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European Radiology

, Volume 29, Issue 6, pp 3017–3026 | Cite as

Fractional flow reserve derived from CCTA may have a prognostic role in myocardial bridging

  • Fan Zhou
  • Chun Xiang Tang
  • U. Joseph Schoepf
  • Christian Tesche
  • Maximilian J. Bauer
  • Brian E. Jacobs
  • Chang Sheng Zhou
  • Jing Yan
  • Meng Jie Lu
  • Guang Ming Lu
  • Long Jiang ZhangEmail author
Cardiac

Abstract

Purpose

To evaluate the feasibility of fractional flow reserve (cFFR) derivation from coronary CT angiography (CCTA) in patients with myocardial bridging (MB), its relationship with MB anatomical features, and clinical relevance.

Methods

This retrospective study included 120 patients with MB of the left anterior descending artery (LAD) and 41 controls. MB location, length, depth, muscle index, instance, and stenosis rate were measured. cFFR values were compared between superficial MB (≤ 2 mm), deep MB (> 2 mm), and control groups. Factors associated with abnormal cFFR values (≤ 0.80) were analyzed.

Results

MB patients demonstrated lower cFFR values in MB and distal segments than controls (all p < 0.05). A significant cFFR difference was only found in the MB segment during systole between superficial (0.94, 0.90–0.96) and deep MB (0.91, 0.83–0.95) (p = 0.018). Abnormal cFFR values were found in 69 (57.5%) MB patients (29 [49.2%] superficial vs. 40 [65.6%] deep; p = 0.069). MB length (OR = 1.06, 95% CI 1.03–1.10; p = 0.001) and systolic stenosis (OR = 1.04, 95% CI 1.01–1.07; p = 0.021) were the main predictors for abnormal cFFR, with an area under the curve of 0.774 (95% CI 0.689–0.858; p < 0.001). MB patients with abnormal cFFR reported more typical angina (18.8% vs 3.9%, p = 0.023) than patients with normal values.

Conclusion

MB patients showed lower cFFR values than controls. Abnormal cFFR values have a positive association with symptoms of typical angina. MB length and systolic stenosis demonstrate moderate predictive value for an abnormal cFFR value.

Key Points

• MB patients showed lower cFFR values than controls.

• Abnormal cFFR values have a positive association with typical angina symptoms.

• MB length and systolic stenosis demonstrate moderate predictive value for an abnormal cFFR value .

Keywords

Computed tomography angiography Fractional flow reserve Myocardial bridging 

Abbreviation

AUC

Area under the curve

CAD

Coronary artery disease

CCTA

Coronary computed tomography angiography

CFD

Computational fluid dynamics

cFFR

CCTA-derived fractional flow reserve

DML

Deep-machine-learning

LAD

Left anterior descending coronary artery

MB

Myocardial bridging

OR

Odds ratio

ROC

Receiver operating characteristic

Notes

Funding

This study has received funding by The National Key Research and Development Program of China (2017YFC0113400 for L.J.Z.).

Compliance with ethical standards

Guarantor

The scientific guarantor of this publication is Long Jiang Zhang.

Conflict of interest

UJS is a consultant for and/or receives research support from Astellas, Bayer, General Electric, Guerbet, HeartFlow, and Siemens Healthineers. The other authors have no conflicts of interest to disclose.

Statistics and biometry

Meng Jie Lu has significant statistical expertise.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• retrospective

• observational

• performed at one institution

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Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  • Fan Zhou
    • 1
  • Chun Xiang Tang
    • 1
  • U. Joseph Schoepf
    • 1
    • 2
  • Christian Tesche
    • 2
    • 3
  • Maximilian J. Bauer
    • 2
  • Brian E. Jacobs
    • 2
  • Chang Sheng Zhou
    • 1
  • Jing Yan
    • 4
  • Meng Jie Lu
    • 1
  • Guang Ming Lu
    • 1
  • Long Jiang Zhang
    • 1
    Email author
  1. 1.Department of Medical Imaging, Jinling HospitalMedical School of Nanjing UniversityNanjingChina
  2. 2.Division of Cardiovascular Imaging, Department of Radiology and Radiological ScienceMedical University of South CarolinaCharlestonUSA
  3. 3.Department of Cardiology and Intensive Care MedicineHeart Center Munich-BogenhausenMunichGermany
  4. 4.Siemens Healthcare Ltd.ShanghaiChina

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