Fractional flow reserve derived from CCTA may have a prognostic role in myocardial bridging
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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.
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.
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.
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.
• 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 .
KeywordsComputed tomography angiography Fractional flow reserve Myocardial bridging
Area under the curve
Coronary artery disease
Coronary computed tomography angiography
Computational fluid dynamics
CCTA-derived fractional flow reserve
Left anterior descending coronary artery
Receiver operating characteristic
This study has received funding by The National Key Research and Development Program of China (2017YFC0113400 for L.J.Z.).
Compliance with ethical standards
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.
Written informed consent was obtained from all subjects (patients) in this study.
Institutional Review Board approval was obtained.
• performed at one institution