TCT-722 Coronary artery plaque distribution in functional focal and diffuse disease.

Abstract

Background: The complex relationship between coronary artery hemodynamics and plaque distribution is not fully understood. The pull back pressure gradient (PPG) is a novel metric that quantifies coronary artery disease (CAD) patterns as either focal or diffuse based on coronary physiology. This study explored the association between PPG and plaque burden (PB) as determined by intravascular ultrasound (IVUS). Method(s): This prespecified subanalysis of the PPG Global Registry, a prospective, multicenter, international study, included patients with hemodynamically significant lesions (fractional flow reserve [FFR] <=0.80) scheduled for percutaneous coronary intervention. Subjects underwent manual FFR pull back followed by IVUS before percutaneous coronary intervention. Functional CAD patterns were classified as focal or diffuse based on the median PPG value (0.62). Result(s): A total of 261 patients (264 vessels) with both FFR and IVUS pull backs were included. The mean age was 69 +/- 11 years, 77% were male, and 33% had diabetes mellitus. A significant correlation was found between PPG and PB (r = 0.53; 95% CI: 0.43-0.61). In vessels with focal CAD, PB at the minimum lumen area was higher compared to those with diffuse CAD (83 +/- 5.8% vs 76 +/- 8.2%; P < 0.001). At the vessel level, there was no correlation between PPG and atheroma plaque volume (r = 0.07; 95% CI: -0.05 to 0.19). Atheroma plaque volume was similar between vessels with focal and diffuse CAD (466 +/- 226 mm3 vs 438 +/- 158 mm3; P = 0.258). Conclusion(s): In patients with hemodynamically significant stenosis and high PPG (focal CAD), plaque deposition at the lesion level was greater than in vessels with low PPG (diffuse CAD). Although the total plaque amount was similar regardless of the pressure loss pattern, plaque was more localized in vessels with focal disease. These findings enhance the understanding of the relationship between functional and morphological atherosclerosis patterns. Categories: IMAGING AND PHYSIOLOGY: Imaging: Intravascular.Copyright © 2024