Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Tsuchiura, Ibaraki, Japan.
Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan.
PLoS One. 2024 Aug 15;19(8):e0307384. doi: 10.1371/journal.pone.0307384. eCollection 2024.
Stress-transthoracic Doppler echocardiography (S-TDE) provides a noninvasive assessment of coronary flow parameters in the left anterior descending artery (LAD). However, the association between morphological characteristics and coronary flow changes after elective percutaneous coronary intervention (PCI) remains unclear. We aimed to evaluate the relationships between periprocedural coronary flow changes observed on S-TDE and lesion-specific plaque characteristics obtained by optical coherence tomography (OCT) in the interrogated vessels in patients with chronic coronary syndrome (CCS).
Patients with CCS who underwent pre- and post-PCI S-TDE and elective fractional flow reserve (FFR)-guided PCI under OCT guidance for de novo single LAD lesions were included. S-TDE-derived hyperemic diastolic peak flow velocity (hDPV) was used as a surrogate for coronary flow. Lesions were categorized into two groups based on the %hDPV increase or decrease. The baseline clinical, physiological, and OCT findings were compared between the groups. In total, 103 LAD lesions were studied in 103 patients. After PCI, hDPV significantly increased from 55.6 cm/s to 69.5 cm/s (P<0.01), with a median %hDPV increase of 27.2 (6.32-59.1) %, while %hDPV decreased in 20 (19.4%) patients. The FFR improved in all patients. On OCT, layered plaques were more frequently present in the culprit vessels in the %hDPV-decrease group than in the %hDPV-increase group (85.0% vs. 50.6%, P = 0.01). Multivariable logistic regression analysis showed that the presence of layered plaques and high pre-PCI hDPV were independent predictors of %hDPV decrease.
In patients who underwent successful uncomplicated elective PCI for de novo single LAD lesions, the presence of layered plaques was independently associated with hyperemic coronary flow decrease as assessed by S-TDE.
经胸多普勒超声心动图（S-TDE）可提供左前降支（LAD）冠状动脉血流参数的无创评估。然而，选择性经皮冠状动脉介入治疗（PCI）前后，形态特征与冠状动脉血流变化之间的关系尚不清楚。我们旨在评估慢性冠状动脉综合征（CCS）患者接受经皮冠状动脉介入治疗前后 S-TDE 观察到的冠状动脉血流变化与光学相干断层扫描（OCT）检测到的血管内病变特定斑块特征之间的关系。
纳入了接受慢性冠状动脉综合征患者接受经皮冠状动脉介入治疗前后 S-TDE 和经 OCT 引导的选择性血流储备分数（FFR）指导的单支 LAD 病变的经皮冠状动脉介入治疗。S-TDE 衍生的充血性舒张峰流速（hDPV）作为冠状动脉血流的替代指标。根据 hDPV 增加或减少的百分比，将病变分为两组。比较两组的基线临床、生理和 OCT 发现。共研究了 103 例患者的 103 个 LAD 病变。PCI 后，hDPV 从 55.6cm/s 显著增加到 69.5cm/s（P<0.01），中位数 hDPV 增加 27.2（6.32-59.1）%，而 20 例（19.4%）患者 hDPV 减少。所有患者的 FFR 均得到改善。在 OCT 上，层状斑块在 hDPV 减少组中比在 hDPV 增加组中更常见（85.0%比 50.6%，P=0.01）。多变量逻辑回归分析表明，层状斑块的存在和高 hDPV 是 hDPV 减少的独立预测因子。
在成功接受单纯选择性单支 LAD 病变经皮冠状动脉介入治疗的患者中，层状斑块的存在与 S-TDE 评估的充血性冠状动脉血流减少独立相关。
