The interplay between features of plaque vulnerability and hemodynamic relevance of coronary artery stenoses

Atıcı A.

Turkish Cardiology Congresswith International Participation, Antalya, Turkey, 20 - 23 October 2016, no.139, pp.45-46

  • Publication Type: Conference Paper / Summary Text
  • City: Antalya
  • Country: Turkey
  • Page Numbers: pp.45-46


Background and Aim: Fractional flow reserve (FFR) is widely accepted as an indispensible tool in evaluation of hemodynamic significance of a coronary stenosis. This measurement, however, may not be immune from dynamic hemodynamic perturbations caused by both vessel and lesion related factors. Unraveling these potential influences on epicardial resistance may elucidate the interplay between anatomical substrate and its physiological consequences. Therefore, we hypothesized that virtual histology intravascular ultrasound (VH- IVUS) defined plaque characteristics may be an influential factor on hemodynamic effect of intermediate coronary stenoses. Methods: Seventy-one consecutive patients were prospectively enrolled and 70 lesions from 60 patients were evaluated. After obtaining intracoronary hemodynamic measurements using a pressure sensor equipped guide-wire, quantitative gray scale and VH-IVUS analyses were performed. The four VH-IVUSdefined plaque components (fibrous, fibro-fatty, dense calcium, and necrotic core [NC]), arterial wall compliance, and remodeling index were measured. Results: FFR modestly correlated with minimal lumen area (MLA) (r=0.318, p=0.002), lesion length (r=-0.467, p<0.001) and plaque burden (r=-0.371, p=0.002). In a multivariable model, including thin cap fibroatheroma (TCFA), lesion length, MLA, plaque burden and arterial wall compliance, presence of VH-IVUS defined TCFA was independently associated with lower mean FFR value as compared with the absence of TCFA (adjusted, 0.71±0.024 vs. 0.78±0.019, p=0.034). FFR also correlated with NC area at MLA (r=-0.256, p=0.04) and NC volume across the entire lesion segment (r=-0.264, p=0.032) after controlling for MLA, lesion length and vessel compliance. Conclusions: The current study demonstrated that for a given stenosis geometry, plaque composition, necrotic core content and presence of TCFA, may influence hemodynamic relevance of a certain coronary stenosis.