Influence of coronary calcification patterns on hemodynamic effect of coronary stenoses and vascular remodelling

Atıcı A.

TurkishCardiologyCongresswith International Participation, Antalya, Turkey, 20 - 23 October 2016, no.136, pp.44

  • Publication Type: Conference Paper / Summary Text
  • City: Antalya
  • Country: Turkey
  • Page Numbers: pp.44


Background and Aim: Histologic plaque characteristics may affect the hemodynamic outcome of a given coronary stenosis. In particular, potential effect of the volumetric calcium content and its topographical distribution on physiological outcome in the lesion segment has not been investigated, yet. This study aimed to identify potential correlation between patterns of calcification and fractional flow reserve(FFR). Additionally, this study also investigating the relationship between patterns of calcification and anatomical (coronary remodelling) consequences of coronary stenoses. Methods: A total of 60 patients with non-ST elevation acute coronary syndrome and stable angina pectoris constituted the study population. 70 intermediate coronary stenosis lesion (visually estimated diameter stenosis: 50-80%) assessed via FFR. After obtaining hemodynamic measurements, quantitative gray scale and virtual histology-intravascular ultrasound (VH-IVUS) analysis were performed and reported at the site of minimum lumen area and across the entire lesion segment. And then the lesions identified according to their depth, length and circumferential distribution of calcification. Results: Maximal calcification angle within analyzed segment (area of interest, lesion segment) was correlated with FFR (r=-0.396, p=0.001). Maximal thickness of deep calcification in the area of interest was correlated with FFR (r=-0.285, p=0.021). In lesions with calcification angle >180°, the mean FFR value was significantly lower with compared to those with <180° (0.64±0.17 versus 0.78±0.08, p=0.024). RMI was correlated with maximal angle of superficial (r=-0.437, p<0.001) and with deep (r=0.425, p<0.001) calcification. RMI was also correlated with % dense calcium volume in entire analyzed lesion segment (r=-0,330, p=0.007) and with maximal thickness of superficial (r=-0.357, p=0.003) and with deep (r=0.417, p<0.001) calcium. There was a correlation between RMI and the length of the calcific segment with >180° calcium (r=-0.277, p=0.024). RMI was also correlated with FFR (r=-0.477, p<0.001). Conclusions: This study demonsrated that geometry, location and amount of calcification in a plaque could affect hemodynamic outcome measures in functionally significant stenoses by affecting the vessel wall compliance and may be correlated with remodelling index in patients with acute coronary syndrome and stable angina pectoris.