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Optical Coherence Tomography Based Biomechanical Fluid-Structure Interaction Analysis of Coronary Atherosclerosis Progression
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Prognostic Implications of Changes in Total Physiological Atherosclerotic Burden in Patients With Coronary Artery

Jiapeng Chu1, Deqiang Yuan1, Yan Lai1

  • 1Department of Cardiology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China.

Angiology
|November 23, 2023
PubMed

Insights

Coronary physiological progression, measured by 3-vessel quantitative flow ratio (3V-QFR) and its change (△3V-QFR), independently predicts major adverse cardiovascular events (MACE). This physiological assessment improves risk prediction beyond clinical factors.

Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology
  • Medical Imaging Analysis

Background:

  • The prognostic implications of coronary physiological progression remain underexplored.
  • Assessing atherosclerotic burden using coronary angiography is crucial for cardiovascular risk stratification.

Purpose of the Study:

  • To investigate the association between coronary physiological progression and clinical outcomes.
  • To evaluate the predictive value of total physiological atherosclerotic burden and its longitudinal change for major adverse cardiovascular events (MACE).

Main Methods:

  • Analysis of serial coronary angiography data from 421 patients with at least 6-month intervals.
  • Characterization of total physiological atherosclerotic burden using the sum of quantitative flow ratio in 3 epicardial vessels (3V-QFR).
  • Exploration of the relationship between baseline 3V-QFR, longitudinal change (△3V-QFR), and MACE using multivariable models.

Main Results:

  • Follow-up 3V-QFR values were slightly lower than baseline (P < .001), with a median △3V-QFR of -0.01.
  • Both follow-up 3V-QFR and △3V-QFR were independently associated with MACE (P < .05).
  • Patients with low follow-up and low △3V-QFR had a nearly 3-fold increased risk of MACE (HR: 2.953).

Conclusions:

  • Total physiological atherosclerotic burden and its progression offer incremental prognostic value beyond clinical characteristics.
  • Coronary physiology assessment aids in evaluating disease progression and identifying vulnerable patients.
  • Incorporating 3V-QFR and △3V-QFR into clinical models significantly enhances MACE predictability.

Keywords:
atherosclerosiscoronary artery diseasefractional flow reserveprognosis

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