血管造影衍生的冠状动脉径向壁应变在糖尿病患者和非血流限制性狭窄中的预后意义
Prognostic Implications of Angiographically Derived Coronary Radial Wall Strain in Diabetic Patients and Non-Flow-Limiting Stenosis.
作者信息
Wang Zhiqing, Kedhi Elvin, Liu Xun, Li Chunming, Huang Jiayue, Zhong Jiaxin, Qu Xinkai, Wijns William, Tu Shengxian
机构信息
Department of Cardiology, Huadong Hospital, Fudan University, Shanghai, China; Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China.
Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland; Department of Interventional Cardiology, Royal Victoria Hospital, McGill University Health Center, McGill University, Montreal, Quebec, Canada.
出版信息
JACC Cardiovasc Interv. 2025 May 26;18(10):1232-1242. doi: 10.1016/j.jcin.2025.02.009. Epub 2025 May 10.
BACKGROUND
Coronary radial wall strain (RWS) represents a novel approach enabling discrimination of vulnerable plaques with prognostic significance.
OBJECTIVES
This study sought to evaluate the prognostic impact of RWS in diabetic patients with non-flow-limiting coronary stenosis when compared with optical coherence tomography-detected vulnerability features (OCT-VFs).
METHODS
This was a post hoc analysis of the COMBINE OCT-FFR dataset. The primary endpoint was lesion-oriented composite endpoint (LOCE), a composite of cardiac death, target vessel-related myocardial infarction, and clinically driven target lesion revascularization.
RESULTS
RWS was assessed in 435 eligible non-flow-limiting lesions from 366 patients. Lesion-level maximal RWS was predictive of lesions with any OCT-VFs (area under the curve: 0.630 [95% CI: 0.571-0.688]; P < 0.001). The median follow-up was 3.2 years (Q1-Q3: 2.2-4.1 years). With a prespecified cutoff of ≥13.0%, the incidence of LOCE was 17.0% (15/88; 95% CI: 9.0%-25.1%) in RWS-positive vs 6.8% (19/278; 95% CI: 3.8%-9.8%) in RWS-negative patients (HR: 2.70; 95% CI: 1.37-5.32; P = 0.004). Positive RWS predicted LOCE independently from any OCT-VFs (direct effect β = 0.099 [95% CI: 0.029-0.168]; P = 0.006; indirect effect β = 0.004 [95% CI: -0.008 to 0.015]; P = 0.555; mediation proportion 3.9% [95% CI: -5.0% to 20.3%]). Adding RWS to any OCT-VFs mainly improved the reclassification for LOCE in the lower-risk strata (positive continuous net reclassification improvement [cNRI] -0.060 [95% CI: -0.420 to 0.318]; P = 0.749; negative cNRI 0.583 [95% CI: 0.474-0.681]; P < 0.001; integrated discrimination improvement 0.066 [95% CI: 0.013-0.182]; P = 0.010).
CONCLUSIONS
In diabetic patients with non-flow-limiting stenosis, RWS can help to localize stenoses with OCT-VFs. RWS predicts increased risk for LOCE, both independently from-and incrementally beyond-OCT-VFs. (Combined Optical Coherence Tomography Morphologic and Fractional Flow Reserve Hemodynamic Assessment of Non-Culprit Lesions to Better Predict Adverse Event Outcomes in Diabetes Mellitus Patients [COMBINE OCT-FFR]; NCT02989740).
背景
冠状动脉径向壁应变（RWS）是一种新方法，能够鉴别具有预后意义的易损斑块。
目的
本研究旨在评估与光学相干断层扫描检测到的易损特征（OCT-VFs）相比，RWS对非血流限制性冠状动脉狭窄糖尿病患者的预后影响。
方法
这是对COMBINE OCT-FFR数据集的事后分析。主要终点是病变导向复合终点（LOCE），包括心源性死亡、靶血管相关心肌梗死和临床驱动的靶病变血运重建。
结果
对366例患者的435个符合条件的非血流限制性病变进行了RWS评估。病变水平的最大RWS可预测存在任何OCT-VFs的病变（曲线下面积：0.630[95%CI：0.571-0.688]；P<0.001）。中位随访时间为3.2年（四分位间距：2.2-4.1年）。以预先设定的≥13.0%为临界值，RWS阳性患者的LOCE发生率为17.0%（15/88；95%CI：9.0%-25.1%），而RWS阴性患者为6.8%（19/278；95%CI：3.8%-9.8%）（风险比：2.70；95%CI：1.37-5.32；P=0.004）。阳性RWS独立于任何OCT-VFs预测LOCE（直接效应β=0.099[95%CI：0.029-0.168]；P=0.006；间接效应β=0.004[95%CI：-0.008至0.015]；P=0.555；中介比例3.9%[95%CI：-5.0%至20.3%]）。将RWS添加到任何OCT-VFs中主要改善了低风险分层中LOCE的重新分类（阳性连续净重新分类改善[cNRI]-0.060[95%CI：-0.420至0.318]；P=0.749；阴性cNRI 0.583[95%CI：0.474-0.681]；P<0.001；综合鉴别改善0.066[95%CI：0.013-0.182]；P=0.010）。
结论
在非血流限制性狭窄的糖尿病患者中，RWS有助于定位具有OCT-VFs的狭窄。RWS独立于且在OCT-VFs之外进一步预测LOCE风险增加。（非罪犯病变的光学相干断层扫描形态学和血流储备分数血流动力学联合评估以更好地预测糖尿病患者不良事件结局[COMBINE OCT-FFR]；NCT02989740）
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