Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium; Department of Medicine, Division of Cardiology, Showa University School of Medicine, Tokyo, Japan.
Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium; Division of Clinical Pharmacology, Department of Pharmacology, Showa University, Tokyo, Japan; Department of Cardiovascular Medicine, Gifu Heart Center, Gifu, Japan.
JACC Cardiovasc Imaging. 2023 Nov;16(11):1452-1464. doi: 10.1016/j.jcmg.2023.05.018. Epub 2023 Jul 19.
The interplay between coronary hemodynamics and plaque characteristics remains poorly understood.
The aim of this study was to compare atherosclerotic plaque phenotypes between focal and diffuse coronary artery disease (CAD) defined by coronary hemodynamics.
This multicenter, prospective, single-arm study was conducted in 5 countries. Patients with functionally significant lesions based on an invasive fractional flow reserve ≤0.80 were included. Plaque analysis was performed by using coronary computed tomography angiography and optical coherence tomography. CAD patterns were assessed using motorized fractional flow reserve pullbacks and quantified by pullback pressure gradient (PPG). Focal and diffuse CAD was defined according to the median PPG value.
A total of 117 patients (120 vessels) were included. The median PPG was 0.66 (IQR: 0.54-0.75). According to coronary computed tomography angiography analysis, plaque burden was higher in patients with focal CAD (87% ± 8% focal vs 82% ± 10% diffuse; P = 0.003). Calcifications were significantly more prevalent in patients with diffuse CAD (Agatston score per vessel: 51 [IQR: 11-204] focal vs 158 [IQR: 52-341] diffuse; P = 0.024). According to optical coherence tomography analysis, patients with focal CAD had a significantly higher prevalence of circumferential lipid-rich plaque (37% focal vs 4% diffuse; P = 0.001) and thin-cap fibroatheroma (TCFA) (47% focal vs 10% diffuse; P = 0.002). Focal disease defined by PPG predicted the presence of TCFA with an area under the curve of 0.73 (95% CI: 0.58-0.87).
Atherosclerotic plaque phenotypes associate with intracoronary hemodynamics. Focal CAD had a higher plaque burden and was predominantly lipid-rich with a high prevalence of TCFA, whereas calcifications were more prevalent in diffuse CAD. (Precise Percutaneous Coronary Intervention Plan [P3]; NCT03782688).
冠状动脉血流动力学与斑块特征之间的相互作用仍知之甚少。
本研究旨在比较基于冠状动脉血流动力学定义的局灶性和弥漫性冠状动脉疾病(CAD)之间的动脉粥样硬化斑块表型。
这是一项多中心、前瞻性、单臂研究,在 5 个国家进行。纳入基于有创性血流储备分数(FFR)≤0.80 诊断为有功能性意义病变的患者。通过冠状动脉计算机断层血管造影术和光学相干断层扫描进行斑块分析。采用机械性 FFR 拖曳评估 CAD 模式,并通过拖曳压力梯度(PPG)进行量化。根据中位 PPG 值定义局灶性和弥漫性 CAD。
共纳入 117 例患者(120 支血管)。中位 PPG 为 0.66(IQR:0.54-0.75)。根据冠状动脉计算机断层血管造影分析,局灶性 CAD 患者的斑块负荷更高(87%±8%局灶性 vs 82%±10%弥漫性;P=0.003)。弥漫性 CAD 患者的钙化更为常见(每支血管的 Agatston 评分:51[IQR:11-204]局灶性 vs 158[IQR:52-341]弥漫性;P=0.024)。根据光学相干断层扫描分析,局灶性 CAD 患者的环形富含脂质斑块的发生率明显更高(37%局灶性 vs 4%弥漫性;P=0.001)和薄帽纤维粥样斑块(TCFA)(47%局灶性 vs 10%弥漫性;P=0.002)。PPG 定义的局灶性疾病预测 TCFA 的存在,曲线下面积为 0.73(95%CI:0.58-0.87)。
动脉粥样硬化斑块表型与冠状动脉内血流动力学相关。局灶性 CAD 的斑块负荷更高,主要为富含脂质,TCFA 发生率较高,而弥漫性 CAD 中钙化更为常见。(精准经皮冠状动脉介入治疗计划 [P3];NCT03782688)。