Radial wall strain: a novel angiographic measure of plaque composition and vulnerability

The lipid-to-cap ratio (LCR) and thin-cap fibroatheroma (TCFA) derived from optical coherence tomography (OCT) are indicative of plaque vulnerability.

We aimed to explore the association of a novel method to estimate radial wall strain (RWS) from angiography with plaque composition and features of vulnerability assessed by OCT.

Anonymised data from patients with intermediate stenosis who underwent coronary angiography (CAG) and OCT were analysed in a core laboratory. Angiography-derived RWS_max was computed as the maximum deformation of lumen diameter throughout the cardiac cycle, expressed as a percentage of the largest lumen diameter. The LCR and TCFA were automatically determined on OCT images by a recently validated algorithm based on artificial intelligence.

OCT and CAG images from 114 patients (124 vessels) were analysed. The average time for the analysis of RWS_max was 57 (39-82) seconds. The RWS_max in the interrogated plaques was 12% (10-15%) and correlated positively with the LCR (r=0.584; p<0.001) and lipidic plaque burden (r=0.411; p<0.001), and negatively with fibrous cap thickness (r= -0.439; p<0.001). An RWS_max >12% was an angiographic predictor for an LCR >0.33 (area under the curve [AUC]=0.86, 95% confidence interval [CI]: 0.78-0.91; p<0.001) and TCFA (AUC=0.72, 95% CI: 0.63-0.80; p<0.001). Lesions with RWS_max >12% had a higher prevalence of TCFA (22.0% versus 1.5%; p<0.001), thinner fibrous cap thickness (71 μm versus 101 μm; p<0.001), larger lipidic plaque burden (23.3% versus 15.4%; p<0.001), and higher maximum LCR (0.41 versus 0.18; p<0.001) compared to lesions with RWS_max ≤12%.

Angiography-derived RWS was significantly correlated with plaque composition and known OCT features of plaque vulnerability in patients with intermediate coronary stenosis.