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Morphology of coronary artery lesions assessed by virtual histology intravascular ultrasound tissue characterization and fractional flow reserve

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Abstract

Fractional flow reserve (FFR) is an index of the physiological significance of a coronary stenosis. Patients who have lesions with a FFR of >0.80, even optimally treated with medication, have however a MACE rate ranging from 8 to 21%. Coronary plaques at high risk of rupture and clinical events can be also identified by virtual histology intravascular ultrasound (IVUS-VH) as plaques with high amount of necrotic core (NC) abutting the lumen. Aim of this exploratory study was to investigate whether the geometry and composition of lesions with FFR ≤ 0.80 were different from their counterparts. Fifty-five consecutive patients in whom FFR was clinically indicated on a moderate angiographic lesion, received also an imaging investigation on the same lesion with IVUS-VH. Data on plaque geometry and composition was analyzed. Patients were subdivided in two groups according to the value of FFR (> or ≤0.80). Lesions with a FFR ≤ 0.80 (n = 17) showed a slightly larger plaque burden than those with FFR > 0.80 (n = 38) (54.6 ± 0.7% vs. 51.7 ± 0.7% P = 0.1). In addition, they tend to have less content of necrotic core than their counterparts (14.2 ± 8% vs. 19.2 ± 10.2%, P = 0.08). No difference was found in the distribution of NC-rich plaques (fibroatheroma and thin-capped fibroatheroma) between groups (82% in FFR ≤ 0.80 vs. 79% in FFR > 0.80, P = 0.5). Although FFR ≤ 0.80 lesions have larger plaque size, they do not differ in composition from the ones with FFR > 0.80. Further exploration in a large prospective study is needed to study whether the lesions with FFR > 0.80 that are NC rich are the ones associated with the presence of clinical events at follow-up.

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Authors and Affiliations

  1. Z120, Thoraxcentre, Erasmus MC, ‘s-Gravendijkwal 230, 3015, CE Rotterdam, The Netherlands

    Salvatore Brugaletta, Hector M. Garcia-Garcia, Zhu Jun Shen, Josep Gomez-Lara, Roberto Diletti, Giovanna Sarno & Patrick W. Serruys

  2. Department of Cardiology, Thorax Institute, Hospital Clinic, Barcelona, Spain

    Salvatore Brugaletta

  3. Cardialysis BV, Rotterdam, The Netherlands

    Hector M. Garcia-Garcia

  4. Hospital Clinico, Madrid, Spain

    Nieves Gonzalo & Fernando Alfonso

  5. Cardiovascular Center, Aalst, Belgium

    William Wijns & Bernard de Bruyne

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  1. Salvatore Brugaletta
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Correspondence to Hector M. Garcia-Garcia.

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Brugaletta, S., Garcia-Garcia, H.M., Shen, Z.J. et al. Morphology of coronary artery lesions assessed by virtual histology intravascular ultrasound tissue characterization and fractional flow reserve. Int J Cardiovasc Imaging 28, 221–228 (2012). https://doi.org/10.1007/s10554-011-9816-3

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