Abstract：
BACKGROUND: Coronary angiography-derived radial wall strain (RWS) is a newly developed index that can be readily accessed and describes the biomechanical features of a lesion.
OBJECTIVE: The authors sought to investigate the association of RWS with fractional flow reserve (FFR) and high-risk plaque (HRP), and their relative prognostic implications.
METHODS: We included 484 vessels (351 patients) deferred after FFR measurement with available RWS data and coronary computed tomography angiography. On coronary computed tomography angiography, HRP was defined as a lesion with both minimum lumen area <4 mm2 and plaque burden ≥70%. The primary outcome was target vessel failure (TVF), a composite of target vessel revascularization, target vessel myocardial infarction, or cardiac death.
RESULTS: The mean FFR and RWSmax were 0.89 ± 0.07 and 11.2% ± 2.5%, respectively, whereas 27.7% of lesions had HRP, 15.1% had FFR ≤0.80. An increase in RWSmax was associated with a higher risk of FFR ≤0.80 and HRP, which was consistent after adjustment for clinical or angiographic characteristics (all P < 0.05). An increment of RWSmax was related to a higher risk of TVF (HR: 1.23 [95% CI: 1.03-1.47]; P = 0.022) with an optimal cutoff of 14.25%. RWSmax >14% was a predictor of TVF after adjustment for FFR or HRP components (all P < 0.05) and showed a direct prognostic effect on TVF, not mediated by FFR ≤0.80 or HRP in the mediation analysis. When high RWSmax was added to FFR ≤0.80 or HRP, there were increasing outcome trends (all P for trend <0.001).
CONCLUSIONS: RWS was associated with coronary physiology and plaque morphology but showed independent prognostic significance.
OBJECTIVE: The authors sought to investigate the association of RWS with fractional flow reserve (FFR) and high-risk plaque (HRP), and their relative prognostic implications.
METHODS: We included 484 vessels (351 patients) deferred after FFR measurement with available RWS data and coronary computed tomography angiography. On coronary computed tomography angiography, HRP was defined as a lesion with both minimum lumen area <4 mm2 and plaque burden ≥70%. The primary outcome was target vessel failure (TVF), a composite of target vessel revascularization, target vessel myocardial infarction, or cardiac death.
RESULTS: The mean FFR and RWSmax were 0.89 ± 0.07 and 11.2% ± 2.5%, respectively, whereas 27.7% of lesions had HRP, 15.1% had FFR ≤0.80. An increase in RWSmax was associated with a higher risk of FFR ≤0.80 and HRP, which was consistent after adjustment for clinical or angiographic characteristics (all P < 0.05). An increment of RWSmax was related to a higher risk of TVF (HR: 1.23 [95% CI: 1.03-1.47]; P = 0.022) with an optimal cutoff of 14.25%. RWSmax >14% was a predictor of TVF after adjustment for FFR or HRP components (all P < 0.05) and showed a direct prognostic effect on TVF, not mediated by FFR ≤0.80 or HRP in the mediation analysis. When high RWSmax was added to FFR ≤0.80 or HRP, there were increasing outcome trends (all P for trend <0.001).
CONCLUSIONS: RWS was associated with coronary physiology and plaque morphology but showed independent prognostic significance.
摘要：
背景：冠状动脉血管造影术衍生的桡骨壁应变（RWS）是一种新开发的指标，可以很容易地获得并描述病变的生物力学特征。
目的：作者试图研究RWS与血流储备分数（FFR）和高危斑块（HRP）的关系，以及它们的相对预后意义。
方法：我们纳入了484条血管（351例患者），这些血管在FFR测量后，根据现有的RWS数据和冠状动脉计算机断层扫描血管造影进行延迟。在冠状动脉计算机断层扫描血管造影术中，HRP定义为最小管腔面积<4mm2且斑块负荷≥70%的病变。主要结果是目标血管衰竭（TVF），目标血管血运重建的复合材料，靶血管心肌梗死,或心脏死亡。
结果：平均FFR和RWSmax分别为0.89±0.07和11.2%±2.5%，分别,而27.7%的病变有HRP，15.1%的FFR≤0.80。RWSmax的增加与FFR≤0.80和HRP的高风险相关，在校正临床或血管造影特征后，该结果一致（均P<0.05）。RWSmax的增加与TVF的高风险相关（HR：1.23[95％CI：1.03-1.47];P=0.022），最佳临界值为14.25％。RWSmax>14%是调整FFR或HRP成分后TVF的预测因子(均P<0.05),对TVF有直接预后作用,在调解分析中，FFR≤0.80或HRP不介导。当FFR≤0.80或HRP加入高RWSmax时,结局趋势增加(所有趋势P<0.001).
结论：RWS与冠状动脉生理和斑块形态相关，但显示出独立的预后意义。
目的：作者试图研究RWS与血流储备分数（FFR）和高危斑块（HRP）的关系，以及它们的相对预后意义。
方法：我们纳入了484条血管（351例患者），这些血管在FFR测量后，根据现有的RWS数据和冠状动脉计算机断层扫描血管造影进行延迟。在冠状动脉计算机断层扫描血管造影术中，HRP定义为最小管腔面积<4mm2且斑块负荷≥70%的病变。主要结果是目标血管衰竭（TVF），目标血管血运重建的复合材料，靶血管心肌梗死,或心脏死亡。
结果：平均FFR和RWSmax分别为0.89±0.07和11.2%±2.5%，分别,而27.7%的病变有HRP，15.1%的FFR≤0.80。RWSmax的增加与FFR≤0.80和HRP的高风险相关，在校正临床或血管造影特征后，该结果一致（均P<0.05）。RWSmax的增加与TVF的高风险相关（HR：1.23[95％CI：1.03-1.47];P=0.022），最佳临界值为14.25％。RWSmax>14%是调整FFR或HRP成分后TVF的预测因子(均P<0.05),对TVF有直接预后作用,在调解分析中，FFR≤0.80或HRP不介导。当FFR≤0.80或HRP加入高RWSmax时,结局趋势增加(所有趋势P<0.001).
结论：RWS与冠状动脉生理和斑块形态相关，但显示出独立的预后意义。
