Segmental assessments of coronary plaque morphology and composition by virtual histology intravascular ultrasound and fractional flow reserve.
Fractional flow reserve (FFR) is an index for identifying functionally significant stenotic lesions. A FFR value of ≤0.75 is considered clinically significant and indicative of physiological ischemia. Focal lesions with 30-80 % stenosis by angiography with lesion lengths of less than 20 mm were selected from left anterior descending arteries of 74 patients. The analysis for the total lesion was processed first, and then each lesion was divided into three segments to assess the each segment. Data on plaque geometry and composition of two FFR groups, FFR ≤ 0.75 and FFR > 0.75, were compared by total and segmental analysis. Lesions with FFR ≤ 0.75 had more fibrofatty tissue (13.5 ± 7.4 vs. 10.2 ± 6.5%, p = 0.05) and less dense calcium (7.2 ± 5.3 vs. 11.9 ± 7.5%, p = 0.01) compared to lesions with FFR > 0.75. The content of necrotic core in mid segments was higher compared to proximal and distal segments (22.9 ± 10.6, 20.2 ± 10.9, 17.1 ± 11.2%, respectively, p = 0.032) in lesions with FFR > 0.75 but the difference was less obvious in lesions with FFR ≤ 0.75 (17.9 ± 9.9, 18.7 ± 9.9, 15.8 ± 9.0%, respectively, p = 0.533). Coronary lesions with FFR > 0.75 have larger content of dense calcium and slightly less fibrofatty tissue compared to lesions with FFR ≤ 0.75. While segmental plaque compositions for each segment show noticeable variations in lesions with FFR > 0.75 such as high concentrations of necrotic core in mid segment, these differences in each segment become obscure in FFR ≤ 0.75 and are evenly distributed across the lesion.
Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea.
Ju-Hyun
JH
Chung
Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea.
Soe Hee
SH
Ann
Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea.
Gillian Balbir
GB
Singh
Department of Internal Medicine, Dongsan Medical Center, Keimyung University College of Medicine, Daegu, South Korea.
Chang-Wook
CW
Nam
Division of Cardiology, Inje University Ilsan Paik Hospital, Goyang, South Korea.
Joon-Hyung
JH
Doh
Suntech Research Center, Seoul, South Korea.
Hyung Il
HI
Kim
Department of Internal Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea. bkkoo@snu.ac.kr.|Institute of Aging, Seoul National University, Seoul, South Korea. bkkoo@snu.ac.kr.
Bon-Kwon
BK
Koo
Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea. sesim1989@gmail.com.
Eun-Seok
ES
Shin
D000368:Aged; D019540:Area Under Curve; D006328:Cardiac Catheterization; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000503:physiopathology; D023921:Coronary Stenosis / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000503:physiopathology; D003331:Coronary Vessels / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D005260:Female; D005355:Fibrosis; D053805:Fractional Flow Reserve, Myocardial; D006801:Humans; D008297:Male; D008875:Middle Aged; D058226:Plaque, Atherosclerotic; D011237:Predictive Value of Tests; D012372:ROC Curve; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D018084:Ultrasonography, Interventional; D061205:Vascular Calcification / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000503:physiopathology
Coronary artery disease; Fractional flow reserve; Plaque composition; Segmental analysis; Virtual histology intravascular ultrasound