ArticleThe international journal of cardiovascular imaging2025
Calcific versus non-calcific plaque: a CAD-RADS and FFRCT study.
Article in The international journal of cardiovascular imaging, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Coronary Artery Disease-Reporting and Data System (CAD-RADS) standardises Computed Tomography Coronary Angiography (CTCA) reporting. Coronary calcification can overestimate stenosis. We hypothesized where CADRADS category is assigned due to predominantly calcified maximal stenosis (Ca+), the CTCA-derived Fractional Flow Reserve (FFRCT) would be lower compared to predominantly non-calcified maximal stenoses (Ca-) of the same CAD-RADS category. Consecutive patients undergoing routine clinical CTCA (September 2018 to May 2020) with ≥1 stenosis ≥25% with FFRCT correlation were included. CTCA's were subdivided into Ca+ and Ca-. FFRCT was measured in the left anterior descending (LAD), left circumflex (LCx) and right coronary artery (RCA). Potentially flow-limiting classified as FFRCT≤0.8. A subset had Invasive Coronary Angiography (ICA). 561 patients screened, 320 included (60% men, 69±10 years). Ca+ in 51%, 69% and 50% of CAD-RADS 2, 3 and 4 respectively. There was no difference in the prevalence of FFRCT≤0.8 between Ca+ and Ca- stenoses for each CAD-RADS categories. No difference was demonstrated in the median maximal stenoses FFRCT or end-vessel FFRCT within CAD-RADS 2 and 4. CAD-RADS 3 Ca+ had a lower FFRCT (maximal stenosis p= .02, end-vessel p= .005) vs Ca-. No difference in the prevalence of obstructive disease at ICA between predominantly Ca+ and Ca- for any CAD-RADS category. There was no difference in median FFRCT values or rate of obstructive disease at ICA between Ca+ and Castenosis in both CAD-RADS 2 and 4. Ca+ CAD-RADS 3 was suggestive of an underestimation based on FFRCT but not corroborated at ICA.
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