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R S Driessen, W J Stuijfzand, P G Raijmakers, I Danad, J K Min, J A Leipsic, A Ahmadi, P M Van De Ven, A C Van Rossum, J Narula, P Knaapen, P4200
Vulnerable plaques are revealed by fractional flow reserve but not by instantaneous wave-free ratio, European Heart Journal, Volume 39, Issue suppl_1, August 2018, ehy563.P4200, https://doi.org/10.1093/eurheartj/ehy563.P4200Close - Share Icon Share
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Background: Fractional flow reserve (FFR) is, next to lesion severity, affected by plaque vulnerability as assessed by coronary computed tomography angiography (CCTA) and associated with imminent acute coronary syndromes. Instantaneous wave-free ratio (iFR) has recently emerged as an alternative for FFR to interrogate coronary lesions for ischaemia. It is, however, unknown whether vasodilator free assessment with iFR is associated with plaque stability similarly as FFR.
Purpose: The current substudy of the PACIFIC trial explores the impact of CCTA derived unfavorable plaque features on both hyperaemic and non-hyperaemic flow indices in order to detect vulnerable plaques.
Methods: Of 119 patients (62% men, age 58±8.6 years) with suspected coronary artery disease, 257 vessels were prospectively evaluated. Each patient underwent 256-slice CCTA to assess stenosis severity and plaque features (positive remodeling [PR], low attenuation plaque [LAP], spotty calcification [SC] and napkin ring sign [NRS]), as well as intracoronary pressure measurements (FFR, iFR, Pd/Pa and pressure ratio during adenosine within the wave-free period [iFRa]). CCTA derived plaque characteristics were related to these invasive pressure measurements.
