Vessel-Specific Quantitative Plaque Characteristics on Coronary CT Angiography for Prediction of FFR-Defined Myocardial Ischemia
Year: 2026
Type: article
Study design: Observational Study
Abstract: Objectives : Coronary CT angiography (CCTA)-derived plaque characteristics are associated with myocardial ischemia, but whether these relationships differ across coronary vessels remains unclear. We aimed to investigate vessel-specific associations between quantitative plaque characteristics and fractional flow reserve (FFR)-defined myocardial ischemia nd assess their incremental value beyond stenosis severity. Materials and Methods : This retrospective single-center study included 204 patients comprising 290 coronary vessels (161 LAD, 56 LCX, and 73 RCA) who underwent CCTA followed by invasive coronary angiography with FFR measurement. Quantitative plaque analysis was performed using semi-automated software. Vessel-specific feature selection was conducted using LASSO or Boruta combined with XGBoost within a five-fold cross-validation framework. Bootstrap resampling was used to assess model robustness. Incremental value was evaluated by comparing a baseline model incorporating clinical variables and severe stenosis (≥70%) with an extended model including selected plaque characteristics. Results : Ischemic vessels exhibited longer lesion length, smaller minimal lumen area, greater stenosis severity, and higher plaque burden than non-ischemic vessels. Bootstrap validation confirmed vessel-specific plaque signatures associated with ischemia. Plaque-based models achieved good discrimination for FFR-defined ischemia, with AUCs of 0.91 (95% CI: 0.87–0.97), 0.94 (0.86–1.00), and 0.97 (0.89–1.00) for LAD, LCX, and RCA, respectively. Addition of plaque characteristics significantly improved discrimination and reclassification in LAD (AUC: 0.613 vs. 0.755; NRI=0.736; IDI=0.163) and RCA vessels (AUC: 0.489 vs. 0.767; NRI=0.955; IDI=0.276), but not in LCX vessels. Conclusion : Quantitative CCTA plaque characteristics show vessel-specific associations with FFR-defined myocardial ischemia and provide incremental predictive value beyond stenosis severity, particularly in LAD and RCA vessels.
Source: Diagnostics
Authors: Shuang Li, Tian Ma, Anqi Yang, Yinghao Xu, Yi He
Institutions: Capital Medical University, Beijing Friendship Hospital
Language: English
Subfield: Radiology, Nuclear Medicine and Imaging
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,137
OpenAlex ID: W7168137394