Predictive value of serial coronary CTA-derived fractional flow reserve in patients with coronary artery disease
M Zhang, X Kong, S Zhang, Y Chen, Y Guo, Q Guo, F Zhang, X Liu, S Nie, X WangAbstract
Background
The prognostic significance of longitudinal change in CCTA derived fractional flow reserve (CT-FFR) in patients with coronary artery disease (CAD) remains incompletely defined. We aim to investigate whether hemodynamic changes during serial CCTA examinations are associated with an increased risk of MACE.
Methods
We studied 949 patients who underwent two CCTA examinations with CT-FFR assessment (mean interval between scans: 2.5 years) and followed them for a mean of 4.5 years. MACE was defined as unstable angina, myocardial infarction, and cardiac death. CT-FFR analysis methods included: (1) Longitudinal change classification: stable (|ΔCT-FFR|<0.03), improved (ΔCT-FFR≥0.03), and worsened (ΔCT-FFR≤−0.03); (2) State transition analysis using a 0.80 threshold: CT-FFR > 0.80, CT-FFR ≤ 0.80 → > 0.80, CT-FFR > 0.80 → ≤ 0.80, and CT-FFR ≤ 0.80.
Results
Compared with the functional stability group (n=402, 42.4%), the functional deterioration group (n=277, 29.2%) exhibited a higher risk of MACE (aHR 2.3, 95% CI 1.32–3.96, P=0.003), while the functionally improved group (n=270, 28.5%) showed a non-significant trend (aHR 1.7, 95% CI 0.92–3.01, P=0.09). Compared with functionally stable patients (n=697, 73.4%), the functionally persistent abnormal group (CT-FFR ≤0.80; n=122, 12.9%) had the highest risk (aHR 4.6, 95% CI 2.73–7.66, P<0.001); patients in the functional deterioration group (CT-FFR>0.80→≤0.80; n=70, 7.4%) exhibited significantly higher MACE risk (aHR 3.4, 95% CI 1.73–6.72, P<0.001). Patients in the functionally abnormal-to-normal group (≤0.80→>0.80; n=60, 6.3%) exhibited residual risk that did not reach statistical significance (aHR 2.1, 95% CI 0.91–5.15, P=0.08).
Conclusions
In CAD patients, functional deterioration from CCTA is independently associated with an increased risk of long-term major cardiovascular events. Furthermore, persistent functional deterioration and progression from normal to abnormal levels can identify high-risk patients, supporting the value of risk stratification through repeated functional assessment using CT-FFR.CT-FFR