Affiliation:
1. Smart Sensors Laboratory and CÚRAM, Lambe Institute for Translational Research University of Galway Galway Ireland
2. Biomedical Instrument Institute, School of Biomedical Engineering Shanghai Jiao Tong University Shanghai China
3. International Smart Medical Devices Innovation Center Kunshan Industrial Technology Research Institute Suzhou China
4. Institute of Cardiology Fondazione Policlinico Universitario A. Gemelli IRCCS Rome Italy
5. Institute of Cardiology Università Cattolica del Sacro Cuore Rome Italy
Abstract
AbstractBackgroundThe combination of coronary imaging assessment and blood flow perturbation estimation has the potential to improve percutaneous coronary intervention (PCI) guidance.ObjectivesWe aimed to evaluate a novel method for fast computation of Murray law‐based quantitative flow ratio (μQFR) from coregistered optical coherence tomography (OCT) and angiography (OCT‐modulated μQFR, OCT‐μQFR) in predicting physiological efficacy of PCI.MethodsPatients treated by OCT‐guided PCI in the OCT‐arm of the Fractional Flow Reserve versus Optical Coherence Tomography to Guide RevasculariZAtion of Intermediate Coronary Stenoses trial (FORZA, NCT01824030) were included. Based on angiography and OCT before PCI, simulated residual OCT‐μQFR was computed by assuming full stent expansion to the intended‐to‐treat segment. Plaque composition was automatically characterized using a validated artificial intelligence algorithm. Actual post‐PCI OCT‐μQFR pullback was computed based on coregistration of angiography and OCT acquired immediately after PCI. Suboptimal functional stenting result was defined as OCT‐μQFR ≤ 0.90.ResultsPaired simulated residual OCT‐μQFR and actual post‐PCI OCT‐μQFR were obtained in 76 vessels from 74 patients. Simulated residual OCT‐μQFR showed good correlation (r = 0.80, p < 0.001), agreement (mean difference = −0.02 ± 0.02, p < 0.001), and diagnostic concordance (79%, 95% confidence interval: 70%–88%) with actual post‐PCI OCT‐μQFR. Actual post‐PCI in‐stent OCT‐μQFR had a median value of 0.02 and was associated with left anterior descending artery lesion location (β = 0.38, p < 0.001), higher baseline total plaque burden (β = 0.25, p = 0.031), and fibrous plaque volume (β = 0.24, p = 0.026).ConclusionsThis study based on patients enrolled in a prospective OCT‐guidance PCI trial shows that simulated residual OCT‐μQFR had good correlation, agreement, and diagnostic concordance with actual post‐PCI OCT‐μQFR. In OCT‐guided procedures, OCT‐μQFR in‐stent pressure drop was low and was significantly predicted by pre‐PCI vessel/plaque characteristics.
Funder
Shanghai Jiao Tong University
National Natural Science Foundation of China
Subject
Cardiology and Cardiovascular Medicine,Radiology, Nuclear Medicine and imaging,General Medicine
Cited by
2 articles.
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