Computed tomography quantification of coronary plaque volume may provide further perspective on intermediate severity stenoses

Coronary computed tomography (CT) angiography (CCTA) is an emerging modality for comprehensive non-invasive assessment of coronary artery disease (CAD). CCTA was traditionally used for anatomical assessment of coronary plaque, including luminal narrowing, plaque burden, location, and composition. Preliminary studies have also demonstrated CCTA’s capabilities for functional assessment of coronary plaque, including fractional flow reserve (FFR) and myocardial perfusion—albeit they are not routinely available at all centers and are focus of research. Although the identification and development of treatment strategies of severely stenotic lesions has advanced tremendously over the past years, the evaluation, prognostication, and treatment of patients with intermediate severity stenosis in whom there is equipoise between invasive versus medical management is only now receiving attention. Intermediate severity stenosis is the most likely to benefit from additional measures of disease beyond traditional clinical risk profiling and CCTA visual examination. Nakazato et al. studied 58 patients with intermediate severity stenosis and quantified the percent aggregate plaque volume (%APV), a novel measure of total arterial plaque disease. %APV had the highest correlation with ischemic lesions on FFR, outperforming luminal diameter, luminal area, minimal lumen diameter, and minimal lumen area. This study extracts additional information from pre-existing CT data-sets and suggest novel concept that might improve classification of moderate severity coronary stenoses.