Tufaro, V;
Safi, H;
Torii, R;
Koo, B-K;
Kitslaar, P;
Ramasamy, A;
Mathur, A;
... Bourantas, C; + view all
(2021)
Wall shear stress estimated by 3D-QCA can predict cardiovascular events in lesions with borderline negative fractional flow reserve.
Atherosclerosis
, 322
pp. 24-30.
10.1016/j.atherosclerosis.2021.02.018.
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Abstract
Background and aims: There is some evidence of the implications of wall shear stress (WSS) derived from three-dimensional quantitative coronary angiography (3D-QCA) models in predicting adverse cardiovascular events. This study investigates the efficacy of 3D-QCA-derived WSS in detecting lesions with a borderline negative fractional flow reserve (FFR: 0.81–0.85) that progressed and caused events. Methods: In this retrospective cohort study, we identified 548 patients who had at least one lesion with an FFR 0.81–0.85 and complete follow-up data; 293 lesions (286 patients) with suitable angiographic characteristics were reconstructed using a dedicated 3D-QCA software and included in the analysis. In the reconstructed models blood flow simulation was performed and the value of 3D-QCA variables and WSS distribution in predicting events was examined. The primary endpoint of the study was the composite of cardiac death, target lesion related myocardial infarction or clinically indicated target lesion revascularization. Results: During a median follow-up of 49.4 months, 37 events were reported. Culprit lesions had a greater area stenosis [(AS), 66.1% (59.5–72.3) vs 54.8% (46.5–63.2), p<0.001], smaller minimum lumen area [(MLA), 1.66 mm2 (1.45–2.30) vs 2.10 mm2 (1.69–2.70), p=0.011] and higher maximum WSS [9.0 Pa (5.10–12.46) vs 5.0 Pa (3.37–7.54), p < 0.001] than those that remained quiescent. In multivariable analysis, AS [hazard ratio (HR): 1.06, 95% confidence interval (CI): 1.03–1.10, p=0.001] and maximum WSS (HR: 1.08, 95% CI: 1.02–1.14, p=0.012) were the only independent predictors of the primary endpoint. Lesions with an increased AS (≥58.6%) that were exposed to high WSS (≥7.69Pa) were more likely to progress and cause events (27.8%) than those with a low AS exposed to high WSS (7.4%) or those exposed to low WSS that had increased (12.8%) or low AS (2.7%, p<0.001). Conclusions: This study for the first time highlights the potential value of 3D-QCA-derived WSS in detecting, among lesions with a borderline negative FFR, those that cause cardiovascular events.
| Type: | Article |
|---|---|
| Title: | Wall shear stress estimated by 3D-QCA can predict cardiovascular events in lesions with borderline negative fractional flow reserve |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1016/j.atherosclerosis.2021.02.018 |
| Publisher version: | https://doi.org/10.1016/j.atherosclerosis.2021.02.... |
| Additional information: | This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions. |
| Keywords: | Peripheral Vascular Disease, Cardiovascular System & Cardiology, 3D-QCA, Vulnerable plaque, Wall shear stress, QUANTITATIVE CORONARY-ANGIOGRAPHY, PROSPECTIVE NATURAL-HISTORY, PLAQUE, SEVERITY, FEATURES |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Cardiovascular Science UCL > Provost and Vice Provost Offices > UCL BEAMS UCL > Provost and Vice Provost Offices > UCL BEAMS > Faculty of Engineering Science UCL > Provost and Vice Provost Offices > UCL BEAMS > Faculty of Engineering Science > Dept of Mechanical Engineering |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10137709 |
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