub>CT</sub> across the lesion (ΔFFR<sub>CT</sub>) were obtained. The association among local hemodynamics and their discrimination ability for culprit lesions from non-culprit lesions were compared.</p><p><bold>Results:</bold> A total of 66 culprit lesions for later ACS and 150 non-culprit lesions were identified. WSS, APS, PG, and ΔFFR<sub>CT</sub> were strongly correlated with each other (all <italic>p</italic> &lt; 0.001). This association was persistent in all lesion subtypes according to a vessel, lesion location, anatomical severity, high-risk plaque, or FFR<sub>CT</sub> ≤ 0.80. In discrimination of culprit lesions causing ACS from non-culprit lesions, WSS, PG, APS, and ΔFFR<sub>CT</sub> were independent predictors after adjustment for lesion characteristics, high-risk plaque, and FFR<sub>CT</sub> ≤ 0.80; and all local hemodynamic parameters significantly improved the predictive value for culprit lesions of high-risk plaque and FFR<sub>CT</sub> ≤ 0.80 (all <italic>p</italic> &lt; 0.05). The risk prediction model for culprit lesions with FFR<sub>CT</sub> ≤ 0.80, high-risk plaque, and ΔFFR<sub>CT</sub> had a similar or superior discrimination ability to that with FFR<sub>CT</sub> ≤ 0.80, high-risk plaque, and WSS, APS, or PG; and the addition of WSS, APS, or PG into ΔFFR<sub>CT</sub> did not improve the model performance.</p><p><bold>Conclusions:</bold> Local hemodynamic indices were significantly intercorrelated, and all indices similarly provided additive and independent predictive values for ACS risk over high-risk plaque and impaired FFR<sub>CT</sub>.</p>