Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK; Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, UK.
Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK; Institute of Cardiovascular Sciences, University College London, London, UK.
Atherosclerosis. 2021 Apr;322:24-30. doi: 10.1016/j.atherosclerosis.2021.02.018. Epub 2021 Feb 24.
There is some evidence of the implications of wall shear stress (WSS) derived from three-dimensional quantitative coronary angiography (3D-QCA) models in predicting adverse cardiovascular events. This study investigates the efficacy of 3D-QCA-derived WSS in detecting lesions with a borderline negative fractional flow reserve (FFR: 0.81-0.85) that progressed and caused events.
In this retrospective cohort study, we identified 548 patients who had at least one lesion with an FFR 0.81-0.85 and complete follow-up data; 293 lesions (286 patients) with suitable angiographic characteristics were reconstructed using a dedicated 3D-QCA software and included in the analysis. In the reconstructed models blood flow simulation was performed and the value of 3D-QCA variables and WSS distribution in predicting events was examined. The primary endpoint of the study was the composite of cardiac death, target lesion related myocardial infarction or clinically indicated target lesion revascularization.
During a median follow-up of 49.4 months, 37 events were reported. Culprit lesions had a greater area stenosis [(AS), 66.1% (59.5-72.3) vs 54.8% (46.5-63.2), p<0.001], smaller minimum lumen area [(MLA), 1.66 mm (1.45-2.30) vs 2.10 mm (1.69-2.70), p=0.011] and higher maximum WSS [9.0 Pa (5.10-12.46) vs 5.0 Pa (3.37-7.54), p < 0.001] than those that remained quiescent. In multivariable analysis, AS [hazard ratio (HR): 1.06, 95% confidence interval (CI): 1.03-1.10, p=0.001] and maximum WSS (HR: 1.08, 95% CI: 1.02-1.14, p=0.012) were the only independent predictors of the primary endpoint. Lesions with an increased AS (≥58.6%) that were exposed to high WSS (≥7.69Pa) were more likely to progress and cause events (27.8%) than those with a low AS exposed to high WSS (7.4%) or those exposed to low WSS that had increased (12.8%) or low AS (2.7%, p<0.001).
This study for the first time highlights the potential value of 3D-QCA-derived WSS in detecting, among lesions with a borderline negative FFR, those that cause cardiovascular events.
有证据表明，基于三维定量冠状动脉造影（3D-QCA）模型的壁切应力（WSS）对预测不良心血管事件有一定影响。本研究旨在探讨 3D-QCA 衍生的 WSS 在检测边界负血流储备分数（FFR：0.81-0.85）病变方面的效果，这些病变进展并导致了事件的发生。
本回顾性队列研究纳入了至少有一个 FFR 0.81-0.85 且具有完整随访数据的 548 例患者；对 293 个（286 例患者）具有合适血管造影特征的病变采用专用的 3D-QCA 软件进行重建，并纳入分析。在重建模型中进行血流模拟，评估 3D-QCA 变量和 WSS 分布对事件的预测价值。研究的主要终点是心脏死亡、靶病变相关心肌梗死或临床需要的靶病变血运重建的复合终点。
在中位随访 49.4 个月期间，报告了 37 例事件。罪犯病变的狭窄面积更大[（AS），66.1%（59.5-72.3）比 54.8%（46.5-63.2），p<0.001]，最小管腔面积更小[（MLA），1.66mm（1.45-2.30）比 2.10mm（1.69-2.70），p=0.011]，最大 WSS 更高[9.0Pa（5.10-12.46）比 5.0Pa（3.37-7.54），p<0.001]。多变量分析显示，AS[危险比（HR）：1.06，95%置信区间（CI）：1.03-1.10，p=0.001]和最大 WSS（HR：1.08，95%CI：1.02-1.14，p=0.012）是主要终点的唯一独立预测因素。AS 增加（≥58.6%）且暴露于高 WSS（≥7.69Pa）的病变比 AS 较低（暴露于高 WSS 的病变（7.4%）或暴露于低 WSS 但 AS 增加（12.8%）或 AS 较低（2.7%）的病变更容易进展并导致事件（p<0.001）。
本研究首次强调了 3D-QCA 衍生的 WSS 在检测边界负 FFR 病变中发生心血管事件的潜在价值。
