CT scans replicate blood flow to evaluate angina patients’ risk

An enhanced CT scan can diagnose individuals with stable angina who have high coronary artery calcium scores with a lower probability of having unfavorable outcomes in three years, claims a research. The Radiological Society of North America (RSNA) publication Radiology published the study’s findings.
To evaluate the fractional flow reserve (CT-FFR) that was discovered using CT angiography and the three-year clinical outcomes of patients who underwent CT angiography, Danish researchers conducted a prospective study. CT-FFR predicts the volume of blood flowing through the coronary arteries using data from coronary CT angiography, AI algorithms, and computational fluid dynamics.
“CT angiography is the first step in identifying the presence of coronary artery disease, but it doesn’t show the impact on blood flow in the arteries,” said lead researcher Kristian T. Madsen, M.D., and Ph.D. candidate in the Department of Cardiology at the University Hospital of Southern Denmark in Esbjerg. “Turbulent blood flow may create abnormal pressure in the vessel that grinds down coronary plaques making them prone to rupture.”
Non-contrast enhanced cardiac CT is typically performed prior to CT angiography to determine the amount of coronary artery calcium, which is a surrogate marker for total coronary plaque, a fatty buildup in the arteries, that can lead to a future heart attack. A coronary artery calcium score of 400 or higher indicates high plaque levels. As calcium absorbs a lot of x-rays, it can be especially challenging to assess coronary CT images of patients with high amounts of coronary artery calcium.
According to Dr. Madsen, imaging options to assess the impact of coronary artery disease on blood-flow have different strengths and weaknesses. He said CT-FFR exhibits high diagnostic performance, and its results correlate well with invasively measured fractional flow reserve, an invasive procedure that measures blood flow directly within the coronary arteries.
“In my opinion, CT-FFR is the best option because it provides a blood-flow estimate similar to what you would obtain if you performed invasive heart catheterization,” he said. “You get a reliable and quick answer without performing additional tests or putting the patient through an invasive procedure.”
Dr. Madsen said CT-FFR will allow clinicians to divide the coronary artery disease patient population by risk level and focus on improving the prognosis of high-risk patients.
“CT-FFR provides diagnostic and prognostic information beyond what can be obtained from CT angiography alone across a wide range of coronary artery calcium levels,” he said. “It’s a tool that offers a lot of exciting prospects for the future.”