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Differential predictability for high-risk plaque characteristics between fractional flow reserve and instantaneous
Joo Myung Lee1, Doosup Shin2, Seung Hun Lee3
1Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, Republic of Korea. drone80@hanmail.net.
Insights
Fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR) both correlate with high-risk plaque characteristics (HRPC) identified by coronary computed tomography angiography. FFR shows a stronger association, particularly with qualitative HRPC, and better predicts multiple HRPC.
Area of Science:
- Cardiovascular Imaging and Physiology
- Interventional Cardiology
Background:
- Coronary computed tomography angiography (CCTA) identifies high-risk plaque characteristics (HRPC).
- Physiologic assessment using instantaneous wave-free ratio (iFR) and fractional flow reserve (FFR) evaluates lesion severity.
Purpose of the Study:
- To compare the differential associations of HRPC with resting (iFR) and hyperemic (FFR) physiologic indexes.
- To assess the predictive ability of FFR and iFR for the presence of HRPC.
Main Methods:
- 214 vessels from 127 patients with stable angina or acute coronary syndrome were analyzed.
- HRPC were classified quantitatively (minimal luminal area < 4 mm², plaque burden ≥ 70%) and qualitatively (low attenuation plaque, positive remodeling, napkin ring sign, spotty calcification).
- Correlations between CCTA-derived HRPC and invasive FFR/iFR values were evaluated.
Main Results:
- Vessels with FFR ≤ 0.80 or iFR ≤ 0.89 had significantly more HRPC.
- FFR was independently associated with both quantitative and qualitative HRPC, while iFR was only associated with quantitative HRPC.
- FFR demonstrated superior discrimination ability for ≥ 3 HRPC compared to iFR (AUC 0.703 vs. 0.648) and for quantitative HRPC (AUC 0.832 vs. 0.744).
Conclusions:
- Both FFR and iFR are significantly associated with CCTA-derived HRPC.
- FFR shows a stronger independent association with qualitative HRPC and higher predictive ability for the presence of multiple HRPC compared to iFR.
Abstract:
To evaluate the differential associations of high-risk plaque characteristics (HRPC) with resting or hyperemic physiologic indexes (instantaneous wave-free ratio [iFR] or fractional flow reserve [FFR]), a total of 214 vessels from 127 patients with stable angina or acute coronary syndrome who underwent coronary computed tomography angiography (CCTA) and invasive physiologic assessment were investigated. HPRC were classified into quantitative (minimal luminal area < 4 mm2 or plaque burden ≥ 70%) and qualitative features (low attenuation plaque, positive remodeling, napkin ring sign, or spotty calcification). Vessels with FFR ≤ 0.80 or iFR ≤ 0.89 had significantly higher proportions of HRPC than those with FFR > 0.80 or iFR > 0.89, respectively. FFR was independently associated with both quantitative and qualitative HRPC, but iFR was only associated with quantitative HRPC. Both FFR and iFR were significantly associated with the presence of ≥ 3 HRPC, and FFR demonstrated higher discrimination ability than iFR (AUC 0.703 vs. 0.648, P = 0.045), which was predominantly driven by greater discriminating ability of FFR for quantitative HRPC (AUC 0.832 vs. 0.744, P = 0.005). In conclusion, both FFR and iFR were significantly associated with CCTA-derived HRPC. Compared with iFR, however, FFR was independently associated with the presence of qualitative HRPC and showed a higher predictive ability for the presence of ≥ 3 HRPC.
