What question did this study set out to answer?

This research aims to evaluate how morphological and CFD characteristics of TCFA lesions can predict future major adverse cardiac events in diabetic individuals.

April 1, 2026

Computational fluid dynamics analysis of the optical coherence tomography verified thin cap fibroatheroma a subanalysis from the COMBINE OCT-FFR study

Key Points

This research aims to evaluate how morphological and CFD characteristics of TCFA lesions can predict future major adverse cardiac events in diabetic individuals.
Conducted a comparative analysis using data from the COMBINE study database.
Assessed morphological and CFD parameters of TCFA from coronary segments via optical coherence tomography (OCT).
Matched TCFA cases with and without MACE based on minimal lumen area, lesion length, and clinical presentation at baseline.
MACE group showed a significantly larger proximal lumen diameter compared to the non-MACE group (3.2 vs 2.6 mm, p<0.05).
MACE lesions had statistically smaller TCFA length (0.20 vs 0.40 mm, p<0.05) and TCFA arc (33 vs 44 degrees, p<0.05).
Numerically lower wall shear stress values were found in the MACE group compared to non-MACE (1.70 vs 2.80, p=0.17).

Abstract

Abstract Background There is a paucity of evidence concerning the comprehensive assessment of both morphological characteristics and computational fluid dynamics (CFD) parameters of thin-cap fibroatheroma (TCFA) lesions in individuals with diabetes mellitus (DM). Aim To determine whether identifying specific morphological and CFD characteristics of coronary arteries with TCFA could enhance the prediction of lesions prone to future major adverse cardiac events (MACE). Methods Using data from the COMBINE study database, we conducted a comprehensive analysis of optical coherence tomography (OCT)-derived morphological and CFD parameters of coronary segments containing TCFA. We compared 13 TCFAs from patients who experienced MACE during an 18-month follow-up with matched TCFA pullbacks from patients without MACE, in order to assess potential differences in TCFA location, morphology, and wall shear stress (WSS) values. Matching of TCFA pullbacks was performed based on minimal lumen area (MLA), lesion length, and the clinical presentation (chronic or acute coronary syndrome) at baseline. Results This analysis showed numerically similar values of lesion length, MLA and area stenosis between both arms. Interestingly, there was a statistically significant bigger proximal lumen diameter in the MACE group (MACE 3.2 (2.8-3.8) vs non-MACE 2.6 (2.3-3.1), p0.05) while minimal lumen diameter (MLD) and distal lumen diameter had similar values. Also, TCFA length and TCFA arc were statistically significantly smaller in the MACE group (respectively 0.20 (0.15-0.35) vs 0.40 (0.25-0.75), p0.05 and 33 (24-43.5) vs 44 (40.5-58), p0.05). WSS values at TCFA site were numerically lower in the MACE group when compared to non-MACE (MACE 1.70 (0.71-3.51) vs non-MACE 2.80 (1.65-5.47), p=0,17). Conclusions Reduced WSS value within lesions containing TCFA may be associated with an increased likelihood of the future MACE.CFD analysisFor image description, please refer to the figure legend and surrounding text.

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Computational fluid dynamics analysis of the optical coherence tomography verified thin cap fibroatheroma a subanalysis from the COMBINE OCT-FFR study

Key Points

Abstract

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