Coronary Artery Vorticity to Predict Functional Plaque Progression in Participants with Type 2 Diabetes Mellitus

Nobuo Tomizawa; Shinichiro Fujimoto; Tomoya Mita; Daigo Takahashi; Yui Nozaki; Ruiheng Fan; Ayako Kudo; Yuko Kawaguchi; Kazuhisa Takamura; Makoto Hiki; Mika Kurita; Kanako K Kumamaru; Hirotaka Watada; Tohru Minamino; Shigeki Aoki

doi:10.1148/ryct.230016

Coronary Artery Vorticity to Predict Functional Plaque Progression in Participants with Type 2 Diabetes Mellitus

Radiol Cardiothorac Imaging. 2023 Aug 24;5(4):e230016. doi: 10.1148/ryct.230016. eCollection 2023 Aug.

Authors

Affiliation

¹ From the Department of Radiology (N.T., R.F., K.K.K., S.A.), Department of Cardiovascular Biology and Medicine (S.F., D.T., Y.N., A.K., Y.K., K.T., M.H., T. Minamino), and Department of Diabetes, Endocrinology, and Metabolism (T. Mita, M.K., H.W.), Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan.

Abstract

Purpose: To investigate whether vorticity could predict functional plaque progression better than high-risk plaque (HRP) and lesion length (LL) in individuals with type 2 diabetes mellitus.

Materials and methods: This single-center prospective study included 61 participants (mean age, 61 years ± 9 [SD]; 43 male participants) who underwent serial coronary CT angiography at 2 years, with 20%-70% stenosis at initial CT between October 2015 and March 2020. The number of the following HRP characteristics was recorded: low attenuation, positive remodeling, spotty calcification, and napkin-ring sign. Vorticity was calculated using a mesh-free simulation. A decrease in CT fractional flow reserve larger than 0.05 indicated functional progression. Models using HRP and LL and vorticity were compared using receiver operating characteristic curve analysis.

Results: Of the 94 vessels evaluated, 25 vessels (27%) showed functional progression. Vessels with functional progression showed higher vorticity at distal stenosis (984 sec^-1; IQR: 730-1253 vs 443 sec^-1; IQR: 295-602; P < .001) than vessels without progression. The area under the receiver operating characteristic curve of vorticity (0.91; 95% CI: 0.84, 0.97) was higher than that of HRP and LL (0.69; 95% CI: 0.56, 0.82; P < .01). Diagnostic accuracy of vorticity (85%; 80 of 94 vessels; 95% CI: 76, 92) was higher than that of HRP and LL (72%; 68 of 94 vessels; 95% CI: 62, 81; P = .004).

Conclusion: In participants with type 2 diabetes mellitus, vorticity at distal stenosis was a better predictor of functional plaque progression than HRP and LL.Keywords: Coronary Artery, Vorticity, Functional Plaque Progression, Type 2 Diabetes, Vasculature, CT Angiography, Computational Fluid Dynamics, Fractional Flow Reserve Supplemental material is available for this article. © RSNA, 2023.

Keywords: CT Angiography; Computational Fluid Dynamics; Coronary Artery; Fractional Flow Reserve; Functional Plaque Progression; Type 2 Diabetes; Vasculature; Vorticity.