Predictors for Vulnerable Plaque in Functionally Significant Lesions

IF 12.8 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Cardiovascular imaging Pub Date : 2024-09-11 DOI:10.1016/j.jcmg.2024.07.021

Seokhun Yang MD, Doyeon Hwang MD, Koshiro Sakai MD PhD, Takuya Mizukami MD PhD, Jonathon Leipsic MD, Marta Belmonte MD, Jeroen Sonck MD PhD, Bjarne L. Nørgaard MD PhD, Hiromasa Otake MD PhD, Brian Ko MD PhD, Michael Maeng MD PhD, Jesper Møller Jensen MD PhD, Dimitri Buytaert MSc, Daniel Munhoz MD PhD, Daniele Andreini MD PhD, Hirofumi Ohashi MD PhD, Toshiro Shinke MD PhD, Charles A. Taylor PhD, Emanuele Barbato MD PhD, Bernard De Bruyne MD PhD, Carlos Collet MD PhD, Bon-Kwon Koo MD PhD

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Abstract

Vulnerable plaque presents prognostic implications in addition to functional significance. The aim of this study was to identify relevant features of vulnerable plaque in functionally significant lesions. In this multicenter, prospective study conducted across 5 countries, including patients who had invasive fractional flow reserve (FFR) ≤0.80, a total of 95 patients with available pullback pressure gradient (PPG) and plaque analysis on coronary computed tomographic angiography and optical coherence tomography were analyzed. Vulnerable plaque was defined as the presence of plaque rupture or thin-cap fibroatheroma on optical coherence tomography. Among the 25 clinical characteristics, invasive angiographic findings, physiological indexes, and coronary computed tomographic angiographic findings, significant predictors of vulnerable plaque were identified. Mean percentage diameter stenosis, FFR, and PPG were 77.8% ± 14.6%, 0.66 ± 0.13, and 0.65 ± 0.13, respectively. Vulnerable plaque was present in 53 lesions (55.8%). PPG and FFR were identified as significant predictors of vulnerable plaque ( 0.05 for all). PPG >0.65 and FFR ≤0.70 were significantly related to a higher probability of vulnerable plaque after adjustment for each other (OR: 6.75 [95% CI: 2.39-19.1]; 0.001] for PPG >0.65; OR: 4.61 [95% CI: 1.66-12.8]; 0.003 for FFR ≤0.70). When categorizing lesions according to combined PPG >0.65 and FFR ≤0.70, the prevalence of vulnerable plaque was 20.0%, 57.1%, 66.7%, and 88.2% in the order of PPG ≤0.65 and FFR >0.70, PPG ≤0.65 and FFR ≤0.70, PPG >0.65 and FFR >0.70, and PPG >0.65 and FFR ≤0.70 ( for trend < 0.001), respectively. Among low-FFR lesions, the presence of vulnerable plaque can be predicted by PPG combined with FFR without additional anatomical or plaque characteristics. (Precise Percutaneous Coronary Intervention Plan [P3] Study; )

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功能性病变中易受损斑块的预测因素

易损斑块除了具有功能意义外，还对预后有影响。本研究旨在确定功能性病变中易受损斑块的相关特征。在这项横跨 5 个国家的多中心前瞻性研究中，包括侵入性分数血流储备（FFR）≤0.80 的患者，共分析了 95 名有回拉压力梯度（PPG）和冠状动脉计算机断层扫描血管成像及光学相干断层扫描斑块分析的患者。易损斑块的定义是在光学相干断层扫描中出现斑块破裂或薄帽纤维血管瘤。在 25 项临床特征、有创血管造影结果、生理指标和冠状动脉计算机断层扫描血管造影结果中，确定了易损斑块的重要预测因素。平均直径狭窄百分比、FFR和PPG分别为77.8%±14.6%、0.66±0.13和0.65±0.13。53个病变（55.8%）存在易损斑块。PPG 和 FFR 被确定为易损斑块的重要预测因子（均为 0.05）。经相互调整后，PPG >0.65 和 FFR ≤0.70 与较高的易损斑块概率显著相关（PPG >0.65 OR：6.75 [95% CI：2.39-19.1]；0.001]；FFR ≤0.70 OR：4.61 [95% CI：2.39-19.1]；0.001]）：4.61[95%CI：1.66-12.8]；FFR ≤0.70：0.003）。如果根据合并的 PPG >0.65 和 FFR ≤0.70 对病变进行分类，易损斑块的发生率依次为 PPG ≤0.65 和 FFR >0.70、PPG ≤0.65 和 FFR ≤0.70、PPG >0.65 和 FFR >0.70、PPG >0.65 和 FFR ≤0.70，分别为 20.0%、57.1%、66.7% 和 88.2%（趋势 < 0.001）。在低FFR病变中，PPG结合FFR可预测是否存在易损斑块，而无需额外的解剖或斑块特征。(精确经皮冠状动脉介入计划 [P3] 研究；)

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

JACC. Cardiovascular imaging CARDIAC & CARDIOVASCULAR SYSTEMS-RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

CiteScore

24.90

自引率

5.70%

发文量

330

审稿时长

4-8 weeks

期刊介绍： JACC: Cardiovascular Imaging, part of the prestigious Journal of the American College of Cardiology (JACC) family, offers readers a comprehensive perspective on all aspects of cardiovascular imaging. This specialist journal covers original clinical research on both non-invasive and invasive imaging techniques, including echocardiography, CT, CMR, nuclear, optical imaging, and cine-angiography. JACC. Cardiovascular imaging highlights advances in basic science and molecular imaging that are expected to significantly impact clinical practice in the next decade. This influence encompasses improvements in diagnostic performance, enhanced understanding of the pathogenetic basis of diseases, and advancements in therapy. In addition to cutting-edge research,the content of JACC: Cardiovascular Imaging emphasizes practical aspects for the practicing cardiologist, including advocacy and practice management.The journal also features state-of-the-art reviews, ensuring a well-rounded and insightful resource for professionals in the field of cardiovascular imaging.