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

2021 ◽  
Vol 10 (11) ◽  
pp. 2379
Author(s):  
Mariusz Tomaniak ◽  
Dorota Ochijewicz ◽  
Łukasz Kołtowski ◽  
Adam Rdzanek ◽  
Arkadiusz Pietrasik ◽  
...  
Keyword(s):  
Necrotic Core ◽  
Plaque Morphology ◽  
Lumen Area ◽  
Fractional Flow ◽  
Intermediate Grade ◽  
Fibrous Cap ◽  
Flow Reserve ◽  
Increased Risk ◽  
Minimal Lumen Area ◽  
Coronary Stenoses

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.

Abstract 1634: Validation of 64-Slice Multi-Detector Computed Tomography Coronary Angiography Against Invasive Hemodynamic Measurements of Fractional Flow Reserve in the Detection of Non-Flow-Limiting Coronary Stenoses

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Kamran Akram ◽  
Robert O’Donnell ◽  
Jennifer LaCorte ◽  
Charles Brown ◽  
Szilard Voros
Keyword(s):  
Coronary Angiography ◽  
Fractional Flow Reserve ◽  
Area Under The Curve ◽  
Fractional Flow ◽  
Flow Reserve ◽  
Minimal Lumen Area ◽  
Coronary Stenoses ◽  
Artery Disease ◽  
Sensitivity Specificity ◽  
Hemodynamic Measurements

Introduction. Multi-detector CT coronary angiography (CorCTA) has been introduced for coronary artery disease (CAD) detection and been validated against invasive angiography (XRA) and intravascular ultrasound (IVUS). However, the diagnostic accuracy of CorCTA-derived area stenosis (%AS), diameter stenosis (%DS), minimal lumen area (MLA) and minimal lumen diameter (MLD) have not been previously validated against fractional flow reserve (FFR). Methods. Twenty consecutive patients enrolled in a study of non-obstructive CAD underwent CorCTA and invasive FFR measurements within 2 weeks. Patients without prior CAD with visual intermediate stenoses (40–70%) by either XRA or CorCTA were eligible. CorCTA was performed on a 64-slice scanner. %AS, %DS, MLA and MLD were measured quantitatively with commercial software (SurePlaque; Vital Images). FFR was determined by averaging 3 independent measurements after intracoronary injection of adenosine. Statistical analysis was done using Analyse-It software. Results. CorCTA-derived values (mean±SD) in the group were as follows: %AS=43.8±21.3%, %DS=58.9±21.4%, MLA=3.9±3.0mm 2 , MLD=1.4±0.8mm, FFR=0.89±0.09. Two patients had flow-limiting stenoses by FFR. Table shows the area under the curve (AUC), optimal cutpoint, sensitivity, specificity, PPV and NPV for the parameters to predict non-flow-limiting FFR. All parameters performed well in predicting non-flow-limiting FFR as expressed by the AUC; these were highly significant. Values below stenosis cutpoints (%AS<60%, %DS<77%) and MLA>3.0 mm 2 , MLD>0.89 mm reliably excluded flow-limiting stenoses. Cutpoints were higher for %DS vs %AS (77% vs. 60%). Conclusions. To our knowledge, this is the first study to compare CorCTA to FFR. %AS, %DS, MLA and MLD performed very well in excluding hemodynamically significant stenoses. While%DS and MLD by CorCTA tend to overestimate the significance of stenosis, %AS and MLA correlate well to similar values derived from IVUS. Accuracy of CorCTA in Excluding Flow Limiting Stenoses As Measured by FFR

NEW CUT-OFF VALUE OF IVUS MINIMAL LUMEN AREA (MLA) AND FRACTIONAL FLOW RESERVE (FFR) TO DEFINE THE FUNCTIONAL SIGNIFICANCE OF DENOVO INTERMEDIATE CORONARY STENOSIS

2015 ◽  
pp. 11-19
Author(s):  
Minh Hung Ngo ◽  
Anh Tien Hoang ◽  
Cuu Long Nguyen ◽  
Thanh Nhan Vo ◽  
Phan Tuong Quynh Le ◽  
...  
Keyword(s):  
Intravascular Ultrasound ◽  
Fractional Flow Reserve ◽  
Functional Significance ◽  
Coronary Stenosis ◽  
Lumen Area ◽  
Plaque Volume ◽  
Fractional Flow ◽  
Flow Reserve ◽  
Minimal Lumen Area ◽  
Study Results

Background: Intravascular Ultrasound (IVUS) is a supportive tool for coronary angiography in evaluating intermediate coronary lesions. However, old cut-off value of 4mm2 of IVUS Minimal Lumen Area (MLA) has been proved very low diagnosic accuracy. Objective: We aimed to assess a new cut-off value of IVUS MLA and its diagnostic performance to predict ischemia, using fractional flow reserve (FFR) as gold standard. Methods: Denovo Intermediate lesions were evaluated with both IVUS and FFR. A total of 32 lesions were enrolled into the study. Results: Thirty two patients, who had denovo intermediate lesions distributing at prox-mid segment of RCA (31.3%), LAD (59.4%) and LCx (6.2%), were enrolled into this study, with average age: 63.97±11.59 (years), male: 71.9% and female: 28.1%, mean diameter stenosis: 50.68% ± 8.83 and mean reference diameter: 2.99 mm ± 0.61mm. IVUS MLA (r = 0.386, p < 0.014) correlated with FFR. The stenotic diameter (r = -0.159, p < 0.192), the length (r = -0.052, p = 0.389) and the plaque volume (r = -0.105, p = 0.284) didn’t well correlate with FFR. Best cut-off value (BCV) of IVUS MLA to define the functional significance (FFR ≤0.8) was 2.55 mm2 (AUC 0.776; 95% CI 0.607-0.946) with sensitivity and specitivity were 66.7% and 88.2% respectively. Conclusion: In this study, an IVUS MLA of 2.55 mm2 was the BCV to define the functional significance of denovo intermediate coronary stenosis. However, when IVUS MLA is used to determine the functional significance, both the lesion diameter and length should be considered. Key words: intermediate lesion, intravascular ultrasound (IVUS), Fractional Flow Reserve (FFR)

scholarly journals Semi-quantitative Analysis of Adenosine Perfusion Magnetic Resonance Imaging Outperforms Visual Analysis in Identifying Fractional Flow Reserve-Altered Intermediate-grade Coronary Artery Stenosis: A Pilot Study

2021 ◽  
Author(s):  
Olivier Ghekiere ◽  
Jean-Nicolas Dacher ◽  
Willem Dewilde ◽  
Wilfried Cools ◽  
Paul Dendale ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Visual Analysis ◽  
Remote Myocardium ◽  
Perfusion Magnetic Resonance Imaging ◽  
Resonance Imaging ◽  
Fractional Flow ◽  
Intermediate Grade ◽  
Flow Reserve ◽  
Coronary Stenoses ◽  
Adenosine Perfusion

Abstract PurposeTo evaluate the diagnostic accuracy of semi-quantitative adenosine perfusion magnetic resonance imaging(MRI) to determine fractional flow reserve(FFR)≤0.80 intermediate-grade coronary stenoses as compared to visual analysis.Methods Forty-six patients (mean age 61±9 years;33 males) with 49 intermediate-grade stenoses underwent adenosine perfusion MRI and FFR measurement within 4 months between 2010 and 2013. Retrospective interpretation of all prospectively acquired data was performed. MRI was visually assessed by 2 experienced readers twice with one-year interval, the second time with the knowledge of the diseased artery. All myocardial enhancement maximal upslopes were evaluated distal to the coronary stenosis (=RISK) and in remote myocardium supplied by normal arteries (=REMOTE); stress subendocardial relative myocardial perfusion index (RMPI; RISK/REMOTE upslopes) was assessed in predicting FFR≤0.80 stenoses. Deep learning boosting models including all RISK and REMOTE upslopes were fitted to confirm the added value of accounting for perfusion changes in remote myocardium for FFR prediction. Results The average FFR value was 0.84±0.09 and 15/49 (31%) stenoses were FFR≤0.80. Both readers had moderate accuracy (range: 36/49(73%)-38/49(78%)) in predicting FFR≤0.80 stenoses, even with the knowledge of the stenosis location. At a cutoff value of 0.84, stress subendocardial RMPI had higher accuracy (43/49(88%)) than individual visual readings to predict FFR≤0.80 stenoses. The best FFR prediction using the boosting model occurred when accounting for REMOTE myocardial perfusion parameters, leading to diagnostic accuracy of 44/49(90%) for FFR≤0.80. Conclusion Semi-quantitative adenosine perfusion MRI accounting for stress perfusion in remote myocardium predicts FFR≤0.80 intermediate-grade coronary stenoses with a higher accuracy than individual visual analysis.

scholarly journals DIAGNOSTIC ACCURACY OF INTRAVASCULAR ULTRASOUND DERivED MINIMAL LUMEN AREA COMPARED TO FRACTIONAL FLOW RESERVE: META–ANALYSIS

2013 ◽  
Vol 61 (10) ◽  
pp. E1768
Author(s):  
Bruno Ramos Nascimento ◽  
Marcos Roberto de Sousa ◽  
Bon Kwon Koo ◽  
Habib Samady ◽  
Hiram Bezerra ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Intravascular Ultrasound ◽  
Fractional Flow Reserve ◽  
Meta Analysis ◽  
Lumen Area ◽  
Fractional Flow ◽  
Flow Reserve ◽  
Minimal Lumen Area

Abstract 102: Cd98 Modulates Atherosclerotic Plaque Morphology by Regulating Smooth Muscle Cell Proliferation via the P-38 Map Kinase Pathway

2015 ◽  
Vol 35 (suppl_1) ◽  
Author(s):  
Sara McCurdy ◽  
Yvonne Baumer ◽  
Franz Hess ◽  
William A Boisvert
Keyword(s):  
Cell Proliferation ◽  
Smooth Muscle ◽  
Smooth Muscle Cells ◽  
Smooth Muscle Cell ◽  
Atherosclerotic Plaque ◽  
Necrotic Core ◽  
Plaque Morphology ◽  
Fibrous Cap ◽  
Plaque Area

Smooth muscle cells (SMC) are known to migrate and proliferate to form a stabilizing fibrous cap that encapsulates atherosclerotic plaques. It has been shown that CD98hc, a transmembrane protein with a known role in amino acid transport and integrin signaling, is involved in proliferation and survival of various cell types including SMC. Based on these data, we hypothesized that CD98hc deficiency selectively in SMC would have pathogenic effects on atherosclerosis development and plaque composition. To test this, we utilized mice with SMC-specific deletion of the CD98hc ( CD98hc fl/fl SM22Cre + ) to determine the effects of CD98hc deficiency on SMC function in the context of atherosclerosis. We performed in vitro proliferation and survival/apoptosis assays to investigate the role of CD98hc in the proliferation and survival of primary mouse aortic vascular smooth muscle cells. We found that VSMC isolated from whole aortas of CD98hc -/- animals displayed approximately 60% reduced cell counts compared to control (41 ± 8.2% of control) after 5 days in culture. EdU assays in vivo showed a defect in the ability of CD98hc -/- SMC to proliferate, with 25% reduction in EdU-positive VSMC compared to controls (2.3 ± 0.2% vs 3 ± 0.2%). In addition, caspase-3 staining of SMC in vitro displayed a 41% increase in propensity of CD98hc -/- SMC to undergo apoptosis compared to controls (7.9 ± 0.6% vs 5.6 ± 0.5%). Furthermore, the absence of CD98hc in SMC caused a sharp increase in phosphorylated p-38, which was partially abrogated towards control levels when the cells were treated with PDGF-BB to induce proliferation. Long-term atherosclerosis study using SMC-CD98hc -/- /LDLR -/- mice showed that atherosclerotic plaque morphology was altered with increased necrotic core area (25.8 ± 1.9% vs 10.9 ± 1.6% necrotic core area per plaque area) due to a reduction in infiltration of SMC within the plaque (2.1 ± 0.4% vs 4.3 ± 0.4% SM22α positive area per plaque area) compared to control LDLR -/- mice. These data support an important role for CD98hc and its regulation of p-38 MAP kinase signaling in aortic vascular smooth muscle cell proliferation and survival. We conclude that CD98hc is critical for the formation of fibrous cap that is important in maintaining the stability of atherosclerotic plaque.

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