糖尿病患者冠状动脉径向壁应变和非血流限制性狭窄的预后意义。

IF 11.7 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Cardiovascular interventions Pub Date : 2025-05-26 DOI:10.1016/j.jcin.2025.02.009

Zhiqing Wang MD, PhD , Elvin Kedhi MD, PhD , Xun Liu BSc , Chunming Li PhD , Jiayue Huang PhD , Jiaxin Zhong MM , Xinkai Qu MD , William Wijns MD, PhD , Shengxian Tu PhD , COMBINE OCT-FFR Study Group

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引用次数: 0

摘要

背景：冠状动脉径向壁应变（RWS）是一种具有预后意义的易损斑块鉴别新方法。目的：本研究旨在评估RWS与光学相干断层扫描检测易损特征（OCT-VFs）相比对非血流限制性冠状动脉狭窄糖尿病患者预后的影响。方法：这是对COMBINE OCT-FFR数据集的事后分析。主要终点为病灶导向复合终点（LOCE），即心源性死亡、靶血管相关性心肌梗死和临床驱动靶病变血运重建的复合终点。结果：对366例患者的435个符合条件的非血流限制病变进行了RWS评估。病变水平的最大RWS可预测任何OCT-VFs的病变(曲线下面积：0.630 [95% CI: 0.571-0.688]；P < 0.001)。中位随访时间为3.2年（Q1-Q3: 2.2-4.1年）。在预先设定的临界值≥13.0%时，LOCE的发生率为17.0% (15/88；95% CI: 9.0%-25.1%) vs 6.8% (19/278；rws阴性患者的95% CI: 3.8%-9.8%) (HR: 2.70；95% ci: 1.37-5.32；p = 0.004)。阳性RWS预测LOCE独立于任何OCT-VFs(直接效应β = 0.099 [95% CI: 0.029-0.168]；p = 0.006；间接影响β= 0.004(95%置信区间CI: -0.008 - 0.015);p = 0.555；中介比例3.9% [95% CI: -5.0% ~ 20.3%])。在OCT-VFs中加入RWS主要改善了低风险层LOCE的再分类(正的连续净再分类改善[cNRI] -0.060 [95% CI: -0.420至0.318]；p = 0.749；负cNRI 0.583 [95% CI: 0.474-0.681]；P < 0.001；综合鉴别改善0.066 [95% CI: 0.013-0.182]；p = 0.010)。结论：对于非血流限制性狭窄的糖尿病患者，RWS可以帮助OCT-VFs定位狭窄。RWS预测LOCE的风险增加，既独立于oct - vfs，也逐渐超出oct - vfs。联合光学相干断层扫描形态学和分数血流储备血流动力学评估非罪魁祸首病变更好地预测糖尿病患者不良事件结局[联合OCT-FFR]；NCT02989740)。

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Prognostic Implications of Angiographically Derived Coronary Radial Wall Strain in Diabetic Patients and Non–Flow-Limiting Stenosis

Background

Coronary radial wall strain (RWS) represents a novel approach enabling discrimination of vulnerable plaques with prognostic significance.

Objectives

This study sought to evaluate the prognostic impact of RWS in diabetic patients with non–flow-limiting coronary stenosis when compared with optical coherence tomography-detected vulnerability features (OCT-VFs).

Methods

This was a post hoc analysis of the COMBINE OCT-FFR dataset. The primary endpoint was lesion-oriented composite endpoint (LOCE), a composite of cardiac death, target vessel-related myocardial infarction, and clinically driven target lesion revascularization.

Results

RWS was assessed in 435 eligible non–flow-limiting lesions from 366 patients. Lesion-level maximal RWS was predictive of lesions with any OCT-VFs (area under the curve: 0.630 [95% CI: 0.571-0.688]; P < 0.001). The median follow-up was 3.2 years (Q1-Q3: 2.2-4.1 years). With a prespecified cutoff of ≥13.0%, the incidence of LOCE was 17.0% (15/88; 95% CI: 9.0%-25.1%) in RWS-positive vs 6.8% (19/278; 95% CI: 3.8%-9.8%) in RWS-negative patients (HR: 2.70; 95% CI: 1.37-5.32; P = 0.004). Positive RWS predicted LOCE independently from any OCT-VFs (direct effect β = 0.099 [95% CI: 0.029-0.168]; P = 0.006; indirect effect β = 0.004 [95% CI: −0.008 to 0.015]; P = 0.555; mediation proportion 3.9% [95% CI: −5.0% to 20.3%]). Adding RWS to any OCT-VFs mainly improved the reclassification for LOCE in the lower-risk strata (positive continuous net reclassification improvement [cNRI] −0.060 [95% CI: −0.420 to 0.318]; P = 0.749; negative cNRI 0.583 [95% CI: 0.474-0.681]; P < 0.001; integrated discrimination improvement 0.066 [95% CI: 0.013-0.182]; P = 0.010).

Conclusions

In diabetic patients with non–flow-limiting stenosis, RWS can help to localize stenoses with OCT-VFs. RWS predicts increased risk for LOCE, both independently from—and incrementally beyond—OCT-VFs. (Combined Optical Coherence Tomography Morphologic and Fractional Flow Reserve Hemodynamic Assessment of Non-Culprit Lesions to Better Predict Adverse Event Outcomes in Diabetes Mellitus Patients [COMBINE OCT-FFR]; NCT02989740)

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来源期刊

JACC. Cardiovascular interventions CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

11.60

自引率

8.80%

发文量

756

审稿时长

4-8 weeks

期刊介绍： JACC: Cardiovascular Interventions is a specialist journal launched by the Journal of the American College of Cardiology (JACC). It covers the entire field of interventional cardiovascular medicine, including cardiac, peripheral, and cerebrovascular interventions. The journal publishes studies that will impact the practice of interventional cardiovascular medicine, including clinical trials, experimental studies, and in-depth discussions by respected experts. To enhance visual understanding, the journal is published both in print and electronically, utilizing the latest technologies.