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Segmental assessments of coronary plaque morphology and composition by virtual histology intravascular ultrasound and fractional flow reserve

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Abstract

Fractional flow reserve (FFR) is an index for identifying functionally significant stenotic lesions. A FFR value of ≤0.75 is considered clinically significant and indicative of physiological ischemia. Focal lesions with 30–80 % stenosis by angiography with lesion lengths of less than 20 mm were selected from left anterior descending arteries of 74 patients. The analysis for the total lesion was processed first, and then each lesion was divided into three segments to assess the each segment. Data on plaque geometry and composition of two FFR groups, FFR ≤ 0.75 and FFR > 0.75, were compared by total and segmental analysis. Lesions with FFR ≤ 0.75 had more fibrofatty tissue (13.5 ± 7.4 vs. 10.2 ± 6.5 %, p = 0.05) and less dense calcium (7.2 ± 5.3 vs. 11.9 ± 7.5 %, p = 0.01) compared to lesions with FFR > 0.75. The content of necrotic core in mid segments was higher compared to proximal and distal segments (22.9 ± 10.6, 20.2 ± 10.9, 17.1 ± 11.2 %, respectively, p = 0.032) in lesions with FFR > 0.75 but the difference was less obvious in lesions with FFR ≤ 0.75 (17.9 ± 9.9, 18.7 ± 9.9, 15.8 ± 9.0 %, respectively, p = 0.533). Coronary lesions with FFR > 0.75 have larger content of dense calcium and slightly less fibrofatty tissue compared to lesions with FFR ≤ 0.75. While segmental plaque compositions for each segment show noticeable variations in lesions with FFR > 0.75 such as high concentrations of necrotic core in mid segment, these differences in each segment become obscure in FFR ≤ 0.75 and are evenly distributed across the lesion.

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Abbreviations

ACS:

Acute coronary syndrome

CaFA:

Calcified fibroatheroma

CaTCFA:

Calcified thin-cap fibroatheroma

DC:

Dense calcium

DS:

Diameter stenosis

FA:

Fibroatheroma

FF:

Fibrofatty tissue

FFR:

Fractional flow reserve

FC:

Fibrocalcific plaque

FI:

Fibrotic plaque

FT:

Fibrous tissue

LA:

Lumen area

LAD:

Left anterior descending

LL:

Lesion length

MACE:

Major adverse cardiac events

MLA:

Minimum lumen area

MLD:

Minimum lumen diameter

NC:

Necrotic core

PCI:

Percutaneous coronary intervention

PIT:

Pathological intimal thicknening

QCA:

Quantitative coronary angiography

ROC:

Receiver operating characteristic

RVD:

Reference vessel diameter

TCFA:

Thin-cap fibroatheroma

VH-IVUS:

Virtual histology intravascular ultrasound

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Authors and Affiliations

  1. Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea

    Ju-Hyun Chung, Soe Hee Ann, Gillian Balbir Singh & Eun-Seok Shin

  2. Department of Internal Medicine, Dongsan Medical Center, Keimyung University College of Medicine, Daegu, South Korea

    Chang-Wook Nam

  3. Division of Cardiology, Inje University Ilsan Paik Hospital, Goyang, South Korea

    Joon-Hyung Doh

  4. Suntech Research Center, Seoul, South Korea

    Hyung Il Kim

  5. Department of Internal Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea

    Bon-Kwon Koo

  6. Institute of Aging, Seoul National University, Seoul, South Korea

    Bon-Kwon Koo

Authors
  1. Ju-Hyun Chung
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  2. Soe Hee Ann
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  3. Gillian Balbir Singh
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  4. Chang-Wook Nam
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  8. Eun-Seok Shin
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Correspondence to Bon-Kwon Koo or Eun-Seok Shin.

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Chung, JH., Ann, S.H., Singh, G.B. et al. Segmental assessments of coronary plaque morphology and composition by virtual histology intravascular ultrasound and fractional flow reserve. Int J Cardiovasc Imaging 32, 373–380 (2016). https://doi.org/10.1007/s10554-015-0794-8

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  • DOI: https://doi.org/10.1007/s10554-015-0794-8

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