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Optical Coherence Tomography Based Biomechanical Fluid-Structure Interaction Analysis of Coronary Atherosclerosis Progression
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Measurement of Hyperemic Pullback Pressure Gradients to Characterize Patterns of Coronary Atherosclerosis

Carlos Collet1, Jeroen Sonck2, Bert Vandeloo3

  • 1Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium.

Journal of the American College of Cardiology
|October 5, 2019
PubMed

Insights

Coronary artery disease (CAD) patterns are better classified using fractional flow reserve (FFR) pullbacks, reclassifying one-third of vessels compared to angiography. A novel PPG index accurately distinguishes focal from diffuse CAD.

Area of Science:

  • Cardiovascular research
  • Medical imaging and diagnostics
  • Interventional cardiology

Background:

  • Diffuse atherosclerosis is common in stable coronary artery disease (CAD), even in angiographically normal segments.
  • Coronary physiology can evaluate epicardial resistance distribution along the vessel.

Purpose of the Study:

  • To characterize pathophysiological patterns of CAD using invasive pressure pullbacks during hyperemia.
  • To assess the utility of fractional flow reserve (FFR) pullbacks in identifying focal versus diffuse coronary artery disease.

Main Methods:

  • A prospective, multicenter study involving patients with stable angina undergoing coronary angiography.
  • Utilized a pressure-wire pullback device at 1 mm/s to generate FFR pullback curves.
  • Characterized epicardial resistance distribution using hyperemic pullback pressure gradients (PPGs) and computed a PPG index.

Main Results:

  • 36% of vessel disease patterns were reclassified compared to conventional angiography using coronary physiology.
  • The PPG index effectively differentiated pathophysiological focal and diffuse CAD (p < 0.001).
  • A novel PPG index quantified epicardial resistance distribution, with lower values indicating diffuse CAD.

Conclusions:

  • Motorized hyperemic PPGs can characterize pathophysiological patterns of CAD.
  • FFR pullback curve evaluation reclassified one-third of vessels compared to angiography.
  • The PPG index is a novel metric for quantifying epicardial resistance and discriminating focal from diffuse CAD.
Abstract

Keywords:
coronary artery diseasecoronary physiologyfractional flow reservepullback

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