Reactive myocardial hyperaemia for functional assessment of coronary stenosis severity

Backgrounds: The aim of the present study is to investigate the relationship between physiological coronary artery stenosis severity and lesion instability by Optical Coherence Tomography (OCT) in patients with stable angina pectoris (SAP). Methods and Results: We investigated 198 culprit lesions of 180 SAP patients who underwent OCT imaging and fractional flow reserve (FFR) measurement before PCI procedure. Physiological coronary stenosis severity was assessed by FFR analysis, and lesions were divided into two groups on the basis of FFR values; severe stenosis group (group S): FFR <0.75 (n=78, 39%), moderate stenosis group (group M): FFR ≥0.75 (n=120, 61%) according to the previous study. Thin-capped fibroatheroma (TCFA) was defined as lipid-rich plaque (lipid arc ≥90°) with fibrous cap thickness <70μm. The median FFR values in total lesions, group S, and group M were 0.77 (interquartile range [IQR]: 0.69—0.83), 0.65 (0.57—0.72), and 0.81 (0.78—0.87), respectively. There were no significant differences in patient characteristics expect for the frequency of previous myocardial infarction (S: 15%, M: 38%, P <0.01) and previous PCI (S: 29%, M: 60%, P <0.01). In angiographic analysis, there were significant differences in the frequency of culprit lesion location in LAD (S: 72%, M: 49%, P <0.01), minimum lumen diameter (S: 1.07±0.36 mm, M: 1.35±0.32 mm, P <0.01), % diameter stenosis (S: 58.9 % [53.1—70.8], M: 52.8 % [47.7—57.5], P <0.01), and lesion length (S: 13.7 mm [10.6—17.5], M: 11.5 mm [9.2—14.5], P = 0.02) between the two groups. In OCT analysis, there were significant differences in the lipid arc (S: 200° [160—232], M: 168° [143—211], P <0.01), CT (S: 110 μm [63—157], M: 140 μm [93—197], P <0.01), and frequency of TCFA (S: 27%, M: 9%, P <0.01) between the two groups. Subgroup analysis of LAD lesions showed similar results between the two groups. Conclusions: Lesions of physiologically severe coronary stenosis in SAP were associated with lesion instability assessed by OCT. These findings may challenge the concept that lesions responsible for acute coronary syndromes are mild in most cases provided that plaque rupture of TCFA evenly results in coronary events in the wide range of stenosis severity in patients with SAP.

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Abstract P189: Factors Associated With Stenosis on Invasive Coronary Angiography for Persons Living With Human Immunodeficiency Virus (PLWH): The HIV Electronic Comprehensive Cohort of CVD Complications (HIVE-4CVD)

Circulation ◽

10.1161/circ.137.suppl_1.p189 ◽

2018 ◽

Vol 137 (suppl_1) ◽

Author(s):

Andrew Furman ◽

Robert Riestenberg ◽

Anna Pawlowski ◽

Daniel Schneider ◽

Donald M Lloyd-Jones ◽

...

Keyword(s):

Viral Load ◽

Coronary Angiography ◽

Coronary Stenosis ◽

Clinical Care ◽

Invasive Coronary Angiography ◽

Hiv Viral Load ◽

Cvd Risk ◽

Significant Difference ◽

Stenosis Severity ◽

Significant Coronary Stenosis

Background: Persons living with HIV (PLWH) have greater risks for atherosclerotic cardiovascular disease (ASCVD) than uninfected persons. However, data are sparse regarding HIV-specific factors associated with coronary atherosclerosis. Methods: HIVE-4CVD is an electronic data repository of demographic and clinical data collected during the routine clinical care of 5041 PLWH and 10082 uninfected controls frequency matched on age, sex, race, zip code, and clinic location receiving care at Northwestern Medicine from 1/1/2000 to 5/17/2017. Using validated natural language extraction algorithms, we analyzed data on coronary stenosis severity for the 286 PLWH and 266 uninfected controls in HIVE-4CVD who underwent coronary angiography. Stenosis severity was recorded as the highest percentage of stenosis noted for each patient in each artery (LAD, LCx, RCA). Multivariable logistic regression models adjusted for demographics and CVD risk factors were used to evaluate odds of significant (≥50%) coronary stenosis (1) for PLWH versus uninfected controls and (2) across different levels of HIV viremia and immune suppression among PLWH. Results: Of the 286 PLWH and 266 uninfected controls undergoing coronary angiography, 205 (55.4%) PLWH vs. 165 (44.6%) uninfected controls had diagnoses of myocardial infarction (p=0.02). The location and severity of coronary stenoses did not differ significantly for PLWH vs. uninfected controls; mean maximal overall stenosis and mean maximal LAD, RCA, and LCx stenoses were 52.3% vs. 50.2% (p=0.52), 44.5% vs. 42.3% (p=0.48), 37.0% vs. 36.1% (p=0.78) and 31.4% vs. 31.6% (p=0.95) respectively. There was no significant difference in odds of having significant coronary stenosis for PLWH vs. uninfected controls (multivariable-adjusted OR 1.15, 95% CI 0.79-1.70). Among PLWH, peak HIV viral load was associated with borderline significantly greater odds of ≥50% coronary stenosis after adjustment for demographics, CVD risk factors, and HIV therapies (OR 1.07 per 10-fold greater peak HIV viral load, 95% CI 1.00-1.14, p=0.04), but lower Nadir CD4+ T cell count (<200 vs. ≥200 cells/mm 3 ) was not (OR 1.05, 95% CI 0.74-1.48, p=0.79). Conclusions: There was no consistent or significant difference in severity of coronary artery stenosis among PLWH and uninfected controls undergoing invasive coronary angiography in the course of routine clinical care. Higher peak HIV viral load is associated with borderline significantly greater odds of having significant coronary stenosis among PLWH undergoing invasive coronary angiography.

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