Coronary Artery Geometry and the Severity of Coronary Atherosclerosis (GEOMETRY-CTA)

June 4, 2020 updated by: Georgios P Rampidis, MD, MSc, Aristotle University Of Thessaloniki

Assessment of Coronary Artery Geometry With Coronary CT Angiography: Evaluation of Atherosclerotic Plaque Burden and Composition

The purpose of this study is to investigate the potential association of coronary artery geometry, based on coronary CT angiography (CCTA), with the complexity and the severity of coronary atherosclerosis.

Study Overview

Status

Unknown

Conditions

Intervention / Treatment

Detailed Description

The angulation of the side branch take-off has been reported to influence the severity of atherosclerosis in coronary bifurcations, as larger angles have been associated with increased plaque burden. Data from computational fluid dynamics studies have confirmed this finding by demonstrating that even in the absence of alterations in the amount of branch flow, a wide angle between the side branches intensifies flow perturbations, increases the spatial endothelial shear stress (ESS) variations in the bifurcation region and the low ESS in the lateral walls, thereby augmenting the atherosclerosis-prone environment. The magnitude of reversed flow, the extension of the recirculation zone and the duration of flow separation during the pulse cycle comprise other haemodynamic parameters which are important in atherogenesis and are amplified by an increased bifurcation angle.

Study Type

Observational

Enrollment (Anticipated)

100

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Greece
      • Thessaloníki, Greece, 54636
        • Recruiting
        • AHEPA University Hospital, Department of Cardiology
        • Contact:
          • Georgios Rampidis, MD, MSc
          • Phone Number: +306976254340
          • Email: grampidi@auth.gr
        • Principal Investigator:
          • Haralambos Karvounis, MD, PhD
        • Principal Investigator:
          • Konstantinos Kouskouras, MD, PhD
        • Principal Investigator:
          • Georgios Rampidis, MD, MSc
        • Principal Investigator:
          • Vasileios Rafailidis, MD, PhD

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

18 years and older (Adult, Older Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Sampling Method

Non-Probability Sample

Study Population

Consecutive patients older than 18 years old at entry, of both genders, who referred for coronary CT angiography

Description

Inclusion Criteria:

  • Patients referred for cardiac CT angiography
  • Patients without previous history of Coronary Artery Disease (CAD)
  • Age ≥ 18 years
  • Patients giving voluntary written consent to participate in the study

Exclusion Criteria:

  • Pregnancy or breast-feeding
  • Patients with serious concurrent disease and life expectancy of < 1 year
  • Patients with a previous history of CAD
  • Patients who refuse to give written consent for participation in the study

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Observational Models: Cohort
  • Time Perspectives: Prospective

Cohorts and Interventions

Group / Cohort
Intervention / Treatment
CCTA Cohort
Consecutive patients with suspected coronary artery disease and low/intermediate pre-test probability
Diagnostic test: CCTA
128-multislice CT coronary angiography and complex atherosclerotic plaque analysis with the use of CT imaging post-processing techniques.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Left Main Coronary Artery (LMCA) angle of take-off from the aortic root
Time Frame: 30 days
Measurement using curved Multiplanar Reconstruction (MPR) technique in advantage workstation server
30 days
Right Coronary Artery (RCA) angle of take-off from the aortic root
Time Frame: 30 days
Measurement using curved MPR technique in advantage workstation server
30 days
Left Anterior Descending (LAD) / Left Circumflex (LCx) bifurcation angle
Time Frame: 30 days
Measurement using curved MPR technique in advantage workstation server
30 days
Indexed Coronary Volume
Time Frame: 30 days
Calculated by dividing the total coronary volume to the left ventricle mass, both derived from CCTA (mm3/gr)
30 days

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Extent of Coronary Atherosclerosis
Time Frame: 30 days
Total atherosclerotic plaque volume (mm3)
30 days
Severity of Coronary Atherosclerosis assessed by using Leiden CTA risk score
Time Frame: 30 days
Leiden CTA risk score incorporates the presence, extent, severity, location, and composition of coronary artery disease (CAD). Leiden CTA score is calculated using the following approach. First, the presence of CAD is determined in each segment. When plaque is absent the score is 0. When plaque is present a score of 1.1, 1.2 or 1.3 is given according to plaque composition (calcified, noncalcified, and mixed plaque, respectively). Subsequently, this score is multiplied by a weight factor for the location of the segment in the coronary artery tree (0.5 through 6 according to vessel, proximal location and system dominance) and multiplied by a weight factor for stenosis severity (1.4 for ≥50% stenosis and 1.0 for stenosis <50%). The final score (range 0 to 42) is calculated by addition of the individual segment scores.
30 days
Severity of Coronary Atherosclerosis assessed by using Gensini score
Time Frame: 30 days
The relative severity of a lesion is indicated using a score of 1 for 1-25% obstruction and doubling that number as the severity of obstruction progresses with each step in the 25-50-75-90-99-100% diameter reduction. Thus, the severity score for each lesion may range from 1 to 32. Furthermore, the score weighed according to the usual blood flow to the left ventricle in each vessel or vessel segment. A multiplying factor is applied to each lesion score based upon its location in the coronary tree, depending on the functional significance of the area supplied by that segment. If a segment is totally occluded or 99% stenosed and receiving collaterals, a collateral adjustment factor is used, and the adjustment is reduced by the extent of disease in the vessel that is the source of collaterals. The final score is the sum of all the lesion scores.
30 days
Complexity of Coronary Artery Disease [CT-SYNTAX score]
Time Frame: 30 days
CCTA-derived SYNTAX score (CT-SYNTAX score) is a lesion-based grading tool to characterise the coronary vasculature with respect to the number of lesions and their functional impact, location, and complexity. Higher SYNTAX scores, indicative of more complex disease, are hypothesized to represent a bigger therapeutic challenge and to have potentially worse prognosis.
30 days
Frequency of occurrence of high-risk plaques
Time Frame: 30 days
Frequency (%) of occurrence of high-risk plaque features (HU < 30, Remodelling Index > 1.1, napkin-ring sign & spotty calcium)
30 days
Plaque burden assessment [Modified Duke CAD Index for coronary CTA]
Time Frame: 30 days
Patients are assigned a risk score between 0-100 based on former patient prognosis data. The score is an extension of the 3-vessel disease score. It also incorporates stenosis severity and calculates with left main stenosis and proximal left anterior descending stenosis. There is a significant difference between patients' cumulative survival for the different categories. Left main plaque with any additional moderate or severe stenosis indicates the worst outcome.
30 days

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Aristotle University Of Thessaloniki

Investigators

  • Study Chair: Haralambos Karvounis, MD, PhD, AHEPA-Department of Cardiology
  • Principal Investigator: Konstantinos Kouskouras, MD, PhD, AHEPA-Department of Radiology
  • Principal Investigator: Georgios Rampidis, MD, MSc, AHEPA-Department of Cardiology
  • Principal Investigator: Vasileios Rafailidis, MD, PhD, AHEPA-Department of Radiology

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

June 4, 2020

Primary Completion (Anticipated)

June 1, 2021

Study Completion (Anticipated)

September 1, 2021

Study Registration Dates

First Submitted

December 1, 2019

First Submitted That Met QC Criteria

December 1, 2019

First Posted (Actual)

December 4, 2019

Study Record Updates

Last Update Posted (Actual)

June 5, 2020

Last Update Submitted That Met QC Criteria

June 4, 2020

Last Verified

June 1, 2020

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • GEOMETRY_29.01.2019.101068

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

Undecided

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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