Association of Physiological Discordance Between Fractional Flow Reserve and Nonhyperemic Pressure Ratios With Lipid-Rich Plaque Burden

Figures

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  Figure 1. Study flowchart. A total of 189 patients with CCS, comprising 217 vessels that underwent FFR, NHPR, and NIRS-IVUS assessments, were included in the study. CCS, chronic coronary syndrome; FFR, fractional flow reserve; IVUS, intravascular ultrasound; NHPR, non-hyperaemic pressure ratio; NIRS, near-infrared spectroscopy.

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  Figure 2. Distribution of FFR and NHPR. Physiological discordance was observed in 24.0% of lesions, with the FFR+/NHPR− pattern accounting for the majority (19.8%). The vertical and horizontal lines indicate the cut-offs for FFR (0.80) and NHPR (0.89), respectively. Abbreviations are as given in Figure 1.

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  Figure 3. Correlations and multivariable linear regression analyses of the associations between physiological indices and maxLCBI4mm. (A) FFR and maxLCBI4mm. (B) Change in Pd/Pa and maxLCBI4mm. (C) NHPR and maxLCBI4mm. (D) Multivariable linear regression analyses for maxLCBI4mm. There was a significant correlation of FFR and change in Pd/Pa with maxLCBI4mm, whereas NHPR showed no significant association. In multivariable linear regression analyses, FFR and change in Pd/Pa were independently associated with maxLCBI4mm, whereas NHPR was not. MaxLCBI4mm, maximum lipid core burden index within any 4-mm segment; Pd/Pa, distal coronary pressure–aortic pressure ratio; CI, confidence interval; other abbreviations are as given in Figure 1.

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  Figure 4. NIRS-derived lipid burden across the physiological classification groups. (A) MaxLCBI4mm. (B) Prevalence of LRP. (C) Multivariable generalized estimating equation analysis for the association between physiological classification patterns and LRP. The FFR+/NHPR− pattern demonstrated the highest maxLCBI4mm and the greatest prevalence of LRP. In multivariable generalized estimating equation analyses, the FFR+/NHPR− pattern was independently associated with the presence of LRP. In panel A, the boxes indicate the interquartile range, with the mid-line representing the median. The whiskers extend from each box to the farthest point within ± 1.5 times the interquartile range. Outliers are shown as individual points. In panel B, error bars indicate 95% confidence intervals. LRP, lipid-rich plaque; OR, odds ratio; other abbreviations are as in Figures 1 and 3.