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In-stent fractional flow reserve variations and related optical coherence tomography findings: the FFR–OCT co-registration study

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Abstract

We sought to assess in-stent variations in fractional flow reserve (FFR) in patients with previous percutaneous coronary intervention (PCI) and to associate any drop in FFR with findings by optical coherence tomography (OCT) imaging. Suboptimal post-PCI FFR values were previously associated with poor outcomes. It is not known to which extent in-stent pressure loss contributes to reduced FFR. In this single-arm observational study, 26 patients who previously underwent PCI with drug-eluting stent or scaffold implantation were enrolled. Motorized FFR pullback during continuous intravenous adenosine infusion and OCT assessments was performed. Post-PCI FFR < 0.94 was defined as suboptimal. At a median of 63 days after PCI (interquartile range: 59–64 days), 18 out of 26 patients (72%) had suboptimal FFR. The in-stent drop in FFR was significantly higher in patients with suboptimal FFR vs. patients with optimal FFR (0.08 ± 0.07 vs. 0.01 ± 0.02, p < 0.001). Receiver operating characteristic curve analysis showed that an in-stent FFR variation of > 0.03 was associated with suboptimal FFR. In patients with suboptimal FFR, the OCT analyses revealed higher mean neointimal area (respectively: 1.06 ± 0.80 vs. 0.51 ± 0.23 mm2; p = 0.018) and higher neointimal thickness of covered struts (respectively 0.11 ± 0.07 vs. 0.06 ± 0.01 mm; p = 0.021). Suboptimal FFR values following stent-implantation are mainly caused by significant in-stent pressure loss during hyperemia. This finding is associated to a larger neointimal proliferation.

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Acknowledgements

The authors of the study are grateful to Medis Medical Imaging Systems bv for supplying the specialized software used in this study.

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Authors and Affiliations

  1. Cardiovascular Research Center Aalst, OLV Clinic, Aalst, Belgium

    Stylianos A. Pyxaras, Emanuele Barbato, Luigi Di Serafino, Frederic De Vroey & William Wijns

  2. I Medizinische Klinik, Landshut-Achdorf Hospital, Landshut, Germany

    Stylianos A. Pyxaras

  3. Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium

    Tom Adriaenssens & Giovanni Jacopo Ughi

  4. Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium

    Tom Adriaenssens & Giovanni Jacopo Ughi

  5. University Heart Center Graz, Graz, Austria

    Gabor Toth

  6. Division of Image Processing, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands

    Shengxian Tu & Johan H. C. Reiber

  7. School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China

    Shengxian Tu

  8. Department of Cardiology, Heart & Lung Center, Leiden University Medical Center, Leiden, The Netherlands

    Jeroen J. Bax

  9. The Lambe Institute for Translational Medicine and Curam, National University of Ireland, Galway, University Road, Galway, Ireland

    William Wijns

  10. Saolta University Healthcare Group, Galway, Ireland

    William Wijns

Authors
  1. Stylianos A. Pyxaras
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  2. Tom Adriaenssens
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  3. Emanuele Barbato
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  4. Giovanni Jacopo Ughi
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  5. Luigi Di Serafino
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  6. Frederic De Vroey
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  7. Gabor Toth
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  8. Shengxian Tu
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  9. Johan H. C. Reiber
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  10. Jeroen J. Bax
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  11. William Wijns
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Corresponding author

Correspondence to William Wijns.

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Conflict of interest

Shengxian Tu received a research grant support from Medis Medical Imaging Systems bv. Johan H. C. Reiber is the CEO of Medis Medical Imaging Systems bv, and has a part-time appointment at LUMC as Professor of Medical Imaging. William Wijns is co-founder and non-executive board member of Argonauts. Stylianos Pyxaras has received consultancy fees from St. Jude Medical; he received an unrestricted educational EAPCI training grant from Medtronic in 2013. Cardiovascular Research Center Aalst has received institutional grants from various device companies, including St. Jude Medical, Terumo and Tryton Medical.

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Pyxaras, S.A., Adriaenssens, T., Barbato, E. et al. In-stent fractional flow reserve variations and related optical coherence tomography findings: the FFR–OCT co-registration study. Int J Cardiovasc Imaging 34, 495–502 (2018). https://doi.org/10.1007/s10554-017-1262-4

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  • DOI: https://doi.org/10.1007/s10554-017-1262-4

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