Assessment of FFR-negative intermediate coronary artery stenoses by spectral analysis of the radiofrequency intravascular ultrasound signal

Jason H Rogers, Jacob Wegelin, Kori Harder, Richard Valente, Reginald Low

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3 Citations (Scopus)

Abstract

BACKGROUND: Assessing the clinical importance of angiographically intermediate coronary artery stenoses at the time of cardiac catheterization remains a challenge. Spectral analysis of radiofrequency ultrasound backscatter signals, or virtual histology (VH), allows in vivo assessment of plaque composition. This study characterizes the VH composition of fractional flow reserve (FFR)-negative intermediate stenoses and adjacent vessel segments. METHODS: Intermediate coronary artery stenoses (> 40% and < 70% diameter stenosis) were assessed by pressure wire. If the FFR was greater than or equal to 0.75, percutaneous coronary intervention was deferred and VH was performed on the lesion and adjacent segments using a commercially available system. The primary clinical endpoint was any adverse cardiac event. RESULTS: Thirty-seven intermediate stenoses in 30 patients were studied. The reference vessel size was 3.02 ± 0.71 mm, the QCA diameter stenosis was 52 ± 6% and the FFR was 0.89 ± 0.07. The target stenoses were characterized by VH as: thin-cap fibroatheroma (VH-TCFA; n ≤ 22); fibrous cap atheroma (n ≤ 5), fibrocalcific lesion (n ≤ 7) and pathological intimal thickening (n ≤ 3). The relative contribution of each stenosis plaque component was conserved across adjacent segments (signature plaque). Three patients, all with VH-TCFAs at index, had events in the clinical follow-up period of 12 ± 2 months, but only 1 of these patients had an event related to the index stenosis. CONCLUSIONS: FFR-negative intermediate stenoses have heterogeneous plaque by VH, but are enriched in VH-TCFAs. Relative plaque composition is conserved along adjacent vessel segments. Although the specificity of VH-TCFA for index stenosis-related events appears low, larger trials are needed to assess the prognostic value of VH in this lesion subset.

Original languageEnglish (US)
Pages (from-to)448-453
Number of pages6
JournalJournal of Invasive Cardiology
Volume18
Issue number10
StatePublished - Oct 2006

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Coronary Stenosis
Histology
Pathologic Constriction
Atherosclerotic Plaques
Tunica Intima
Percutaneous Coronary Intervention
Cardiac Catheterization
Pressure

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Assessment of FFR-negative intermediate coronary artery stenoses by spectral analysis of the radiofrequency intravascular ultrasound signal. / Rogers, Jason H; Wegelin, Jacob; Harder, Kori; Valente, Richard; Low, Reginald.

In: Journal of Invasive Cardiology, Vol. 18, No. 10, 10.2006, p. 448-453.

Research output: Contribution to journalArticle

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abstract = "BACKGROUND: Assessing the clinical importance of angiographically intermediate coronary artery stenoses at the time of cardiac catheterization remains a challenge. Spectral analysis of radiofrequency ultrasound backscatter signals, or virtual histology (VH), allows in vivo assessment of plaque composition. This study characterizes the VH composition of fractional flow reserve (FFR)-negative intermediate stenoses and adjacent vessel segments. METHODS: Intermediate coronary artery stenoses (> 40{\%} and < 70{\%} diameter stenosis) were assessed by pressure wire. If the FFR was greater than or equal to 0.75, percutaneous coronary intervention was deferred and VH was performed on the lesion and adjacent segments using a commercially available system. The primary clinical endpoint was any adverse cardiac event. RESULTS: Thirty-seven intermediate stenoses in 30 patients were studied. The reference vessel size was 3.02 ± 0.71 mm, the QCA diameter stenosis was 52 ± 6{\%} and the FFR was 0.89 ± 0.07. The target stenoses were characterized by VH as: thin-cap fibroatheroma (VH-TCFA; n ≤ 22); fibrous cap atheroma (n ≤ 5), fibrocalcific lesion (n ≤ 7) and pathological intimal thickening (n ≤ 3). The relative contribution of each stenosis plaque component was conserved across adjacent segments (signature plaque). Three patients, all with VH-TCFAs at index, had events in the clinical follow-up period of 12 ± 2 months, but only 1 of these patients had an event related to the index stenosis. CONCLUSIONS: FFR-negative intermediate stenoses have heterogeneous plaque by VH, but are enriched in VH-TCFAs. Relative plaque composition is conserved along adjacent vessel segments. Although the specificity of VH-TCFA for index stenosis-related events appears low, larger trials are needed to assess the prognostic value of VH in this lesion subset.",
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AU - Low, Reginald

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N2 - BACKGROUND: Assessing the clinical importance of angiographically intermediate coronary artery stenoses at the time of cardiac catheterization remains a challenge. Spectral analysis of radiofrequency ultrasound backscatter signals, or virtual histology (VH), allows in vivo assessment of plaque composition. This study characterizes the VH composition of fractional flow reserve (FFR)-negative intermediate stenoses and adjacent vessel segments. METHODS: Intermediate coronary artery stenoses (> 40% and < 70% diameter stenosis) were assessed by pressure wire. If the FFR was greater than or equal to 0.75, percutaneous coronary intervention was deferred and VH was performed on the lesion and adjacent segments using a commercially available system. The primary clinical endpoint was any adverse cardiac event. RESULTS: Thirty-seven intermediate stenoses in 30 patients were studied. The reference vessel size was 3.02 ± 0.71 mm, the QCA diameter stenosis was 52 ± 6% and the FFR was 0.89 ± 0.07. The target stenoses were characterized by VH as: thin-cap fibroatheroma (VH-TCFA; n ≤ 22); fibrous cap atheroma (n ≤ 5), fibrocalcific lesion (n ≤ 7) and pathological intimal thickening (n ≤ 3). The relative contribution of each stenosis plaque component was conserved across adjacent segments (signature plaque). Three patients, all with VH-TCFAs at index, had events in the clinical follow-up period of 12 ± 2 months, but only 1 of these patients had an event related to the index stenosis. CONCLUSIONS: FFR-negative intermediate stenoses have heterogeneous plaque by VH, but are enriched in VH-TCFAs. Relative plaque composition is conserved along adjacent vessel segments. Although the specificity of VH-TCFA for index stenosis-related events appears low, larger trials are needed to assess the prognostic value of VH in this lesion subset.

AB - BACKGROUND: Assessing the clinical importance of angiographically intermediate coronary artery stenoses at the time of cardiac catheterization remains a challenge. Spectral analysis of radiofrequency ultrasound backscatter signals, or virtual histology (VH), allows in vivo assessment of plaque composition. This study characterizes the VH composition of fractional flow reserve (FFR)-negative intermediate stenoses and adjacent vessel segments. METHODS: Intermediate coronary artery stenoses (> 40% and < 70% diameter stenosis) were assessed by pressure wire. If the FFR was greater than or equal to 0.75, percutaneous coronary intervention was deferred and VH was performed on the lesion and adjacent segments using a commercially available system. The primary clinical endpoint was any adverse cardiac event. RESULTS: Thirty-seven intermediate stenoses in 30 patients were studied. The reference vessel size was 3.02 ± 0.71 mm, the QCA diameter stenosis was 52 ± 6% and the FFR was 0.89 ± 0.07. The target stenoses were characterized by VH as: thin-cap fibroatheroma (VH-TCFA; n ≤ 22); fibrous cap atheroma (n ≤ 5), fibrocalcific lesion (n ≤ 7) and pathological intimal thickening (n ≤ 3). The relative contribution of each stenosis plaque component was conserved across adjacent segments (signature plaque). Three patients, all with VH-TCFAs at index, had events in the clinical follow-up period of 12 ± 2 months, but only 1 of these patients had an event related to the index stenosis. CONCLUSIONS: FFR-negative intermediate stenoses have heterogeneous plaque by VH, but are enriched in VH-TCFAs. Relative plaque composition is conserved along adjacent vessel segments. Although the specificity of VH-TCFA for index stenosis-related events appears low, larger trials are needed to assess the prognostic value of VH in this lesion subset.

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