Multimodality imaging in coronary artery disease: plaque characterization, computational haemodynamic simulation and risk stratification

Abstract

In part I, multimodality imaging was used for coronary plaque characterization and computational haemodynamic simulation. Quantitative flow ratio (QFR) is a novel technique to calculate invasive fractional flow reserve (FFR), without the need for a pressure wire or hyperaemia induction. We confirmed the potential of QFR to accurately detect myocardial ischaemia on single-photon emission computed tomography myocardial perfusion imaging (SPECT MPI). Despite the increased risk of coronary microvascular dysfunction, QFR was highly accurate in a diabetic patient population compared with invasive FFR. Moreover, QFR is feasible to use for the selection of patients for invasive FFR referral.

Coronary computed tomography angiography is able to non-invasively assess the progression of coronary artery disease. We showed an increased progression of calcified coronary plaque and reduced progression of non-calcified coronary plaque in statin-taking patients. Moreover, our results show the ability of specific lipid species to predict non-calcified coronary plaque changes. In part II, non-invasive imaging modalities were used for risk stratification. Our results confirmed the long-term prognostic value of SPECT MPI to predict cardiac death or reinfarction. Also, we showed that left atrial appendage morphology could be assessed for risk stratification in patients with and without atrial fibrillation.