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ȣ - 550936 240 |
| Virtual Histology -Intravascular Ultrasound (VH-IVUS) Tissue Characteristics Analysis of the Intermediate Coronary Artery Stenosis Lesion Predicting Physiologic Myocardial Ischemia by Fraction Flow Reserve (FFR) |
| 인제대학교 일산백병원 순환기내과¹ ,서울대학교 병원 순환기내과² , 계명대학교 동산의료원 순환기내과³ |
| 도준형¹, 구본권² , 김지현² ,남창욱³ , 최현민¹ , 이성윤¹ , 남궁준¹ , 권성욱¹ , 곽재진¹ , 이원로¹ |
Background: Recent clinical trials demonstrated that virtual histology-intravascular ultrasound (VH-IVUS) is a useful test predicting clinical outcomes of the coronary artery disease (CAD). Thin cap fibroatheroma (VH-TCFA) was proposed a predictor of cardiovascular event by VH-IVUS combined with more than 70% plaque burden and less than 4mm² minimal lumen area (MLA) by IVUS. Fractional flow reserve (FFR) is an established index of the physiological significance of a coronary stenosis. Recent large scale trials demonstrated FFR guided PCI showed favorable clinical outcomes. VH-IVUS represents anatomical severity, but FFR represents functional severity of CAD. Few studies reported relevance between two tests. Aim of this study was to investigate whether the geometry and composition of lesions were different under FFR criteria. Methods: 55 coronary segments of the 42 patients with intermediate stenosis were prospectively enrolled from 3 centers. VH-IVUS and FFR examination were performed simultaneously for all segments. Functionally significant stenosis was defined as FFR less than 0.80. All angiographic, VH-IVUS data were analyzed in core laboratories. Patients were divided in two groups according to the value of FFR (> 0.80, n=42 or ≤0.80, n=13). Results: Lesions with FFR ≤ 0.8 showed significantly smaller MLA (2.80 ± 0.77 mm² vs 3.96 ± 1.69 mm² (mean ± SD) but similar plaque burden (74.86 ± 0.7% vs. 69.91 ± 0.7% P = 0.1). Plaque composition by VH-IVUS were not different in necrotic core (NC) , dense calcium (DC), fibrotic (FI) and fibrofatty (FF) (NC : 22.02 ± 7.58% vs.22.16 ± 9.38%, DC :8.0 ± 7.39% vs10.0 ± 9.87%, FI : 57.06 ± 11.30% vs53.09 ± 12.14%, FF : 13.56 ± 10.47% vs.13.84 ±12.038%, P = NS). No difference was found in the distribution of NC-rich plaques (fibroatheroma and thin-capped fibroatheroma) between groups (66.7% in FFR ≤ 0.80 vs. 77.8% in FFR > 0.80, P =NS) and VH-TCFA(8.3% in FFR ≤ 0.80 vs.9.5% in FFR > 0.80, P =NS) . Conclusions: Although FFR ≤ 0.80 lesions have smaller minimal lumen area, VH-IVUS tissue characteristics between two groups were not different. Further exploration in a large prospective study is needed to study whether the lesions with FFR > 0.80 that are NC rich plaques and VH-TCFA are the ones associated with future cardiovascular events at follow-up.
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