Plaque Morphology Could Modify Functional Measurements

The vulnerable features of plaque are independently associated to functional measurements done under hyperemia far better than baseline measurements such as iFR. These findings suggest that not only stenosis severity but also plaque features contribute to functional measurements. 

La morfología de la placa podría modificar las mediciones funcionales

This is a sub-study of the PACIFIC (Prospective Comparison of Cardiac PET/CT, SPECT/CT Perfusion Imaging and CT Coronary Angiography with Invasive Coronary Angiography) which explores the impact of vulnerable plaque by CT on both hyperemic and non-hyperemic flow indices. Vulnerable plaque morphology by CT affects FFR measurements, which has been associated to imminent acute coronary syndrome. 

Instantaneous wave-free ratio (iFR) has recently emerged as an alternative to FFR and has been shown as good, even better, in most plaques, even though we know little about this equivalence in plaques with special risk characteristics. 


Read also: 16 Years of Superiority of Primary Angioplasty.


The study prospectively assessed 257 vessels in 120 patients with suspected coronary artery disease. All patients received 256-slice coronary CT angiography to assess lesion severity and plaque characteristics. Positive remodeling, low attenuation plaque, spotty calcification and napkin ring sign were considered signs of vulnerable plaque by CT. All these plaques were assessed by FFR and iFR, including iFRa (during adenosine). 

On a per vessel basis, significant luminal stenosis corresponded to low FFR, iFR and iFRa measurements. Multivariable analysis showed both FFR and iFR were associated with ≥ 70% stenosis (p<0.001 y p=0.003, respectively).


Read also: Virtual ACC 2020 | More Evidence in Support of the Demanding 2017 Hypertension Guidelines.


Vulnerable morphology was independently associated to abnormal FFR but not to iFR.

Conclusion

Vulnerable morphology of plaques by CT is associated to indices measured during hyperemia such as FFR but not to those done without adenosine such as iFR. These findings should be validated and suggest that not only stenosis severity but also plaque features contribute to functional measurements. 

Original Title: Adverse Plaque Characteristics Relate More Strongly With Hyperemic Fractional Flow Reserve and Instantaneous Wave-Free Ratio Than With Resting Instantaneous Wave-Free Ratio.

Reference: Roel S. Driessen et al. J Am Coll Cardiol Img 2020, article in press.


Subscribe to our weekly newsletter

Get the latest scientific articles on interventional cardiology

We are interested in your opinion. Please, leave your comments, thoughts, questions, etc., below. They will be most welcome.

More articles by this author

Unplanned Coronary Angiography After TAVR: Incidence, Predictors, and Outcomes

The importance of assessing coronary artery disease in patients undergoing transcatheter aortic valve replacement (TAVR) is well recognized due to the high prevalence of...

Intravascular Lithotripsy in Calcified Coronary Lesions: Success Predictors

Coronary artery calcification (CAC) is increasingly common in patients undergoing percutaneous coronary intervention (PCI). Intravascular lithotripsy (IVL) has been established as an effective tool...

FLAVOUR Trial Substudy: FFR or IVUS in the Assessment of Diabetic Patients

Patients with diabetes often present with more complex coronary artery disease compared to non-diabetic patients, with a higher prevalence of diffuse or multivessel disease....

Mechanical Circulatory Support in Complex Anatomies and Severe Deterioration of Left Ventricular Function

Severe coronary artery disease (CAD) frequently causes left ventricular function deterioration, and is often treated with myocardial revascularization surgery (CABG), especially when ejection fraction...

LEAVE A REPLY

Please enter your comment!
Please enter your name here

Related Articles

SOLACI Sessionsspot_img

Recent Articles

Unplanned Coronary Angiography After TAVR: Incidence, Predictors, and Outcomes

The importance of assessing coronary artery disease in patients undergoing transcatheter aortic valve replacement (TAVR) is well recognized due to the high prevalence of...

Intravascular Lithotripsy in Calcified Coronary Lesions: Success Predictors

Coronary artery calcification (CAC) is increasingly common in patients undergoing percutaneous coronary intervention (PCI). Intravascular lithotripsy (IVL) has been established as an effective tool...

TAVR Unload: TAVR in Moderate Aortic Stenosis and Ventricular Function Deterioration

Aortic Stenosis (AS) significantly contributes to valvulo-arterial impedance in patients with heart failure and reduced ejection fraction (HFrEF), making it a relevant therapeutic target...