Skip to main content

Advertisement

SpringerLink
Log in

Correlation between fractional flow reserve and instantaneous wave-free ratio with morphometric assessment by optical coherence tomography in diabetic patients

  • Original Paper
  • Published:
The International Journal of Cardiovascular Imaging Aims and scope Submit manuscript

Abstract

Currently there is lack of data regarding the use of optical coherence tomography (OCT) to depict the hemodynamic relevance of coronary stenoses in diabetic patients. We sought to assess the diagnostic accuracy of OCT-derived morphologic assessment in identifying hemodynamically significant coronary lesions as determined by both, the resting instantaneous wave-free ratio (iFR) and the hyperemic fractional flow reserve (FFR) in diabetic patients. Diabetic patients presenting with at least one intermediate coronary lesion were prospectively and consecutively enrolled. All lesions were systematically assessed by iFR, FFR and OCT. A total of 41 intermediate lesions were analysed. Mean iFR and FFR values were 0.90 ± 0.04 and 0.81 ± 0.06, respectively (intra-class correlation coefficient 0.49; 95% CI 0.22–0.79). A moderate correlation between iFR and OCT derived minimal lumen diameter (MLD, r = 0.49) and minimal lumen area (MLA, r = 0.50) was found. Conversely, there was a poor correlation between FFR and OCT-derived MLD (r = 0.34) and MLA (r = 0.32). The diagnostic efficiency of MLA and MLD to identify iFR significant stenoses showed an AUC of 0.82 (95% CI 0.69–0.95) for MLD and 0.83 (95% CI 0.71–0.96) for MLA. A worse diagnostic efficiency was found when FFR was used as the reference with an AUC of 0.71 (95% CI 0.54–0.87) for MLD and 0.70 (95% CI 0.53–0.87). OCT-derived MLA and MLD were the strongest independent anatomic predictors of abnormal iFR and FFR values. In diabetic patients, OCT-derived MLA and MLD showed a moderate diagnostic efficiency in identifying functionally significant coronary stenoses by FFR or iFR. In diabetics, anatomic OCT measurements better predicted resting than FFR-determined physiologically significant lesions.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Tonino PA, Fearon WF, De Bruyne B et al (2010) Angiographic versus functional severity of coronary artery stenoses in the FAME study fractional flow reserve versus angiography in multivessel evaluation. J Am Coll Cardiol 55:2816–2821

    Article  Google Scholar 

  2. Pijls NH, De Bruyne B, Peels K et al (1996) Measurement of fractional flow reserve to assess the functional severity of coronary-artery stenoses. N Engl J Med 334:1703–1708

    Article  CAS  Google Scholar 

  3. Neumann FJ, Sousa-Uva M, Ahlsson A, Alfonso F (2018) 2018 ESC/EACTS Guidelines on myocardial revascularization. Eur Heart J. https://doi.org/10.1093/eurheartj/ehy394

    Article  PubMed  PubMed Central  Google Scholar 

  4. Davies JE, Sen S, Dehbi H-M et al (2017) Use of the instantaneous wave-free ratio or fractional flow reserve in PCI. N Engl J Med 376:1824–1834

    Article  Google Scholar 

  5. Götberg M, Christiansen EH, Gudmundsdottir IJ et al (2017) Instantaneous wave-free ratio versus fractional flow reserve to guide PCI. N Engl J Med 376:1813–1823

    Article  Google Scholar 

  6. Fabrizio D’Ascenzo MD, Umberto Barbero MD et al (2015) Accuracy of intravascular ultrasound and optical coherence tomography in identifying functionally significant coronary stenosis according to vessel diameter: a meta-analysis of 2,581 patients and 2,807 lesions. Am Heart J 169(5):663–673

    Article  Google Scholar 

  7. Kubo T, Akasaka T, Shite J et al (2013) OCT compared with IVUS in a coronary lesion assessment: the OPUS-CLASS study. JACC Cardiovasc Imaging 6(10):1095–1104

    Article  Google Scholar 

  8. Gonzalo N, Escaned J, Alfonso F et al (2012) Morphometric assessment of coronary stenosis relevance with optical coherence tomography: a comparison with fractional flow reserve and intravascular ultrasound. J Am Coll Cardiol 59:1080–1089

    Article  Google Scholar 

  9. Stefano GT, Bezerra HG, Attizzani G, Chamié D, Mehanna E, Yamamoto H, Costa MA (2011) Utilization of frequency domain optical coherence tomography and fractional flow reserve to assess intermediate coronary artery stenoses: conciliating anatomic and physiologic information. Int J Cardiovasc Imaging 27(2):299–308

    Article  Google Scholar 

  10. Rivero F, Cuesta J, Bastante T, Benedicto A, García-Guimaraes M et al (2017) Diagnostic accuracy of a hybrid approach of instantaneous wave-free ratio and fractional flow reserve using high-dose intracoronary adenosine to characterize intermediate coronary lesions: Results of the PALS (Practical Assessment of Lesion Severity) prospective study. Catheter Cardiovasc Interv 90(7):1070–1076

    Article  Google Scholar 

  11. Rivero F, Cuesta J, Bastante T, Benedicto A, Fernández-Pérez C et al (2017) Reliability of physiological assessment of coronary stenosis severity using intracoronary pressure techniques: a comprehensive analysis from a large cohort of consecutive intermediate coronary lesions. EuroIntervention 13(2):e193–e200

    Article  Google Scholar 

  12. Nicholls SJ, Tuzcu EM, Kalidindi S, Wolski K, Moon KW, Sipahi I, Schoenhagen P, Nissen SE (2008) Effect of diabetes on progression of coronary atherosclerosis and arterial remodeling: a pooled analysis of 5 intravascular ultrasound trials. J Am Coll Cardiol 52:255–262

    Article  CAS  Google Scholar 

  13. Di Carli MF, Janisse J, Grunberger G, Ager J (2003) Role of chronic hyperglycemia in the pathogenesis of coronary microvascular dysfunction in diabetes. J Am Coll Cardiol 41(8):1387–1393

    Article  Google Scholar 

  14. Echavarria-Pinto M, Escaned J, Macías E et al (2013) Disturbed coronary hemodynamics in vessels with intermediate stenoses evaluated with fractional flow reserve: a combined analysis of epicardial and microcirculatory involvement in ischemic heart disease. Circulation 128:2557–2566

    Article  Google Scholar 

  15. Sen S, Asrress KN, Nijjer S, Petraco R, Malik IS, Foale RA, Mikhail GW, Foin N, Broyd C, Hadjiloizou N, Sethi A, Al-Bustami M, Hackett D, Khan MA, Khawaja MZ, Baker CS, Bellamy M, Parker KH, Hughes AD, Francis DP, Mayet J, Di Mario C, Escaned J, Redwood S, Davies JE (2013) Diagnostic classification of the instantaneous wave-free ratio is equivalent to fractional flow reserve and is not improved with adenosine administration. Results of CLARIFY (Classification Accuracy of Pressure-Only Ratios Against Indices Using Flow Study). J Am Coll Cardiol 61:1409–1420

    Article  Google Scholar 

  16. Petraco R, van de Hoef TP, Nijjer S, Sen S, van Lavieren MA, Foale RA, Meuwissen M, Broyd C, Echavarria-Pinto M, Foin N, Malik IS, Mikhail GW, Hughes AD, Francis DP, Mayet J, Di Mario C, Escaned J, Piek JJ, Davies JE (2014) Baseline instantaneous wave-free ratio as a pressure-only estimation of underlying coronary flow reserve: results of the JUSTIFY-CFR Study (Joined Coronary Pressure and Flow Analysis to Determine Diagnostic Characteristics of Basal and Hyperemic Indices of Functional Lesion Severity-Coronary Flow Reserve). Circ Cardiovasc Interv 7:492–502

    Article  Google Scholar 

  17. Escaned J, Echavarría-Pinto M, Garcia-Garcia HM, van de Hoef TP, de Vries T, Kaul P, Raveendran G, Altman JD, Kurz HI, Brechtken J, Tulli M, Von Birgelen C, Schneider JE, Khashaba AA, Jeremias A, Baucum J, Moreno R, Meuwissen M, Mishkel G, van Geuns RJ, Levite H, Lopez-Palop R, Mayhew M, Serruys PW, Samady H, Piek JJ, Lerman A, ADVISE II Study Group (2015) Prospective assessment of the diagnostic accuracy of instantaneous wave-free ratio to assess coronary stenosis relevance: results of ADVISE II International, Multicenter Study (ADenosine Vasodilator Independent Stenosis Evaluation II). JACC Cardiovasc Interv 8(6):824–833

    Article  Google Scholar 

  18. Lee JM, Hwang D, Park J, Tong Y, Koo BK (2017) Physiologic mechanism of discordance between instantaneous wave-free ratio and fractional flow reserve: insight from (13)N-ammonium positron emission tomography. Int J Cardiol 243:91–94

    Article  Google Scholar 

  19. Nijjer SS, de Waard GA, Sen S, van de Hoef TP, Petraco R, Echavarría-Pinto M, van Lavieren MA, Meuwissen M, Danad I, Knaapen P, Escaned J, Piek JJ, Davies JE, van Royen N (2016) Coronary pressure and flow relationships in humans: phasic analysis of normal and pathological vessels and the implications for stenosis assessment: a report from the Iberian–Dutch–English (IDEAL) Collaborators. Eur Heart J 37(26):2069–2080

    Article  Google Scholar 

  20. Marciano C, Galderisi M, Gargiulo P, Acampa W, D’Amore C, Esposito R, Capasso E, Savarese G, Casaretti L, Lo Iudice F, Esposito G, Rengo G, Leosco D, Cuocolo A, Perrone-Filardi P (2012) Effects of type 2 diabetes mellitus on coronary microvascular function and myocardial perfusion in patients without obstructive coronary artery disease. Eur J Nucl Med Mol Imaging 39:1199–1206

    Article  Google Scholar 

  21. Ali ZA, Maehara A, Généreux P, Shlofmitz RA, Fabbiocchi F, Nazif TM, Guagliumi G, Meraj PM, Alfonso F, Samady H, Akasaka T, Carlson EB, Leesar MA, Matsumura M, Ozan MO, Mintz GS, Ben-Yehuda O, Stone GW (2016) Optical coherence tomography compared with intravascular ultrasound and with angiography to guide coronary stent implantation (ILUMIEN III: OPTIMIZE PCI): a randomised controlled trial. Lancet 388(10060):2618–2628

    Article  Google Scholar 

  22. Takagi A, Tsurumi Y, Ishii Y, Suzuki K, Kawana M, Kasanuki H (1999) Clinical potential of intravascular ultrasound for physiological assessment of coronary stenosis: relationship between quantitative ultrasound tomography and pressure-derived fractional flow reserve. Circulation 100:250–255

    Article  CAS  Google Scholar 

  23. Ben-Dor I, Torguson R, Gaglia MA Jr et al (2011) Correlation between fractional flow reserve and intravascular ultrasound lumen area in intermediate coronary artery stenosis. EuroIntervention 7:225–233

    Article  Google Scholar 

  24. Koo BK, Yang HM, Doh JH et al (2011) Optimal intravascular ultrasound criteria and their accuracy for defining the functional significance of intermediate coronary stenoses of different locations. J Am Coll Cardiol Interv 4:803–811

    Article  Google Scholar 

  25. Waksman R, Legutko J, Singh J, Orlando Q, Marso S, Schloss T, Tugaoen J, DeVries J, Palmer N, Haude M, Swymelar S, Torguson R (2015) FIRST: fractional flow reserve and intravascular ultrasound relationship study. J Am Coll Cardiol 2013;61(9):917–923. doi: 10.1016/j.jacc.2012.12.012. Erratum in: J Am Coll Cardiol 66(3)335 (Epub 23 Jan 2013)

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Cardiology Department, Hospital Universitario de La Princesa, IIS-IP, CIBERCV, C/ Diego de Leon 62, 28006, Madrid, Spain

    Fernando Rivero, Paula Antuña, Marcos García-Guimaraes, César Jiménez, Javier Cuesta, Teresa Bastante & Fernando Alfonso

Authors
  1. Fernando Rivero
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Paula Antuña
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Marcos García-Guimaraes
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. César Jiménez
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Javier Cuesta
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Teresa Bastante
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Fernando Alfonso
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Fernando Alfonso.

Ethics declarations

Conflict of interest

Authors have nothing to disclose in relation to this manuscript.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Rivero, F., Antuña, P., García-Guimaraes, M. et al. Correlation between fractional flow reserve and instantaneous wave-free ratio with morphometric assessment by optical coherence tomography in diabetic patients. Int J Cardiovasc Imaging 36, 1193–1201 (2020). https://doi.org/10.1007/s10554-020-01819-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10554-020-01819-3

Keywords

Search

Navigation