Short-Term Risk Stratification of Non-Flow-Limiting Coronary Stenosis by Angiographically Derived Radial Wall Strain

Shengxian Tu; Bo Xu; Lianglong Chen; Huihong Hong; Zhiqing Wang; Chunming Li; Miao Chu; Lei Song; Changdong Guan; Bo Yu; Zening Jin; Guosheng Fu; Xuebo Liu; Junqing Yang; Yundai Chen; Junbo Ge; Shubin Qiao; William Wijns; FAVOR III China Study Group

doi:10.1016/j.jacc.2022.11.056

Short-Term Risk Stratification of Non-Flow-Limiting Coronary Stenosis by Angiographically Derived Radial Wall Strain

J Am Coll Cardiol. 2023 Feb 28;81(8):756-767. doi: 10.1016/j.jacc.2022.11.056.

Authors

Shengxian Tu¹, Bo Xu², Lianglong Chen³, Huihong Hong³, Zhiqing Wang⁴, Chunming Li⁵, Miao Chu⁵, Lei Song⁶, Changdong Guan⁶, Bo Yu⁷, Zening Jin⁸, Guosheng Fu⁹, Xuebo Liu¹⁰, Junqing Yang¹¹, Yundai Chen¹², Junbo Ge¹³, Shubin Qiao⁶, William Wijns¹⁴; FAVOR III China Study Group

Affiliations

¹ Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China. Electronic address: sxtu@sjtu.edu.cn.
² Department of Cardiology, Fuwai Hospital, National Clinical Research Center for Cardiovascular Diseases, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital Chinese Academy of Medical Sciences, Shenzhen, Shenzhen, China. Electronic address: bxu@citmd.com.
³ Department of Cardiology, Fujian Medical University Union Hospital, Fuzhou, China.
⁴ Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China; Department of Cardiology, Fujian Medical University Union Hospital, Fuzhou, China.
⁵ Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China.
⁶ Department of Cardiology, Fuwai Hospital, National Clinical Research Center for Cardiovascular Diseases, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
⁷ Department of Cardiology, the Second Affiliated Hospital of Harbin Medical University, Harbin, China.
⁸ Department of Cardiology, Beijing Tiantan Hospital, Capital Medical University, Beijing China.
⁹ Department of Cardiology, Sir Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China.
¹⁰ Department of Cardiology, Tongji Hospital, Tongji University School of Medicine, Shanghai, China.
¹¹ Department of Cardiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
¹² Department of Cardiology, the Sixth Medical Center, Chinese PLA General Hospital, Beijing, China.
¹³ Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China.
¹⁴ Lambe Institute for Translational Medicine and CURAM, University of Galway, Galway, Ireland.

PMID: 36813375
DOI: 10.1016/j.jacc.2022.11.056

Abstract

Background: Deferred revascularization of mildly stenotic coronary vessels based exclusively on physiological evaluation is associated with up to 5% residual incidence of future adverse events at 1 year.

Objectives: We aimed to evaluate the incremental value of angiography-derived radial wall strain (RWS) in risk stratification of non-flow-limiting mild coronary narrowings.

Methods: This is a post hoc analysis of 824 non-flow-limiting vessels in 751 patients from the FAVOR III China (Comparison of Quantitative Flow Ratio Guided and Angiography Guided Percutaneous Intervention in Patients With Coronary Artery Disease) trial. Each individual vessel had ≥1 mildly stenotic lesion. The primary outcome was vessel-oriented composite endpoint (VOCE), defined as the composite of vessel-related cardiac death, vessel-related myocardial infarction (nonprocedural), and ischemia-driven target vessel revascularization at 1-year follow-up.

Results: During 1-year follow-up, VOCE occurred in 46 of 824 vessels, with a cumulative incidence of 5.6%. Maximum RWS (RWS_max) was predictive of 1-year VOCE with an area under the curve of 0.68 (95% CI: 0.58-0.77; P < 0.001). The incidence of VOCE was 14.3% in vessels with RWS_max >12% vs 2.9% in those with RWS_max ≤12%. In the multivariable Cox regression model, RWS_max >12% was a strong independent predictor of 1-year VOCE in deferred non-flow-limiting vessels (adjusted HR: 4.44; 95% CI: 2.43-8.14; P < 0.001). The risk of deferred revascularization based on combined normal RWS_max and Murray-law-based quantitative flow ratio (μQFR) was significantly reduced compared with μQFR alone (adjusted HR: 0.52; 95% CI: 0.30-0.90; P = 0.019).

Conclusions: Among vessels with preserved coronary flow, angiography-derived RWS analysis has the potential to further discriminate vessels at risk of 1-year VOCE. (Comparison of Quantitative Flow Ratio Guided and Angiography Guided Percutaneous Intervention in Patients With Coronary Artery Disease [FAVOR III China Study]; NCT03656848).

Keywords: angiography-derived radial wall strain; non–flow-limiting vessel; quantitative flow ratio; vessel-oriented composite endpoint.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Coronary Angiography
Coronary Artery Disease* / etiology
Coronary Stenosis* / etiology
Coronary Vessels
Fractional Flow Reserve, Myocardial* / physiology
Humans
Percutaneous Coronary Intervention* / adverse effects
Predictive Value of Tests
Risk Assessment
Risk Factors
Treatment Outcome

Associated data

ClinicalTrials.gov/NCT03656848