Author + information
- Received May 3, 2018
- Revision received June 20, 2018
- Accepted July 10, 2018
- Published online October 15, 2018.
- Eisuke Usui, MDa,b,
- Taishi Yonetsu, MDa,
- Yoshihisa Kanaji, MDa,
- Masahiro Hoshino, MDa,
- Masao Yamaguchi, MDa,
- Masahiro Hada, MDa,
- Tadashi Fukuda, MDa,
- Yohei Sumino, MDa,
- Hiroaki Ohya, MDa,
- Rikuta Hamaya, MDa,
- Yoshinori Kanno, MDa,
- Haruhito Yuki, MDa,
- Tadashi Murai, MD, PhDa,
- Tetsumin Lee, MD, PhDa,
- Kenzo Hirao, MD, PhDb and
- Tsunekazu Kakuta, MD, PhDa,∗ ()
- aDepartment of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Tsuchiura, Ibaraki, Japan
- bDepartment of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
- ↵∗Address for correspondence:
Dr. Tsunekazu Kakuta, Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, 4-1-1, Otsuno, Tsuchiura, Ibaraki 300-0028, Japan.
Objectives This study sought to investigate the relationship of unstable plaque features with physiological lesion severity and microvascular dysfunction.
Background The functional severity of epicardial lesions and microvascular dysfunction are both related to adverse clinical outcomes.
Methods We investigated 382 de novo intermediate and severe coronary lesions in 340 patients who underwent optical coherence tomography, fractional flow reserve (FFR), and index of microcirculatory resistance (IMR) examinations. Lesions were divided into tertiles based on either FFR or IMR values. The optical coherence tomography findings were compared among the tertiles of FFR and IMR. Each tertile was defined as follows: FFR-T1 (FFR <0.74), FFR-T2 (0.74 ≤ FFR ≤0.81), and FFR-T3 (FFR >0.81); and IMR-T1 (IMR ≥25), IMR-T2 (15 < IMR <25), and IMR-T3 (IMR ≤15).
Results No significant relationship was observed between FFR and IMR. The prevalence of optical coherence tomography–defined thin-cap fibroatheroma (TCFA) was significantly greater in IMR-T1 than in IMR-T2 and IMR-T3. An overall significant difference in the prevalence of TCFAs was detected among FFR tertiles, although no pairwise comparison revealed statistical significance. The prevalence of ruptured plaque was significantly greater in IMR-T1 than in IMR-T2 and IMR-T3, although no significant difference was observed between FFR tertiles. Multivariate analysis showed that FFR and IMR were independent predictors of the prevalence of TCFAs (odds ratio: 0.036; 95% confidence interval: 0.004 to 0342; p = 0.004; and odds ratio: 1.034; 95% confidence interval: 1.014 to 1.054; p = 0.001, respectively).
Conclusions Lower FFR and higher IMR values were independent predictors of the presence of a TCFA in angiographically intermediate-to-severe stable lesions or nonculprit lesions in acute coronary syndrome.
- coronary artery disease
- fractional flow reserve
- microvascular dysfunction
- optical coherence tomography
- stenosis severity
All authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received May 3, 2018.
- Revision received June 20, 2018.
- Accepted July 10, 2018.
- 2018 American College of Cardiology Foundation