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Abstract：
BACKGROUND: Stress-transthoracic Doppler echocardiography (S-TDE) provides a noninvasive assessment of coronary flow parameters in the left anterior descending artery (LAD). However, the association between morphological characteristics and coronary flow changes after elective percutaneous coronary intervention (PCI) remains unclear. We aimed to evaluate the relationships between periprocedural coronary flow changes observed on S-TDE and lesion-specific plaque characteristics obtained by optical coherence tomography (OCT) in the interrogated vessels in patients with chronic coronary syndrome (CCS).
RESULTS: Patients with CCS who underwent pre- and post-PCI S-TDE and elective fractional flow reserve (FFR)-guided PCI under OCT guidance for de novo single LAD lesions were included. S-TDE-derived hyperemic diastolic peak flow velocity (hDPV) was used as a surrogate for coronary flow. Lesions were categorized into two groups based on the %hDPV increase or decrease. The baseline clinical, physiological, and OCT findings were compared between the groups. In total, 103 LAD lesions were studied in 103 patients. After PCI, hDPV significantly increased from 55.6 cm/s to 69.5 cm/s (P<0.01), with a median %hDPV increase of 27.2 (6.32-59.1) %, while %hDPV decreased in 20 (19.4%) patients. The FFR improved in all patients. On OCT, layered plaques were more frequently present in the culprit vessels in the %hDPV-decrease group than in the %hDPV-increase group (85.0% vs. 50.6%, P = 0.01). Multivariable logistic regression analysis showed that the presence of layered plaques and high pre-PCI hDPV were independent predictors of %hDPV decrease.
CONCLUSIONS: In patients who underwent successful uncomplicated elective PCI for de novo single LAD lesions, the presence of layered plaques was independently associated with hyperemic coronary flow decrease as assessed by S-TDE.
RESULTS: Patients with CCS who underwent pre- and post-PCI S-TDE and elective fractional flow reserve (FFR)-guided PCI under OCT guidance for de novo single LAD lesions were included. S-TDE-derived hyperemic diastolic peak flow velocity (hDPV) was used as a surrogate for coronary flow. Lesions were categorized into two groups based on the %hDPV increase or decrease. The baseline clinical, physiological, and OCT findings were compared between the groups. In total, 103 LAD lesions were studied in 103 patients. After PCI, hDPV significantly increased from 55.6 cm/s to 69.5 cm/s (P<0.01), with a median %hDPV increase of 27.2 (6.32-59.1) %, while %hDPV decreased in 20 (19.4%) patients. The FFR improved in all patients. On OCT, layered plaques were more frequently present in the culprit vessels in the %hDPV-decrease group than in the %hDPV-increase group (85.0% vs. 50.6%, P = 0.01). Multivariable logistic regression analysis showed that the presence of layered plaques and high pre-PCI hDPV were independent predictors of %hDPV decrease.
CONCLUSIONS: In patients who underwent successful uncomplicated elective PCI for de novo single LAD lesions, the presence of layered plaques was independently associated with hyperemic coronary flow decrease as assessed by S-TDE.
摘要：
背景：压力-经胸多普勒超声心动图（S-TDE）提供了对左前降支（LAD）冠状动脉血流参数的无创性评估。然而,形态学特征与择期经皮冠状动脉介入治疗(PCI)后冠状动脉血流变化之间的关联尚不清楚.我们旨在评估慢性冠脉综合征（CCS）患者在S-TDE上观察到的围手术期冠状动脉血流变化与光学相干断层扫描（OCT）获得的病变特异性斑块特征之间的关系。
结果：纳入在OCT指导下接受PCI术前和术后S-TDE和选择性血流储备分数(FFR)引导PCI的CCS患者，以治疗新的单个LAD病变。S-TDE衍生的充血舒张峰值流速（hDPV）用作冠状动脉血流的替代指标。根据%hDPV增加或减少将病变分为两组。基线临床，生理,比较各组间的OCT结果.总的来说,在103例患者中研究了103例LAD病变。PCI术后hDPV从55.6cm/s显著升高至69.5cm/s(P<0.01),hDPV中位数增加27.2（6.32-59.1）%，而20例（19.4%）患者的%hDPV下降。所有患者的FFR均得到改善。在OCT上,与%hDPV增加组相比，%hDPV降低组的罪魁祸首血管中存在分层斑块的频率更高(85.0%vs.50.6%,P=0.01）。多变量logistic回归分析显示，分层斑块的存在和PCI前hDPV升高是hDPV降低的独立预测因子。
结论：在接受了从头单个LAD病变的无并发症择期PCI成功的患者中，通过S-TDE评估,分层斑块的存在与冠状动脉血流充血减少独立相关.
结果：纳入在OCT指导下接受PCI术前和术后S-TDE和选择性血流储备分数(FFR)引导PCI的CCS患者，以治疗新的单个LAD病变。S-TDE衍生的充血舒张峰值流速（hDPV）用作冠状动脉血流的替代指标。根据%hDPV增加或减少将病变分为两组。基线临床，生理,比较各组间的OCT结果.总的来说,在103例患者中研究了103例LAD病变。PCI术后hDPV从55.6cm/s显著升高至69.5cm/s(P<0.01),hDPV中位数增加27.2（6.32-59.1）%，而20例（19.4%）患者的%hDPV下降。所有患者的FFR均得到改善。在OCT上,与%hDPV增加组相比，%hDPV降低组的罪魁祸首血管中存在分层斑块的频率更高(85.0%vs.50.6%,P=0.01）。多变量logistic回归分析显示，分层斑块的存在和PCI前hDPV升高是hDPV降低的独立预测因子。
结论：在接受了从头单个LAD病变的无并发症择期PCI成功的患者中，通过S-TDE评估,分层斑块的存在与冠状动脉血流充血减少独立相关.
