Angiography-Based Computational Modeling for In Vivo Assessment of Endothelial Dynamic Strain in Coronary Arteries with De Novo Lesions: Comparison of Treatment Effects of Drug-Coated Balloons Between Small and Large Arteries

Abstract

Acute morphological changes in de novo coronary lesions after drug-coated balloon (DCB) angioplasty can affect endothelial mechanics and consequently clinical outcomes. Angiography-based computational modeling has been validated to assess endothelial dynamic strain (EDS) in coronary arteries in vivo. The EDS was calculated on the basis of pre- and post-DCB angiography. Parameters of quantitative coronary angiography and EDS were quantified at cross-sections in the treated segments. A total of 336 and 348 lesion cross-sections were included in the small/large vessel groups, respectively. The acute lumen gain after DCB was significantly higher in large than small vessels (relative changes: 21.3% [17.4%, 25.1%] vs. 7.4% [4.8%, 10.1%], P < 0.001). Before treatment, three indices of EDS were significantly higher in small than large vessels (for ED-EDS: 29.2% [19.8%, 44.8%] vs. 20.4% [14.3%, 30.2%]; for ES-EDS: 26.8% [18.9%, 37.7%] vs. 18.3% [13.9%, 25.4%]; for TA-EDS: 19.1% [13.9%, 27.8%] vs. 14.3% [10.5%, 20.1%], P < 0.001). After treatment, the EDS in small vessels significantly decreased (P < 0.001). ED-EDS showed the highest correlation with pre-DCB DSP (r = 0.43, P < 0.001) and post-DCB MLD (r = 0.35, P < 0.001). The levels of EDS parameters for small or large vessel lesions significantly differed. Further study is required to examine the clinical value of EDS in predicting cardiac events after DCB treatment.