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Association of Acute Procedural Results with Long-term Outcomes After CTO-PCI Letter by Jiang et al Regarding Article, “Direct Comparison of Cardiac Myosin-Binding Protein C With Cardiac Troponins for the Early Diagnosis of Acute Myocardial Infarction” Mild Hypothermia in Cardiogenic Shock Complicating Myocardial Infarction - The Randomized SHOCK-COOL Trial Fractional flow reserve vs. angiography in guiding management to optimize outcomes in non-ST-segment elevation myocardial infarction: the British Heart Foundation FAMOUS-NSTEMI randomized trial Invasive Management of Acute Myocardial Infarction Complicated by Cardiogenic Shock: A Scientific Statement From the American Heart Association The prognostic role of mid-range ejection fraction in ST-segment elevation myocardial infarction Decreased inspired oxygen stimulates de novo formation of coronary collaterals in adult heart Epinephrine Versus Norepinephrine for Cardiogenic Shock After Acute Myocardial Infarction Clarification of Myocardial Infarction Types Association Between Haptoglobin Phenotype and Microvascular Obstruction in Patients With STEMI: A Cardiac Magnetic Resonance Study

Clinical Trial2018 Feb 6;71(5):499-509.

JOURNAL:J Am Coll Cardiol. Article Link

Effect of Plaque Burden and Morphology on Myocardial Blood Flow and Fractional Flow Reserve

Driessen RS, Stuijfzand WJ, Knaapen P et al. Keywords: coronary artery disease; coronary computed tomography angiography; fractional flow reserve; myocardial perfusion; plaque; positron emission tomography

ABSTRACT


BACKGROUND - Atherosclerotic plaque characteristics may affect downstream myocardial perfusion, as well as coronary lesion severity.


OBJECTIVES - This study sought to evaluate the association between quantitative plaque burden and plaque morphology obtained using coronary computed tomography angiography (CTA) and quantitative myocardial perfusion obtained using [15O]H2O positron emission tomography (PET), as well as fractional flow reserve (FFR) derived invasively.


METHODS - Two hundred eight patients (63% men; age 58 ± 8.7 years) with suspected coronary artery disease were prospectively included. All patients underwent 256-slice coronary CTA, [15O]H2O PET, and invasive FFR measurements. Coronary CTA-derived plaque burden and morphology were assessed using commercially available software and compared with PET perfusion and FFR.

RESULTS - Atherosclerotic plaques were present in 179 patients (86%) and 415 of 610 (68%) evaluable coronary arteries. On a per-vessel basis, traditional coronary plaque burden indexes, such as plaque length and volume, minimal lumen area, and stenosis percentage, were significantly associated with impaired hyperemic myocardial blood flow (MBF) and FFR. In addition, morphological features, such as partially calcified plaques, positive remodeling (PR), and low attenuation plaque, displayed a negative impact on hyperemic MBF and FFR. Multivariable analysis revealed that the morphological feature of PR was independently related to impaired hyperemic MBF as well as an unfavorable FFR (p = 0.004 and p = 0.007, respectively), next to stenosis percentage (p = 0.001 and p < 0.001, respectively) and noncalcified plaque volume (p < 0.001 and p = 0.010, respectively).

CONCLUSIONS - PR and noncalcified plaque volume are associated with detrimental downstream hyperemic myocardial perfusion and FFR, independent of lesion severity.

Copyright © 2018 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.