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 .
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Abbreviations
- 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
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Funding
This study has received funding by The National Key Research and Development Program of China (2017YFC0113400 for L.J.Z.).
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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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Zhou, F., Tang, C.X., Schoepf, U.J. et al. Fractional flow reserve derived from CCTA may have a prognostic role in myocardial bridging. Eur Radiol 29, 3017–3026 (2019). https://doi.org/10.1007/s00330-018-5811-6
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DOI: https://doi.org/10.1007/s00330-018-5811-6