open access

Vol 25, No 2 (2018)
Original articles — Interventional cardiology
Published online: 2017-07-14
Get Citation

Multimodality imaging of intermediate lesions: Data from fractional flow reserve, optical coherence tomography, near-infrared spectroscopy-intravascular ultrasound

Dariusz Biały, Magdalena Wawrzyńska, Jacek Arkowski, Marcin Rogała, Klaudia Proniewska, Wojciech Wańha, Wojciech Wojakowski, Tomasz Roleder
DOI: 10.5603/CJ.a2017.0082
·
Pubmed: 28714527
·
Cardiol J 2018;25(2):196-202.

open access

Vol 25, No 2 (2018)
Original articles — Interventional cardiology
Published online: 2017-07-14

Abstract

Background: Fractional flow reserve (FFR) assesses a functional impact of the atheroma on the myocardial ischemia, but it does not take into account the morphology of the lesion. Previous optical coherence tomography (OCT), intravascular ultrasound (IVUS) and near-infrared spectroscopy (NIRS) studies presented their potential to detect vulnerable plaques, which is not possible by FFR assessment. With the following study, the intermediate lesions were assessed by FFR, OCT and combined NIRS-IVUS imaging to identify plaque vulnerability.

Methods: Thirteen intermediate lesions were analyzed simultaneously by FFR, OCT and combined NIRS-IVUS imaging.

Results: Two lesions were found to have FFR ≤ 0.80 (0.65 and 0.76). The other 11 lesions had FFR > 0.80 with a mean FFR 0.88 ± 0.049. Two lesions with FFR ≤ 0.80 had plaque burden (PB) > 70% and minimal lumen area (MLA) < 4 mm2, but neither of these 2 lesions were identified as OCT de­fined thin fibrous cap atheroma (TCFA), or NIRS-IVUS possible TCFA. Among the other 11 lesions with FFR > 0.80, 8 were identified as OCT-defined TCFA, 4 had PB > 70%, 6 had MLA < 4 mm2, 2 had both PB > 70% and MLA < 4 mm2, 3 lesions were identified as NIRS-IVUS possible TCFA, and 4 lesions had lipid core burden index > 400.

Conclusions: The FFR-negative lesions pose traits of vulnerability as assessed simultaneously by IVUS, OCT and NIRS imaging.  

Abstract

Background: Fractional flow reserve (FFR) assesses a functional impact of the atheroma on the myocardial ischemia, but it does not take into account the morphology of the lesion. Previous optical coherence tomography (OCT), intravascular ultrasound (IVUS) and near-infrared spectroscopy (NIRS) studies presented their potential to detect vulnerable plaques, which is not possible by FFR assessment. With the following study, the intermediate lesions were assessed by FFR, OCT and combined NIRS-IVUS imaging to identify plaque vulnerability.

Methods: Thirteen intermediate lesions were analyzed simultaneously by FFR, OCT and combined NIRS-IVUS imaging.

Results: Two lesions were found to have FFR ≤ 0.80 (0.65 and 0.76). The other 11 lesions had FFR > 0.80 with a mean FFR 0.88 ± 0.049. Two lesions with FFR ≤ 0.80 had plaque burden (PB) > 70% and minimal lumen area (MLA) < 4 mm2, but neither of these 2 lesions were identified as OCT de­fined thin fibrous cap atheroma (TCFA), or NIRS-IVUS possible TCFA. Among the other 11 lesions with FFR > 0.80, 8 were identified as OCT-defined TCFA, 4 had PB > 70%, 6 had MLA < 4 mm2, 2 had both PB > 70% and MLA < 4 mm2, 3 lesions were identified as NIRS-IVUS possible TCFA, and 4 lesions had lipid core burden index > 400.

Conclusions: The FFR-negative lesions pose traits of vulnerability as assessed simultaneously by IVUS, OCT and NIRS imaging.  

Get Citation

Keywords

vulnerable plaque, fractional flow reserve, optical coherence tomography, near-infrared spectroscopy, intravascular ultrasound

About this article
Title

Multimodality imaging of intermediate lesions: Data from fractional flow reserve, optical coherence tomography, near-infrared spectroscopy-intravascular ultrasound

Journal

Cardiology Journal

Issue

Vol 25, No 2 (2018)

Pages

196-202

Published online

2017-07-14

DOI

10.5603/CJ.a2017.0082

Pubmed

28714527

Bibliographic record

Cardiol J 2018;25(2):196-202.

Keywords

vulnerable plaque
fractional flow reserve
optical coherence tomography
near-infrared spectroscopy
intravascular ultrasound

Authors

Dariusz Biały
Magdalena Wawrzyńska
Jacek Arkowski
Marcin Rogała
Klaudia Proniewska
Wojciech Wańha
Wojciech Wojakowski
Tomasz Roleder

References (26)
  1. Windecker S, Kolh P, Alfonso F, et al. Authors/Task Force members. 2014 ESC/EACTS Guidelines on myocardial revascularization: The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS)Developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur Heart J. 2014; 35(37): 2541–2619.
  2. Narula J, Nakano M, Virmani R, et al. Histopathologic characteristics of atherosclerotic coronary disease and implications of the findings for the invasive and noninvasive detection of vulnerable plaques. J Am Coll Cardiol. 2013; 61(10): 1041–1051.
  3. Galon MZ, Wang Z, Bezerra HG, et al. Differences determined by optical coherence tomography volumetric analysis in non-culprit lesion morphology and inflammation in ST-segment elevation myocardial infarction and stable angina pectoris patients. Catheter Cardiovasc Interv. 2015; 85(4): E108–E115.
  4. Stone GW, Maehara A, Lansky AJ, et al. PROSPECT Investigators. A prospective natural-history study of coronary atherosclerosis. N Engl J Med. 2011; 364(3): 226–235.
  5. Oemrawsingh RM, Cheng JM, García-García HM, et al. ATHEROREMO-NIRS Investigators. Near-infrared spectroscopy predicts cardiovascular outcome in patients with coronary artery disease. J Am Coll Cardiol. 2014; 64(23): 2510–2518.
  6. Roleder T, Kovacic JC, Ali Z, et al. Combined NIRS and IVUS imaging detects vulnerable plaque using a single catheter system: a head-to-head comparison with OCT. EuroIntervention. 2014; 10(3): 303–311.
  7. Yabushita H, Bouma BE, Houser SL, et al. Characterization of human atherosclerosis by optical coherence tomography. Circulation. 2002; 106(13): 1640–1645.
  8. Madder RD, Puri R, Muller JE, et al. Confirmation of the Intracoronary Near-Infrared Spectroscopy Threshold of Lipid-Rich Plaques That Underlie ST-Segment-Elevation Myocardial Infarction. Arterioscler Thromb Vasc Biol. 2016; 36(5): 1010–1015.
  9. Barbato E, Toth GG, Johnson NP, et al. A Prospective Natural History Study of Coronary Atherosclerosis Using Fractional Flow Reserve. J Am Coll Cardiol. 2016; 68(21): 2247–2255.
  10. De Bruyne B, Pijls NHJ, Kalesan B, et al. FAME 2 Trial Investigators. Fractional flow reserve-guided PCI versus medical therapy in stable coronary disease. N Engl J Med. 2012; 367(11): 991–1001.
  11. Iskander S, Iskandrian AE. Risk assessment using single-photon emission computed tomographic technetium-99m sestamibi imaging. J Am Coll Cardiol. 1998; 32(1): 57–62.
  12. Tonino P, Bruyne BDe, Pijls N, et al. Fractional Flow Reserve versus Angiography for Guiding Percutaneous Coronary Intervention. New England Journal of Medicine. 2009; 360(3): 213–224.
  13. Sakurai S, Takashima H, Waseda K, et al. Influence of plaque characteristics on fractional flow reserve for coronary lesions with intermediate to obstructive stenosis: insights from integrated-backscatter intravascular ultrasound analysis. Int J Cardiovasc Imaging. 2015; 31(7): 1295–1301.
  14. Chung JH, Ann SH, Singh GB, et al. Segmental assessments of coronary plaque morphology and composition by virtual histology intravascular ultrasound and fractional flow reserve. Int J Cardiovasc Imaging. 2016; 32(3): 373–380.
  15. Yang HM, Tahk SJ, Lim HS, et al. Relationship between intravascular ultrasound parameters and fractional flow reserve in intermediate coronary artery stenosis of left anterior descending artery: intravascular ultrasound volumetric analysis. Catheter Cardiovasc Interv. 2014; 83(3): 386–394.
  16. de la Torre Hernandez JM, Lopez-Palop R, Garcia Camarero T, et al. Clinical outcomes after intravascular ultrasound and fractional flow reserve assessment of intermediate coronary lesions. Propensity score matching of large cohorts from two institutions with a differential approach. EuroIntervention. 2013; 9(7): 824–830.
  17. Waksman R, Legutko J, Singh J, et al. FIRST: Fractional Flow Reserve and Intravascular Ultrasound Relationship Study. J Am Coll Cardiol. 2013; 61(9): 917–923.
  18. Maejima N, Hibi K, Saka K, et al. Morphological features of non-culprit plaques on optical coherence tomography and integrated backscatter intravascular ultrasound in patients with acute coronary syndromes. Eur Heart J Cardiovasc Imaging. 2015; 16(2): 190–197.
  19. Kataoka Yu, Hammadah M, Puri R, et al. Plaque vulnerability at non-culprit lesions in obese patients with coronary artery disease: Frequency-domain optical coherence tomography analysis. Eur J Prev Cardiol. 2015; 22(10): 1331–1339.
  20. Lee SY, Shin DH, Shehata I, et al. Association between fractional flow reserve and coronary plaque characteristics assessed by optical coherence tomography. J Cardiol. 2016; 68(4): 342–345.
  21. Kennedy MW, Fabris E, Ijsselmuiden AJ, et al. Combined optical coherence tomography morphologic and fractional flow reserve hemodynamic assessment of non- culprit lesions to better predict adverse event outcomes in diabetes mellitus patients: COMBINE (OCT-FFR) prospective study. Rationale and design. Cardiovasc Diabetol. 2016; 15(1): 144.
  22. Moreno PR, Lodder RA, Purushothaman KR, et al. Detection of lipid pool, thin fibrous cap, and inflammatory cells in human aortic atherosclerotic plaques by near-infrared spectroscopy. Circulation. 2002; 105(8): 923–927.
  23. Madder RD, Smith JL, Dixon SR, et al. Composition of target lesions by near-infrared spectroscopy in patients with acute coronary syndrome versus stable angina. Circ Cardiovasc Interv. 2012; 5(1): 55–61.
  24. Bourantas CV, Serruys PW, Nakatani S, et al. Bioresorbable vascular scaffold treatment induces the formation of neointimal cap that seals the underlying plaque without compromising the luminal dimensions: a concept based on serial optical coherence tomography data. EuroIntervention. 2015; 11(7): 746–756.
  25. Komukai K, Kubo T, Kitabata H, et al. Effect of atorvastatin therapy on fibrous cap thickness in coronary atherosclerotic plaque as assessed by optical coherence tomography: the EASY-FIT study. J Am Coll Cardiol. 2014; 64(21): 2207–2217.
  26. Kini AS, Baber U, Kovacic JC, et al. Changes in plaque lipid content after short-term intensive versus standard statin therapy: the YELLOW trial (reduction in yellow plaque by aggressive lipid-lowering therapy). J Am Coll Cardiol. 2013; 62(1): 21–29.

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

By "Via Medica sp. z o.o." sp.k., ul. Świętokrzyska 73, 80–180 Gdańsk, Poland
tel.:+48 58 320 94 94, fax:+48 58 320 94 60, e-mail: viamedica@viamedica.pl