Use of CTFFR and CTCA to Diagnose and Triage Patients of INOCA: A Retrospective Study

Atul Kapoor; Goldaa Mahajan; Aprajita Kapur

doi:doi:10.11648/j.ccr.20210502.13

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Use of CTFFR and CTCA to Diagnose and Triage Patients of INOCA: A Retrospective Study

Atul Kapoor, Goldaa Mahajan, Aprajita Kapur

Published in Cardiology and Cardiovascular Research (Volume 5, Issue 2)

Received: 18 April 2021 Accepted: 7 May 2021 Published: 14 May 2021

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Abstract

Objectives: INOCA (Ischemia in non- obstructive coronary arteries) has been recognized as a global health problem and poses a diagnostic challenge to establish the diagnosis which involves first ruling out obstructive coronary artery disease by the use of CT coronary angiography (CTCA) or an invasive angiogram. Second step involves the use of intracoronary pressure and Doppler monitoring which is not only costly, time consuming and lacks easy availability. CTFFR has emerged as frontline tool in the non invasive evaluation of patients with stable chest pain. This retrospective study was designed to evaluate the spectrum of findings of ischemia on CTCA and CT FFR in patients with stable chest pain to determine if this protocol can be used to identify patients with INOCA before they are subjected to invasive protocol. Methods: This was a retrospective study of 500 consecutive patients of stable chest pain with more than >1mm ST depression on resting EKG and or positive stress test who underwent CTCA along with CTFFR evaluation using a prescribed CT angiographic protocol. Post processing was done to reconstruct multiplanar angiographic views followed by CT FFR evaluation. All patients with no obstruction or stenosis less than 50% and with CT FFR of <0.80 were labeled as having INOCA. Subcategorisation of all INOCA patients was done based on Vessel tapering index (VTI), Plaque volume Index (PVI) into four subtypes- TypeI (vasospastic), Type II (site specific atherosclerotic), Type III (distal macrovascular dysfunction- DMD), Type IV (mixed). Results: Study showed 122 (34%) patients of stable chest pain had INOCA. Types I, III formed the largest group of patients 38% and 31% followed by the other two subtypes and showed significant differences in the VTI and PVI along with reduced FFR of <.80 in all these patients. Conclusion: Use of CTCA and CTFFR can be used as a first line tool to not only rule out obstructive coronary disease with ischemia but also to non invasively detect INOCA in patients with stable chest pain before subjecting these patients for further invasive protocols and can influence accurate management of such patients.

Published in	Cardiology and Cardiovascular Research (Volume 5, Issue 2)
DOI	10.11648/j.ccr.20210502.13
Page(s)	67-73
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2021. Published by Science Publishing Group

Keywords

INOCA, CTFFR, CT Coronary Angiography

References

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[4]	Kunadian V, Chieffo A, Camici PG, Berry C, Escaned J, Maas AH, Prescott E et al. An EAPCI Expert Consensus Document on Ischaemia with Non-Obstructive Coronary Arteries in Collaboration with European Society of Cardiology Working Group on Coronary Pathophysiology & Microcirculation Endorsed by Coronary Vasomotor Disorders International Study Group European Heart Journal (2020) 41, 3504–3520.
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APA Style

Atul Kapoor, Goldaa Mahajan, Aprajita Kapur. (2021). Use of CTFFR and CTCA to Diagnose and Triage Patients of INOCA: A Retrospective Study. Cardiology and Cardiovascular Research, 5(2), 67-73. https://doi.org/10.11648/j.ccr.20210502.13

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ACS Style

Atul Kapoor; Goldaa Mahajan; Aprajita Kapur. Use of CTFFR and CTCA to Diagnose and Triage Patients of INOCA: A Retrospective Study. Cardiol. Cardiovasc. Res. 2021, 5(2), 67-73. doi: 10.11648/j.ccr.20210502.13

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AMA Style

Atul Kapoor, Goldaa Mahajan, Aprajita Kapur. Use of CTFFR and CTCA to Diagnose and Triage Patients of INOCA: A Retrospective Study. Cardiol Cardiovasc Res. 2021;5(2):67-73. doi: 10.11648/j.ccr.20210502.13

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@article{10.11648/j.ccr.20210502.13,
  author = {Atul Kapoor and Goldaa Mahajan and Aprajita Kapur},
  title = {Use of CTFFR and CTCA to Diagnose and Triage Patients of INOCA: A Retrospective Study},
  journal = {Cardiology and Cardiovascular Research},
  volume = {5},
  number = {2},
  pages = {67-73},
  doi = {10.11648/j.ccr.20210502.13},
  url = {https://doi.org/10.11648/j.ccr.20210502.13},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ccr.20210502.13},
  abstract = {Objectives: INOCA (Ischemia in non- obstructive coronary arteries) has been recognized as a global health problem and poses a diagnostic challenge to establish the diagnosis which involves first ruling out obstructive coronary artery disease by the use of CT coronary angiography (CTCA) or an invasive angiogram. Second step involves the use of intracoronary pressure and Doppler monitoring which is not only costly, time consuming and lacks easy availability. CTFFR has emerged as frontline tool in the non invasive evaluation of patients with stable chest pain. This retrospective study was designed to evaluate the spectrum of findings of ischemia on CTCA and CT FFR in patients with stable chest pain to determine if this protocol can be used to identify patients with INOCA before they are subjected to invasive protocol. Methods: This was a retrospective study of 500 consecutive patients of stable chest pain with more than >1mm ST depression on resting EKG and or positive stress test who underwent CTCA along with CTFFR evaluation using a prescribed CT angiographic protocol. Post processing was done to reconstruct multiplanar angiographic views followed by CT FFR evaluation. All patients with no obstruction or stenosis less than 50% and with CT FFR of <0.80 were labeled as having INOCA. Subcategorisation of all INOCA patients was done based on Vessel tapering index (VTI), Plaque volume Index (PVI) into four subtypes- TypeI (vasospastic), Type II (site specific atherosclerotic), Type III (distal macrovascular dysfunction- DMD), Type IV (mixed). Results: Study showed 122 (34%) patients of stable chest pain had INOCA. Types I, III formed the largest group of patients 38% and 31% followed by the other two subtypes and showed significant differences in the VTI and PVI along with reduced FFR of <.80 in all these patients. Conclusion: Use of CTCA and CTFFR can be used as a first line tool to not only rule out obstructive coronary disease with ischemia but also to non invasively detect INOCA in patients with stable chest pain before subjecting these patients for further invasive protocols and can influence accurate management of such patients.},
 year = {2021}
}

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TY  - JOUR
T1  - Use of CTFFR and CTCA to Diagnose and Triage Patients of INOCA: A Retrospective Study
AU  - Atul Kapoor
AU  - Goldaa Mahajan
AU  - Aprajita Kapur
Y1  - 2021/05/14
PY  - 2021
N1  - https://doi.org/10.11648/j.ccr.20210502.13
DO  - 10.11648/j.ccr.20210502.13
T2  - Cardiology and Cardiovascular Research
JF  - Cardiology and Cardiovascular Research
JO  - Cardiology and Cardiovascular Research
SP  - 67
EP  - 73
PB  - Science Publishing Group
SN  - 2578-8914
UR  - https://doi.org/10.11648/j.ccr.20210502.13
AB  - Objectives: INOCA (Ischemia in non- obstructive coronary arteries) has been recognized as a global health problem and poses a diagnostic challenge to establish the diagnosis which involves first ruling out obstructive coronary artery disease by the use of CT coronary angiography (CTCA) or an invasive angiogram. Second step involves the use of intracoronary pressure and Doppler monitoring which is not only costly, time consuming and lacks easy availability. CTFFR has emerged as frontline tool in the non invasive evaluation of patients with stable chest pain. This retrospective study was designed to evaluate the spectrum of findings of ischemia on CTCA and CT FFR in patients with stable chest pain to determine if this protocol can be used to identify patients with INOCA before they are subjected to invasive protocol. Methods: This was a retrospective study of 500 consecutive patients of stable chest pain with more than >1mm ST depression on resting EKG and or positive stress test who underwent CTCA along with CTFFR evaluation using a prescribed CT angiographic protocol. Post processing was done to reconstruct multiplanar angiographic views followed by CT FFR evaluation. All patients with no obstruction or stenosis less than 50% and with CT FFR of <0.80 were labeled as having INOCA. Subcategorisation of all INOCA patients was done based on Vessel tapering index (VTI), Plaque volume Index (PVI) into four subtypes- TypeI (vasospastic), Type II (site specific atherosclerotic), Type III (distal macrovascular dysfunction- DMD), Type IV (mixed). Results: Study showed 122 (34%) patients of stable chest pain had INOCA. Types I, III formed the largest group of patients 38% and 31% followed by the other two subtypes and showed significant differences in the VTI and PVI along with reduced FFR of <.80 in all these patients. Conclusion: Use of CTCA and CTFFR can be used as a first line tool to not only rule out obstructive coronary disease with ischemia but also to non invasively detect INOCA in patients with stable chest pain before subjecting these patients for further invasive protocols and can influence accurate management of such patients.
VL  - 5
IS  - 2
ER  -

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Author Information

Atul Kapoor

Department of Radiodiagnosis, Advanced Diagnostics and Institute of Imaging, Punjab, India
Goldaa Mahajan

Department of Radiodiagnosis, Advanced Diagnostics and Institute of Imaging, Punjab, India
Aprajita Kapur

Department of Radiodiagnosis, Advanced Diagnostics and Institute of Imaging, Punjab, India

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APA Style

Atul Kapoor, Goldaa Mahajan, Aprajita Kapur. (2021). Use of CTFFR and CTCA to Diagnose and Triage Patients of INOCA: A Retrospective Study. Cardiology and Cardiovascular Research, 5(2), 67-73. https://doi.org/10.11648/j.ccr.20210502.13

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ACS Style

Atul Kapoor; Goldaa Mahajan; Aprajita Kapur. Use of CTFFR and CTCA to Diagnose and Triage Patients of INOCA: A Retrospective Study. Cardiol. Cardiovasc. Res. 2021, 5(2), 67-73. doi: 10.11648/j.ccr.20210502.13

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AMA Style

Atul Kapoor, Goldaa Mahajan, Aprajita Kapur. Use of CTFFR and CTCA to Diagnose and Triage Patients of INOCA: A Retrospective Study. Cardiol Cardiovasc Res. 2021;5(2):67-73. doi: 10.11648/j.ccr.20210502.13

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@article{10.11648/j.ccr.20210502.13,
  author = {Atul Kapoor and Goldaa Mahajan and Aprajita Kapur},
  title = {Use of CTFFR and CTCA to Diagnose and Triage Patients of INOCA: A Retrospective Study},
  journal = {Cardiology and Cardiovascular Research},
  volume = {5},
  number = {2},
  pages = {67-73},
  doi = {10.11648/j.ccr.20210502.13},
  url = {https://doi.org/10.11648/j.ccr.20210502.13},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ccr.20210502.13},
  abstract = {Objectives: INOCA (Ischemia in non- obstructive coronary arteries) has been recognized as a global health problem and poses a diagnostic challenge to establish the diagnosis which involves first ruling out obstructive coronary artery disease by the use of CT coronary angiography (CTCA) or an invasive angiogram. Second step involves the use of intracoronary pressure and Doppler monitoring which is not only costly, time consuming and lacks easy availability. CTFFR has emerged as frontline tool in the non invasive evaluation of patients with stable chest pain. This retrospective study was designed to evaluate the spectrum of findings of ischemia on CTCA and CT FFR in patients with stable chest pain to determine if this protocol can be used to identify patients with INOCA before they are subjected to invasive protocol. Methods: This was a retrospective study of 500 consecutive patients of stable chest pain with more than >1mm ST depression on resting EKG and or positive stress test who underwent CTCA along with CTFFR evaluation using a prescribed CT angiographic protocol. Post processing was done to reconstruct multiplanar angiographic views followed by CT FFR evaluation. All patients with no obstruction or stenosis less than 50% and with CT FFR of <0.80 were labeled as having INOCA. Subcategorisation of all INOCA patients was done based on Vessel tapering index (VTI), Plaque volume Index (PVI) into four subtypes- TypeI (vasospastic), Type II (site specific atherosclerotic), Type III (distal macrovascular dysfunction- DMD), Type IV (mixed). Results: Study showed 122 (34%) patients of stable chest pain had INOCA. Types I, III formed the largest group of patients 38% and 31% followed by the other two subtypes and showed significant differences in the VTI and PVI along with reduced FFR of <.80 in all these patients. Conclusion: Use of CTCA and CTFFR can be used as a first line tool to not only rule out obstructive coronary disease with ischemia but also to non invasively detect INOCA in patients with stable chest pain before subjecting these patients for further invasive protocols and can influence accurate management of such patients.},
 year = {2021}
}

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TY  - JOUR
T1  - Use of CTFFR and CTCA to Diagnose and Triage Patients of INOCA: A Retrospective Study
AU  - Atul Kapoor
AU  - Goldaa Mahajan
AU  - Aprajita Kapur
Y1  - 2021/05/14
PY  - 2021
N1  - https://doi.org/10.11648/j.ccr.20210502.13
DO  - 10.11648/j.ccr.20210502.13
T2  - Cardiology and Cardiovascular Research
JF  - Cardiology and Cardiovascular Research
JO  - Cardiology and Cardiovascular Research
SP  - 67
EP  - 73
PB  - Science Publishing Group
SN  - 2578-8914
UR  - https://doi.org/10.11648/j.ccr.20210502.13
AB  - Objectives: INOCA (Ischemia in non- obstructive coronary arteries) has been recognized as a global health problem and poses a diagnostic challenge to establish the diagnosis which involves first ruling out obstructive coronary artery disease by the use of CT coronary angiography (CTCA) or an invasive angiogram. Second step involves the use of intracoronary pressure and Doppler monitoring which is not only costly, time consuming and lacks easy availability. CTFFR has emerged as frontline tool in the non invasive evaluation of patients with stable chest pain. This retrospective study was designed to evaluate the spectrum of findings of ischemia on CTCA and CT FFR in patients with stable chest pain to determine if this protocol can be used to identify patients with INOCA before they are subjected to invasive protocol. Methods: This was a retrospective study of 500 consecutive patients of stable chest pain with more than >1mm ST depression on resting EKG and or positive stress test who underwent CTCA along with CTFFR evaluation using a prescribed CT angiographic protocol. Post processing was done to reconstruct multiplanar angiographic views followed by CT FFR evaluation. All patients with no obstruction or stenosis less than 50% and with CT FFR of <0.80 were labeled as having INOCA. Subcategorisation of all INOCA patients was done based on Vessel tapering index (VTI), Plaque volume Index (PVI) into four subtypes- TypeI (vasospastic), Type II (site specific atherosclerotic), Type III (distal macrovascular dysfunction- DMD), Type IV (mixed). Results: Study showed 122 (34%) patients of stable chest pain had INOCA. Types I, III formed the largest group of patients 38% and 31% followed by the other two subtypes and showed significant differences in the VTI and PVI along with reduced FFR of <.80 in all these patients. Conclusion: Use of CTCA and CTFFR can be used as a first line tool to not only rule out obstructive coronary disease with ischemia but also to non invasively detect INOCA in patients with stable chest pain before subjecting these patients for further invasive protocols and can influence accurate management of such patients.
VL  - 5
IS  - 2
ER  -

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