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Long and mixt/non-calcified plaques as predictors of functionally significant coronary aretry disease
Session:
Sessão de Posters 29 - Intervenção coronária percutânea
Speaker:
Rafael Viana
Congress:
CPC 2024
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
25. Interventional Cardiology
Subtheme:
25.2 Coronary Intervention
Session Type:
Cartazes
FP Number:
---
Authors:
Rafael Viana; Diogo Brás; Rita Rocha; Gustavo Mendes; David Neves; Ângela Bento; Renato Fernandes; Lino Patrício
Abstract
<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Coronary artery disease (CAD) can manifest as a broad range of plaque phenotypes. Vessel hemodynamics, more specifically endothelial wall shear stress and tensile stress, have also been associated with specific plaque phenotypes. However, the interplay between plaque morphology and local hemodynamics remains incompletely understood. Atherosclerosis can be characterized by using invasive and noninvasive imaging methods that quantify volume, extension, and composition. Large plaque burden, lipid-rich plaques and thin-cap fibroatheromas have been identified as predictors of adverse events. Conversely, calcifications are considered markers of plaque stability. We aimed to characterize intermediate plaques observed on coronary computed tomography angiography (CCTA) and their functional significance through invasive instantaneous wave-free ratio (iwFR) and fractional flow reserve (FFR).</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">METHODS AND RESULTS: Retrospective, single-centre study. Included patients with coronary plaques with >50% stenosis on CCTA, performed in context of chest pain investigation, that have been submitted to invasive functional evaluation (iwFR or FFR). 36 patients were included, 66% of which being males, with mean age 65±11 years. A total of 45 coronary lesions were assessed by CCTA and iwFR/FFR, the majority of which in the left anterior descending artery (48%). Mean iwFR was 0,93 ± 0,05. 49% of patients had no functionally significant CAD. A total of 13 coronary angioplasties with drug-eluting stent (DES) were performed, in functionally positive lesions (iwFR ≤0.89 or FFR ≤0.8). Regarding CCTA analysis, plaque lesions with 50-75% stenosis were likely not significant (p =0.005). Both mixt plaque and non-calcified plaque phenotypes were associated with functional significance (p<0.005). Also long lesions (defined as >10mm extension) were likely functionally significant (p=0.001). In contrast, proximal segment lesions were not associated with functional significance (p=0.604). </span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Interestingly, the presence of long and mixt/non-calcified plaques showed to be a strong predictor to rule-in functionally significant CAD, with a area-under-curve (AUC) of 0.894.</span></span></p> <p><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif">CONCLUSIONS: CCTA is a non-invasive imaging method that allows characterization of coronary artery lesions. Our study show that plaque lesions 50-75% on CCTA were likely not significant through iwFR. Considering the extension and composition of plaques, the presence of long and mixt/non-calcified plaques can predict functionally significant CAD. More studies, with larger sample, are needed to corroborate our findings.</span></span></p>
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