Work

Prediction of coronary events by computed tomography-derived Murray law-based quantitative flow ratio

Year: 2026

Type: article

Abstract: BACKGROUND: Coronary computed tomography angiography (CCTA)-derived Murray law-based quantitative flow ratio (CT-μFR) provides a non-invasive measure of vessel-level ischaemia but may not capture local haemodynamic abnormalities reflected by the longitudinal pressure gradient across the lesion (CT-μFR gradient). AIMS: We aimed to evaluate the association of CT-μFR and the CT-μFR gradient with 3-year vessel-level subsequent coronary events and to determine the incremental prognostic value of their combined assessment. METHODS: Our study included a total of 885 vessels from 312 patients who underwent invasive coronary angiography for acute coronary syndrome (ACS) or stable angina and had prior CCTA performed 6 months to 3 years earlier. CT-μFR and the CT-μFR gradient were assessed by an independent core laboratory blinded to the clinical data. The primary outcome was 3-year subsequent coronary events (a composite of vessel-specific myocardial infarction or urgent revascularisation for ACS). The discrimination ability of predictive models was assessed using Harrell's C-index. RESULTS: Vessels with CT-μFR ≤0.80 or a CT-μFR gradient ≥0.004/mm had a higher risk of events than those with CT-μFR>0.80 (79.1% vs 20.4%, adjusted hazard ratio [HR] 6.87, 95% confidence interval [CI]: 5.26-8.96; p<0.001) or a CT-μFR gradient <0.004/mm (72.6% vs 27.4%, adjusted HR 4.08, 95% CI: 3.15-5.28; p<0.001), respectively. Among vessels with CT-μFR>0.80, a CT-μFR gradient ≥0.004/mm remained associated with increased risk (adjusted HR 2.59, 95% CI: 1.63-4.11; p<0.001). Adding the CT-μFR gradient to CT-μFR improved discrimination in the overall cohort (C-index 0.700 to 0.755; p<0.001) as well as the subgroup with CT-μFR>0.80 (C-index 0.575 to 0.655; p<0.001). CONCLUSIONS: Both CT-μFR and the CT-μFR gradient are independently associated with 3-year subsequent coronary events. Their combined assessment improves risk stratification beyond CT-μFR alone. (ClinicalTrials.gov: NCT04794868).

Source: EuroIntervention

DOI: 10.4244/eij-d-26-00575

Authors: Dong Hyun Gim, Seung Hun Lee, Daixin Ding, Zhiqing Wang, Doosup Shin, Sung Mok Kim, Sang Yoon Lee, Ki Hong Choi, Taek Kyu Park, Jeong Hoon Yang, Young Bin Song, Joo-Yong Hahn, Seung-Hyuk Choi, Yeon Hyeon Choe, Hyeon-Cheol Gwon, Shengxian Tu, Joo Myung Lee

Institutions: Samsung Medical Center, Sungkyunkwan University, Chonnam National University, Chonnam National University Hospital, Shanghai Jiao Tong University, Renji Hospital, Fudan University, Huadong Hospital, St. Francis Hospital

Language: English

Topic: Cardiac Imaging and Diagnostics

Subfield: Radiology, Nuclear Medicine and Imaging

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: green

OpenAlex ID: W7223651667

FWCI:

Cites: 28

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Related to: 10