title: Potential contribution of virtual histology plaque composition to hemodynamic-morphologic dissociation in patients with non-ST elevation acute coronary syndrome.
abstract: OBJECTIVE
  Histologic plaque characteristics may influence the hemodynamic effect generated by physiologically significant unstable coronary lesions where plaque content and surface related factors are expected to contribute to the maximum translesional pressure drop. In this study, we aimed to identify local lesion specific virtual histological characteristics that may potentially affect hemodynamic outcome measures.
  
  
  METHODS
  Forty-eight consecutive patients with non-ST-elevation acute coronary syndrome (NSTEACS) having paired hemodynamic and morphological data were enrolled. A dual sensor guide-wire was used for the assessment of fractional flow reserve (FFR) and stenosis resistance (HSR) in the culprit vessel. Virtual histology intravascular ultrasound imaging was performed after obtaining hemodynamic data.
  
  
  RESULTS
  In a hemodynamically significant lesion subset (FFR<0.75 [n=34]), after controlling for lesion length, MLA and coronary artery compliance, FFR correlated with necrotic core (NC) area (r=-0.423, p=0.028) at MLA and NC volume (r=-0.497, p=0.008) and dense calcium (DC) volume (r=-0.332, p=0.03) across the entire lesion segment. Likewise, NC (r=-0.544, p=0.005) and DC (r=0.376, p=0.03) areas at MLA and NC (r=0.545, p=0.005) and DC (r=0.576, p=0.003) volumes across the entire lesion segment were associated with HSR in the hemodynamically significant lesion group (HSR>0.80 [n=33]). However, no correlation has been observed between intracoronary hemodynamic end-points and plaque components in hemodynamically insignificant lesions.
  
  
  CONCLUSIONS
  This study demonstrated that for a given coronary stenosis geometry and arterial compliance, plaque composition may influence hemodynamic outcome measures in functionally significant stenoses in patients with NSTEACS.
authors.affiliation: Istanbul University, Istanbul Faculty of Medicine, Department of Cardiology, Turkey. Electronic address: dunkan8@gmail.com.
authors.forename: Güneş
authors.initials: G
authors.lastname: Hüseyinova
authors.affiliation: Koç University School of Medicine, Department of Cardiology, Turkey. Electronic address: easlanger@kuh.ku.edu.tr.
authors.forename: Emre
authors.initials: E
authors.lastname: Aslanger
authors.affiliation: Istanbul University, Istanbul Faculty of Medicine, Department of Cardiology, Turkey. Electronic address: mozancakir@yahoo.com.
authors.forename: Ozan
authors.initials: O
authors.lastname: Çakır
authors.affiliation: Istanbul University, Istanbul Faculty of Medicine, Department of Cardiology, Turkey. Electronic address: adematici10@gmail.com.
authors.forename: Adem
authors.initials: A
authors.lastname: Atıcı
authors.affiliation: Istanbul University, Istanbul Faculty of Medicine, Department of Cardiology, Turkey. Electronic address: caferpanc@gmail.com.
authors.forename: Cafer
authors.initials: C
authors.lastname: Panç
authors.affiliation: Istanbul University, Istanbul Faculty of Medicine, Department of Cardiology, Turkey. Electronic address: ademirkiran@hotmail.com.
authors.forename: Ahmet
authors.initials: A
authors.lastname: Demirkıran
authors.affiliation: Istanbul University, Istanbul Faculty of Medicine, Department of Cardiology, Turkey. Electronic address: surmen@gmail.com.
authors.forename: Semih
authors.initials: S
authors.lastname: Sürmen
authors.affiliation: Istanbul University, Istanbul Faculty of Medicine, Department of Cardiology, Turkey. Electronic address: remzisarikaya@hotmail.com.
authors.forename: Remzi
authors.initials: R
authors.lastname: Sarıkaya
authors.affiliation: Istanbul University, Istanbul Faculty of Medicine, Department of Cardiology, Turkey. Electronic address: onurerdogan86@gmail.com.
authors.forename: Onur
authors.initials: O
authors.lastname: Erdoğan
authors.affiliation: Koç University School of Medicine, Department of Cardiology, Turkey. Electronic address: sgolcuk@kuh.ku.edu.tr.
authors.forename: Ebru
authors.initials: E
authors.lastname: Gölcük
authors.affiliation: Istanbul University, Istanbul Faculty of Medicine, Department of Cardiology, Turkey. Electronic address: summan@istanbul.edu.tr.
authors.forename: Sabahattin
authors.initials: S
authors.lastname: Umman
authors.affiliation: Koç University School of Medicine, Department of Cardiology, Turkey. Electronic address: muratsezer@ku.edu.tr.
authors.forename: Murat
authors.initials: M
authors.lastname: Sezer
mesh_terms: D054058:Acute Coronary Syndrome / Q000150:complications / Q000473:pathology* / Q000503:physiopathology*; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D058226:Plaque, Atherosclerotic / Q000150:complications / Q000473:pathology* / Q000503:physiopathology*; D011446:Prospective Studies
keywords: Coronary flow; Intravascular ultrasound (IVUS); Plaque rupture; Virtual histology