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Integrated Photoacoustic Ophthalmoscopy and Spectral-domain Optical Coherence Tomography
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Optical Coherence Tomography-Defined Plaque Vulnerability in Relation to Functional Stenosis Severity and

Eisuke Usui1, Taishi Yonetsu2, Yoshihisa Kanaji2

  • 1Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Tsuchiura, Ibaraki, Japan; Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan.

JACC. Cardiovascular Interventions
|October 20, 2018
PubMed
Summary

Unstable plaque features like thin-cap fibroatheroma (TCFA) are linked to microvascular dysfunction, not lesion severity. Higher index of microcirculatory resistance (IMR) indicates more TCFAs, while fractional flow reserve (FFR) is an independent predictor.

Keywords:
coronary artery diseasefractional flow reservemicrovascular dysfunctionoptical coherence tomographystenosis severity

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Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Vascular Biology

Background:

  • Epicardial lesion severity and microvascular dysfunction are critical determinants of adverse clinical outcomes.
  • Understanding the interplay between plaque characteristics and physiological measures is essential for risk stratification.

Purpose of the Study:

  • To investigate the relationship between unstable plaque features, assessed by optical coherence tomography (OCT), and physiological lesion severity (fractional flow reserve, FFR) and microvascular dysfunction (index of microcirculatory resistance, IMR).

Main Methods:

  • 382 intermediate-to-severe coronary lesions in 340 patients were analyzed using OCT, FFR, and IMR.
  • Lesions were stratified into tertiles based on FFR (<0.74, 0.74–0.81, >0.81) and IMR (≥25, 15–25, ≤15).
  • OCT findings, including thin-cap fibroatheroma (TCFA) and ruptured plaque, were compared across FFR and IMR tertiles.

Main Results:

  • No significant correlation was found between FFR and IMR.
  • Prevalence of TCFA and ruptured plaque was significantly higher in the highest IMR tertile (IMR-T1) compared to lower tertiles.
  • While TCFA prevalence differed across FFR tertiles, no pairwise comparisons were significant.
  • Multivariate analysis identified FFR and IMR as independent predictors of TCFA prevalence.

Conclusions:

  • Lower FFR and higher IMR are independent predictors of TCFA presence in intermediate-to-severe coronary lesions.
  • Microvascular dysfunction, indicated by higher IMR, is more strongly associated with unstable plaque features than epicardial lesion severity (FFR).