Validation of hemodynamic stress calculation in coronary computed tomography angiography versus intravascular ultrasound

BACKGROUND: Development in computational fluid dynamics and 3D construction could facilitate the calculation of hemodynamic stresses in coronary computed tomography angiography (CCTA). However, the agreement between CCTA derived stresses and intravascular ultrasound/intravascular coronary angiography (IVUS/ICA)-derived stresses remains undetermined. Thus, the purpose of this study is to investigate if CCTA can serve as alternative to IVUS/ICA for hemodynamic evaluation. METHODS: In this retrospective study, 13 patients (14 arteries) with unstable angina who underwent both CCTA and IVUS/ICA at an interval of less than 7 days were consecutively included at the Chinese PLA General Hospital within the year of 2021. Slice-level minimal lumen area (MLA), percent area stenosis, velocity, pressure, Reynolds number, wall shear stress (WSS) and axial plaque stress (APS) were determined by both modalities. The agreement between CCTA and IVUS/ICA was assessed using the intraclass correlation coefficient (ICC), Pearson’s correlation coefficient and Bland-Altman analysis. RESULTS: CCTA overestimated the degree of area stenosis (50.22%±16.15% vs. 36.41%±19.37%, P=0.004) with the MLA showing no significant difference (5.81±2.24 vs. 6.72±2.04 mm(2), P=0.126). No statistical difference was observed in WSS (6.57±6.26 vs. 5.98±5.55 Pa, P=0.420) and APS (16.03±1,159.45 vs. −1.27±890.39 Pa, P=0.691) between CCTA and IVUS. Good correlation was found in velocity (ICC: 0.796, 95% CI: 0.752–0.833), Reynolds number (ICC: 0.810, 95% CI: 0.768–0.844) and WSS (ICC: 0.769, 95% CI: 0.718–0.810), while the ICC of APS was (ICC: 0.341, 95% CI: 0.197–0.458), indicating a relatively poor correlation. CONCLUSIONS: CCTA can serve as a satisfactory alternative to the reference standard, IVUS/ICA in morphology simulation and hemodynamic stress calculation, especially in the calculation of WSS.