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Published on: April 13, 2015
Fractional Flow Reserve Relates Stronger to Coronary Plaque Burden Than Nonhyperemic Pressure Indexes
Ruurt A Jukema1, Jorge Dahdal1,2, Nick S Nurmohamed1,3
1Department of Cardiology Amsterdam Cardiovascular Sciences, Amsterdam University Medical Center, Vrije Universiteit Amsterdam Amsterdam the Netherlands.
Insights
Fractional flow reserve (FFR) better reflects plaque burden than non-flow limiting pressure indices. Both FFR and resting full-cycle ratio (RFR)/instantaneous wave-free ratio (iFR) identify low-attenuation plaque, but not positive remodeling.
Area of Science:
- Cardiovascular medicine
- Interventional cardiology
- Medical imaging
Background:
- Assessing coronary artery disease severity requires understanding the relationship between invasive pressure measurements and coronary plaque characteristics.
- Fractional flow reserve (FFR), resting distal pressure/aortic pressure (Pd/Pa), and instantaneous wave-free ratio (iFR)/resting full-cycle ratio (RFR) are key invasive pressure indices.
- Computed tomography angiography (CTA) provides detailed plaque information, including burden and phenotype.
Purpose of the Study:
- To elucidate the relationship between invasive pressure measurements (FFR, Pd/Pa, iFR/RFR) and coronary plaque characteristics (burden and phenotype) assessed by CTA.
- To compare the correlation of FFR and nonhyperemic indices with plaque burden (percentage atheroma volume - PAV).
- To determine the association of invasive pressure measurements with specific plaque phenotypes (low-attenuation plaque and positive remodeling).
Main Methods:
- A single-center prospective cohort study enrolled 241 patients with suspected coronary artery disease.
- Patients underwent invasive coronary angiography with FFR, Pd/Pa, and iFR/RFR measurements.
- Computed tomography angiography (CTA) was performed to assess percentage atheroma volume (PAV), positive remodeling, and low-attenuation plaque.
Main Results:
- FFR showed a stronger correlation with PAV (plaque burden) compared to Pd/Pa and iFR/RFR.
- Vessels with discordant FFR and Pd/Pa had higher PAV when FFR was abnormal.
- FFR and iFR/RFR, but not Pd/Pa, were independently associated with low-attenuation plaque. None of the indices were associated with positive remodeling.
Conclusions:
- FFR is a stronger correlate of coronary plaque burden than nonhyperemic pressure indices.
- FFR and iFR/RFR are associated with low-attenuation plaque, a marker of vulnerable plaque.
- None of the invasive pressure measurements were independently associated with positive remodeling, suggesting different underlying pathophysiology.
Background:
The relationship between fractional flow reserve (FFR), resting full-cycle ratio (RFR), instantaneous wave-free ratio (iFR), resting distal pressure/aortic pressure (Pd/Pa), and plaque burden as well as phenotype requires further elucidation.
Methods And Results:
In this single-center cohort study, patients with suspected coronary artery disease who underwent invasive coronary angiography, including routine hyperemic (FFR) and nonhyperemic invasive pressure (Pd/Pa and iFR or RFR) interrogation and computed coronary tomography angiography were prospectively enrolled. Computed coronary tomography angiography was used to assess percentage atheroma volume (PAV), positive remodeling, and low-attenuation plaque.
Abstract:
Among 241 patients with 556 vessels, FFR correlated stronger to PAV compared with Pd/Pa (r=-0.56; versus r=-0.43; P<0.01) and iFR/RFR (r=-0.47; P=0.04). Vessels with FFR and Pd/Pa discordancy showed higher PAV in case of abnormal FFR (34% versus 14%; P<0.01), whereas vessels with FFR and iFR/RFR discordancy showed similar PAV levels. FFR and iFR/RFR, but not Pd/Pa, were independently associated with the presence of low-attenuation plaque (β, -0.03, P<0.01; β, -0.03, P=0.01; and β, -0.02, P=0.10, respectively). None of the invasive pressure measurements was independently associated with positive remodeling. Pressure index discordancy was not associated with positive remodeling or low-attenuation plaque.
Conclusions:
FFR correlated stronger to plaque burden, as defined by PAV, than nonhyperemic pressure indexes. For plaque phenotype, both FFR and iFR/RFR were independently associated with low-attenuation plaque, whereas none of the invasive pressure indexes was associated with positive remodeling.
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