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Published on: December 7, 2013
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Coronary Atherosclerosis Phenotypes in Focal and Diffuse Disease
Koshiro Sakai1, Takuya Mizukami2, Jonathon Leipsic3
1Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium; Department of Medicine, Division of Cardiology, Showa University School of Medicine, Tokyo, Japan.
JACC. Cardiovascular Imaging
|July 22, 2023
Summary
Focal coronary artery disease (CAD) shows higher plaque burden and lipid-rich plaques with thin-cap fibroatheroma (TCFA), while diffuse CAD has more calcifications. This links plaque characteristics to coronary hemodynamics.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Medical Imaging
Background:
- The relationship between coronary hemodynamics and atherosclerotic plaque characteristics is not fully understood.
- Differentiating between focal and diffuse coronary artery disease (CAD) based on hemodynamics is crucial for understanding plaque behavior.
Purpose of the Study:
- To compare atherosclerotic plaque phenotypes in focal versus diffuse CAD, as defined by coronary hemodynamics.
- To investigate the association between pullback pressure gradient (PPG) and plaque morphology.
Main Methods:
- A multicenter, prospective study included 117 patients with functionally significant lesions (FFR ≤0.80).
- Plaque analysis utilized coronary computed tomography angiography (CCTA) and optical coherence tomography (OCT).
- CAD patterns were assessed using motorized FFR pullbacks, quantifying focal vs. diffuse disease by median PPG.
Main Results:
- Focal CAD exhibited higher plaque burden (87% vs. 82%, P=0.003) on CCTA.
- Diffuse CAD showed significantly more calcifications (Agatston score: 158 vs. 51, P=0.024).
- OCT revealed a higher prevalence of lipid-rich plaques (37% vs. 4%, P=0.001) and TCFAs (47% vs. 10%, P=0.002) in focal CAD.
Conclusions:
- Atherosclerotic plaque phenotypes are associated with intracoronary hemodynamics.
- Focal CAD is characterized by higher plaque burden and lipid-rich plaques with TCFAs.
- Diffuse CAD is associated with more prevalent calcifications, highlighting distinct hemodynamic-morphological patterns.
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