OCT-Derived Plaque Morphology and FFR-Determined Hemodynamic Relevance in Intermediate Coronary Stenoses.

Mariusz Tomaniak,Krzysztof P Malinowski,Janusz Kochman,Adam Rdzanek,Arkadiusz Pietrasik,Piotr Barus,Jakub Maksym,Martyna Zaleska,Łukasz Kołtowski,Grzegorz Opolski,Jacek Jąkała,Dorota Ochijewicz,Krzysztof J Filipiak,Tomasz Roleder,Magdalena Slezak

doi:10.3390/jcm10112379

Abstract

Background: optical coherence tomography (OCT) might allow identifying lesion features reportedly associated with plaque vulnerability and increased risk of clinical events. Previous studies on correlation between OCT and functional lesion significance indices reported contradictory results, yet integration of complementary information from both modalities is gaining increased interest. The aim of the study was to compare plaque morphology using OCT in hemodynamically relevant vs. non-relevant lesions by fractional flow reserve (FFR). Methods: consecutive patients with intermediate grade coronary stenoses by angiography were evaluated by both FFR and OCT in this single-center study. Stenoses were labeled hemodynamically relevant in case of the FFR ≤ 0.80. Minimal lumen area (MLA), fibrous cap thickness (FCT), minimal cap thickness over the calcium, angle of the calcium, and necrotic core within the lesions were evaluated. Results: a total of 105 patients (124 vessels) were analyzed. Of them, 65 patients were identified with at least one lesion identified as hemodynamically relevant by FFR (72 vessels, 58.1%). Lesions with FFR ≤0.80 presented with lower mean and minimal lumen area (3.46 ± 1.29 vs. 4.65 ± 2.19, p =0.001 and 1.84 ± 0.97 vs. 2.66 ± 1.40, p = 0.001) compared to patients with FFR > 0.80. No differences were found between groups in the mean and minimal FCT, mean, and maximal necrotic core, calcium angle, as well as the overall rate of calcified and lipid plaques. Conclusion: hemodynamic relevance of intermediate grade lesions correlated moderately with the luminal assessment by OCT. No differences were identified in the plaque morphology between relevant and non-relevant coronary stenoses by FFR.

Highlights

Fractional flow reserve (FFR) represents a guideline-recommended modality for functional assessment of intermediate grade coronary stenosis [1,2]
There is a substantial heterogeneity in the results of studies addressing correlation between FFR- and optical coherence tomography (OCT)-based quantitative and qualitative measurements [3,8,9,10]
We aimed to explore the association between FFR measurements and OCT-derived plaque characteristics by comparing plaque morphology using

Summary

Introduction

Fractional flow reserve (FFR) represents a guideline-recommended modality for functional assessment of intermediate grade coronary stenosis [1,2]. The ability of FFR to predict ischemia-related symptoms, and risk for acute coronary syndromes (ACS), often related to plaque rupture and/or erosion with subsequent coronary thrombosis, represents a subject of ongoing research [3,4,5]. Atherosclerotic plaques with large necrotic cores have been associated, with higher risk of rupture and cause ACS [6]. Emerging evidence suggests a relationship between plaque volume, atherosclerotic plaque characteristic, and the extent of ischemia, as assessed by FFR [4,5,7]. The relationship between FFR and OCT-detected plaque components, including features suggestive of plaque vulnerability and subsequent adverse clinical events, such as thin cap fibroatheroma (TCFA), remains not sufficiently understood [11,12,13]

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Discussion

Conclusion