Turk Kardiyol Dern Ars. 2017; 45(7): 606-613 | DOI: 10.5543/tkda.2017.94493
Influence of coronary calcification patterns on hemodynamic outcome of coronary stenoses and remodeling
, Ozan Çakır2
, Adem Atıcı1
, Emre Aslanger4
, Cansu Akdeniz3
, Berrin Umman1
, Sabahattin Umman1
, Zehra Bugra1
, Murat Sezer11
Department of Cardiology, Istanbul University Faculty of Medicine, İstanbul, Turkey2
Department of Cardiology, Zonguldak Atatürk State Hospital, Zonguldak, Turkey3
Department of Cardiology, Şişli Florence Nightingale Hospital, İstanbul, Turkey4
Department of Cardiology, Yeditepe University Faculty of Medicine Hospital, İstanbul, Turkey
OBJECTIVE The histological characteristics of plaque may affect the hemodynamic outcome of a given coronary stenosis. In particular, the potential effect of volumetric calcium content and the topographical distribution in the lesion segment on physiological outcome has not yet been investigated. The aim of this study was to identify any potential correlation between patterns of calcification and the fractional flow reserve (FFR) and the coronary remodeling index (RMI).
METHODS A total of 26 stable angina pectoris and 34 acute coronary syndrome patients without persistent ST-segment elevation constituted the study population. FFR was used to assess 70 intermediate coronary stenosis lesions. After obtaining hemodynamic measurements, quantitative grayscale and virtual histology-intravascular ultrasound analyses were performed. The depth, length, and circumferential distribution of calcification of the lesions were also recorded.
RESULTS Within the analyzed segment (area of interest, lesion segment), FFR was correlated with maximal thickness of deep calcification (r=-0.285; p=0.021) and calcification angle (r=-0.396; p=0.001). In lesions with a calcification angle >180°, the mean FFR value was significantly lower compared with those <180° (0.64±0.17 vs. 0.78±0.08; p=0.024). RMI was correlated with maximal angle of superficial (r=-0.437; p<0.001) and deep (r=0.425; p<0.001) calcification. RMI was correlated with maximal thickness of superficial (r=-0.357; p=0.003) and deep (r=0.417; p<0.001) calcification. RMI was also correlated with FFR (r=-0.477; p<0.001).
CONCLUSION This study demonstrated that the geometry, location, and amount of calcification of a plaque could affect hemodynamic and anatomical outcome measures in functionally significant stenoses by affecting vessel wall compliance.
Coronary calcification, coronary remodeling, fractional flow reserve, intravascular ultrasound.
Ahmet Demirkıran, Ozan Çakır, Adem Atıcı, Emre Aslanger, Cansu Akdeniz, Berrin Umman, Sabahattin Umman, Zehra Bugra, Murat Sezer. Influence of coronary calcification patterns on hemodynamic outcome of coronary stenoses and remodeling. Turk Kardiyol Dern Ars. 2017; 45(7): 606-613
Corresponding Author: Ahmet Demirkıran, Türkiye