☆ 4.6 Article

Optical Coherence Tomography-Defined Plaque Vulnerability in Relation to Functional Stenosis Severity and Microvascular Dysfunction

JACC-CARDIOVASCULAR INTERVENTIONS (2018)

Journal

JACC-CARDIOVASCULAR INTERVENTIONS

Volume 11, Issue 20, Pages 2058-2068

Publisher

ELSEVIER SCIENCE INC

DOI: 10.1016/j.jcin.2018.07.012

Keywords

coronary artery disease; fractional flow reserve; microvascular dysfunction; optical coherence tomography; stenosis severity

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Abstract

OBJECTIVES This study sought to investigate the relationship of unstable plaque features with physiological lesion severity and microvascular dysfunction. BACKGROUND The functional severity of epicardial lesions and microvascular dysfunction are both related to adverse clinical outcomes. METHODS We investigated 382 de novo intermediate and severe coronary lesions in 340 patients who underwent optical coherence tomography, fractional flow reserve (FFR), and index of microcirculatory resistance (IMR) examinations. Lesions were divided into tertiles based on either FFR or IMR values. The optical coherence tomography findings were compared among the tertiles of FFR and IMR. Each tertile was defined as follows: FFR-T1 (FFR <0.74), FFR-T2 (0.74 <= FFR <= 0.81), and FFR-T3 (FFR >0.81); and IMR-T1 (IMR >= 25), IMR-T2 (15 <25), and IMR-T3 (IMR <= 15). RESULTS No significant relationship was observed between FFR and IMR. The prevalence of optical coherence tomography-defined thin-cap fibroatheroma (TCFA) was significantly greater in IMR-T1 than in IMR-T2 and IMR-T3. An overall significant difference in the prevalence of TCFAs was detected among FFR tertiles, although no pairwise comparison revealed statistical significance. The prevalence of ruptured plaque was significantly greater in IMR-T1 than in IMR-T2 and IMR-T3, although no significant difference was observed between FFR tertiles. Multivariate analysis showed that FFR and IMR were independent predictors of the prevalence of TCFAs (odds ratio: 0.036; 95% confidence interval: 0.004 to 0342; p = 0.004; and odds ratio: 1.034; 95% confidence interval: 1.014 to 1.054; p = 0.001, respectively). CONCLUSIONS Lower FFR and higher IMR values were independent predictors of the presence of a TCFA in angiographically intermediate-to-severe stable lesions or nonculprit lesions in acute coronary syndrome. (c) 2018 by the American College of Cardiology Foundation.

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Microvascular Resistance Reserve for Assessment of Coronary Microvascular Function JACC Technology Corner

Bernard De Bruyne, Nico H. J. Pijls, Emanuele Gallinoro, Alessandro Candreva, Stephane Fournier, Danielle C. J. Keulards, Jeroen Sonck, Marcel Van't Veer, Emanuele Barbato, Jozef Bartunek, Marc Vanderheyden, Eric Wyffels, Annemiek De Vos, Mohamed El Farissi, Pim A. L. Tonino, Olivier Muller, Carlos Collet, William F. Fearon

Summary: This study proposes microvascular resistance reserve (MRR) as a specific index for assessing coronary microvascular function, independent of autoregulation and myocardial mass, based on absolute values of coronary flow and pressure. The research found a strong correlation between continuous thermodilution-derived MRR and Doppler MRR, suggesting MRR as a specific, quantitative, and operator-independent metric for quantifying coronary microvascular dysfunction.

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY (2021)