Key result
Wider coronary bifurcation angle is linked to greater FFRCT decline in disease-free vessels.
Why the study?
The association of the coronary bifurcation angle with computed tomography derived fractional flow reserve (FFRCT) decline in vessels without apparent coronary artery disease is not entirely understood.
Does coronary bifurcation angle impact the decline of CT-derived fractional flow reserve (FFRCT) in vessels with no apparent coronary artery disease?
Observational (n=83)
No
Does coronary bifurcation angle impact the decline of CT-derived fractional flow reserve (FFRCT) in vessels with no apparent coronary artery disease?
Effect estimate: r = 0.35
p-value: p=0.001
In vessels without apparent CAD, the coronary bifurcation angle and vessel length significantly contribute to the progressive decline in FFRCT, which should be considered when interpreting FFRCT values.
Bifurcation angle correlates with FFRCT decline in non-diseased vessels; leaves open whether angle adjustment refines diagnostic thresholds.
Objectives Computed tomography (CT) derived fractional flow reserve (FFRCT) decreases from the proximal to the distal part due to a variety of factors. The energy loss due to the bifurcation angle may potentially contribute to a progressive decline in FFRCT. However, the association of the bifurcation angle with FFRCT is still not entirely understood. This study aimed to investigate the impact of various bifurcation angles on FFRCT decline below the clinically crucial relevance of 0.80 in vessels with no apparent coronary artery disease (CAD). Methods A total of 83 patients who underwent both CT angiography including FFRCT and invasive coronary angiography, exhibiting no apparent CAD were evaluated. ΔFFRCT was defined as the change in FFRCT from the proximal to the distal in the left anterior descending artery (LAD) and left circumflex artery (LCX). The bifurcation angle was calculated from three-dimensional volume rendered images. Vessel morphology and plaque characteristics were also assessed. Results ΔFFRCT significantly correlated with the bifurcation angle (LAD angle, r = 0.35, p = 0.001; LCX angle, r = 0.26, p = 0.02) and vessel length (LAD angle, r = 0.30, p = 0.005; LCX angle, r = 0.49, p < 0.0001). In LAD, vessel length was the strongest predictor for distal FFRCT of ≤ 0.80 (β-coefficient = 0.55, p = 0.0003), immediately followed by the bifurcation angle (β-coefficient = 0.24, p = 0.02). The bifurcation angle was a good predictor for a distal FFRCT ≤ 0.80 (LAD angle, cut-off 31.0°, AUC 0.70, sensitivity 74%, specificity 68%; LCX angle, cut-off 52.6°, AUC 0.86, sensitivity 88%, specificity 85%). Conclusions In vessels with no apparent CAD, vessel length was the most influential factor on FFRCT, directly followed by the bifurcation angle. Key Points • Both LAD and LCX bifurcation angles are factors influencing FFRCT. • Bifurcation angle is one of the predictors of a distal FFRCTof ≤ 0.80 and an optimal cut-off value of 31.0° for the LAD and 52.6° for the LCX. • Bifurcation angle should be taken into consideration when interpreting numerical values of FFRCT.
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Tsugu et al. (2022) conducted an observational in Suspected coronary artery disease with no apparent CAD (n=83). Coronary bifurcation angle was evaluated on Correlation between ΔFFRCT (change in FFRCT from proximal to distal) and bifurcation angle in the left anterior descending artery (LAD) (r = 0.35, p=0.001). In vessels with no apparent coronary artery disease, the coronary bifurcation angle significantly correlated with the decline in FFRCT (r=0.35 for LAD, p=0.001) and predicted a distal FFRCT ≤ 0.80.
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