Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
Department of Cardiology, Southwestern Hospital, Esbjerg, Denmark.
Clin Cardiol. 2022 Oct;45(10):986-994. doi: 10.1002/clc.23895. Epub 2022 Sep 3.
Coronary CT angiography (CTA) derived fractional flow reserve (FFR ) shows high diagnostic performance when compared to invasively measured FFR. Presence and extent of low attenuation plaque density have been shown to be associated with abnormal physiology by measured FFR. Moreover, it is well established that statin therapy reduces the rate of plaque progression and results in morphology alterations underlying atherosclerosis. However, the interplay between lipid lowering treatment, plaque regression, and the coronary physiology has not previously been investigated.
To test whether lipid lowering therapy is associated with significant improvement in FFR , and whether there is a dose-response relationship between lipid lowering intensity, plaque regression, and coronary flow recovery.
Investigator driven, prospective, multicenter, randomized study of patients with stable angina, coronary stenosis ≥50% determined by clinically indicated first-line CTA, and FFR ≤ 0.80 in whom coronary revascularization was deferred. Patients are randomized to standard (atorvastatin 40 mg daily) or intensive (rosuvastatin 40 mg + ezetimibe 10 mg daily) lipid lowering therapy for 18 months. Coronary CTA scans with blinded coronary plaque and FFR analyses will be repeated after 9 and 18 months. The primary endpoint is the 18-month difference in FFR using (1) the FFR value 2 cm distal to stenosis and (2) the lowest distal value in the vessel of interest. A total of 104 patients will be included in the study.
The results of this study will provide novel insights into the interplay between lipid lowering, and the pathophysiology in coronary artery disease.
与有创测量的 FFR 相比，冠状动脉 CT 血管造影（CTA）衍生的血流储备分数（FFR）显示出较高的诊断性能。通过有创测量的 FFR 显示，低衰减斑块密度的存在和程度与异常生理学有关。此外，他汀类药物治疗可降低斑块进展速度，并导致动脉粥样硬化下的形态学改变，这一点已得到充分证实。然而，降脂治疗、斑块消退和冠状动脉生理学之间的相互作用尚未得到研究。
检测降脂治疗是否与 FFR 显著改善相关，以及降脂强度、斑块消退和冠状动脉血流恢复之间是否存在剂量反应关系。
研究者驱动的前瞻性、多中心、随机研究，纳入稳定型心绞痛患者，根据临床指征行首次 CTA 检查，发现冠状动脉狭窄≥50%，FFR ≤ 0.80，且延迟冠状动脉血运重建。患者随机分为标准（阿托伐他汀 40mg 每日）或强化（瑞舒伐他汀 40mg + 依折麦布 10mg 每日）降脂治疗组，治疗 18 个月。在 9 个月和 18 个月时，将重复进行冠状动脉 CTA 扫描，并进行冠状动脉斑块和 FFR 分析。主要终点是使用（1）狭窄 2cm 远端的 FFR 值和（2）感兴趣血管中最低远端值，比较 18 个月时 FFR 的差异。将纳入 104 例患者进行研究。
该研究结果将为降脂治疗与冠状动脉疾病病理生理学之间的相互作用提供新的见解。
