Segmental post-percutaneous coronary intervention physiological gradients using ultrasonic or optical flow ratio: insights from ASET JAPAN study

European Heart Journal - Imaging Methods and Practice, vol. 3, pp. qyaf017

Abstract

Abstract Aims Segmental pressure gradients post-percutaneous coronary intervention (PCI) can detect residual disease and optimization targets. Ultrasonic flow ratio (UFR) or optical flow ratio (OFR) offer simultaneous physiological and morphological assessment using a single imaging catheter. This study evaluated the utility of UFR and OFR in identifying residual disease post-PCI. Methods and results The study include patients from the Acetyl Salicylic Elimination Trial JAPAN Pilot study with complete intravascular imaging pullback data, where UFR or OFR was obtained post-PCI. Anatomical focal lesions distal and proximal to the stent were analysed in segments ≥5 mm long. UFR or OFR virtual pullback curves assessed intra-stent pressure gradients, defining physiological focal or diffuse by segmental pressure drops ≥0.05 over lengths <10 or ≥10 mm, respectively. The median post-PCI UFR/OFR was 0.93 (0.88–0.96) with 35.4% (69/195) vessels having a UFR/OFR < 0.91. There were significantly more focal lesions, both anatomical and physiological, proximal and distal to the stent in vessels with UFR/OFR < 0.91 compared with those ≥0.91. Agreement between anatomical and physiological focal lesions was moderate proximally (kappa = 0.553, P < 0.001) and fair distally (kappa = 0.219, P = 0.002). The in-stent gradient poorly predicted significant stent under-expansion. However, the virtual fractional flow reserve gradient performed well in detecting proximal or distal focal disease (area under the curve = 0.835 and 0.877, respectively). Conclusion UFR/OFR effectively identifies sub-optimal vessel physiology post-PCI and locates precise anatomical issues, validated by intravascular imaging. Trial registration The ASET JAPAN ClinicalTrials.gov reference: NCT05117866

Authors 16

1. Pruthvi C. Revaiah

   Ollscoil na Gaillimhe – University of Galway

   Affiliation as printed

   CORRIB Research Centre for Advanced Imaging and Core Laboratory, University of Galway , University Road, Galway, H91 TK33 ,

   CORRIB Research Centre for Advanced Imaging and Core Laboratory. University of Galway, Ireland

2. Kotaro Miyashita

   Ollscoil na Gaillimhe – University of Galway

   Affiliation as printed

   CORRIB Research Centre for Advanced Imaging and Core Laboratory, University of Galway , University Road, Galway, H91 TK33 ,

   CORRIB Research Centre for Advanced Imaging and Core Laboratory. University of Galway, Ireland

3. Tsung-Ying Tsai

   Ollscoil na Gaillimhe – University of Galway

   Affiliation as printed

   CORRIB Research Centre for Advanced Imaging and Core Laboratory, University of Galway , University Road, Galway, H91 TK33 ,

   CORRIB Research Centre for Advanced Imaging and Core Laboratory. University of Galway, Ireland

4. Retesh Bajaj

   National Health Service · Barts Health NHS Trust

   Affiliation as printed

   Department of Cardiology, Barts Heart Center, Barts Health NHS Trust , London ,

   Department of Cardiology, Barts Heart Center, Barts Health NHS Trust, London, United Kingdom

5. Nozomi Kotoku

   Ollscoil na Gaillimhe – University of Galway

   Affiliation as printed

   CORRIB Research Centre for Advanced Imaging and Core Laboratory, University of Galway , University Road, Galway, H91 TK33 ,

   CORRIB Research Centre for Advanced Imaging and Core Laboratory. University of Galway, Ireland

6. Akihiro Tobe

   Ollscoil na Gaillimhe – University of Galway

   Affiliation as printed

   CORRIB Research Centre for Advanced Imaging and Core Laboratory, University of Galway , University Road, Galway, H91 TK33 ,

   CORRIB Research Centre for Advanced Imaging and Core Laboratory. University of Galway, Ireland

7. Takashi Muramatsu

   Fujita Health University · Fujita Health University Hospital

   Affiliation as printed

   Department of Cardiology, Fujita Health University Hospital , Toyoake ,

   Department of Cardiology, Fujita Health University Hospital, Toyoake, Japan

8. Kengo Tanabe

   Mitsui Memorial Hospital

   Affiliation as printed

   Division of Cardiology, Mitsui Memorial Hospital , Tokyo ,

   Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan

9. Ken Kozuma

   Teikyo University Hospital · Teikyo University

   Affiliation as printed

   Department of Cardiology, Teikyo University Hospital , Tokyo ,

   Department of Cardiology, Teikyo University Hospital, Tokyo, Japan

10. Yukio Ozaki

    Fujita Health University Okazaki Medical Center

    Affiliation as printed

    Department of Cardiology, Fujita Health University Okazaki Medical Center , Okazaki ,

    Department of Cardiology, Fujita Health University Okazaki Medical Center, Okazaki, Japan

11. Scot Garg

    Royal Blackburn Teaching Hospital

    Affiliation as printed

    Department of Cardiology, Royal Blackburn Hospital , Blackburn ,

    Department of Cardiology, Royal Blackburn Hospital, Blackburn, United Kingdom

12. Shengxian Tu

    Shanghai Jiao Tong University

    Affiliation as printed

    School of Biomedical Engineering, Shanghai Jiao Tong University , Shanghai ,

    School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China

13. Jouke Dijkstra Aachen Division of Image Processing (LKEB) Department of Radiology, Leiden University Medical Center

    Leiden University Medical Center

    Affiliation as printed

    Division of Image Processing, Department of Radiology, Leiden University Medical Center , Leiden ,

    Division of Image Processing, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands

14. Christos V. Bourantas

    National Health Service · Queen Mary University of London · Barts Health NHS Trust · William Harvey Research Institute

    Affiliation as printed

    Cardiovascular Devices Hub, Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London , London ,

    Department of Cardiology, Barts Heart Center, Barts Health NHS Trust , London ,

    Cardiovascular Devices Hub, Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom

    Department of Cardiology, Barts Heart Center, Barts Health NHS Trust, London, United Kingdom

15. Yoshinobu Onuma

    Ollscoil na Gaillimhe – University of Galway

    Affiliation as printed

    CORRIB Research Centre for Advanced Imaging and Core Laboratory, University of Galway , University Road, Galway, H91 TK33 ,

    CORRIB Research Centre for Advanced Imaging and Core Laboratory. University of Galway, Ireland

16. Patrick W.J.C. Serruys corresponding

    Ollscoil na Gaillimhe – University of Galway

    Affiliation as printed

    CORRIB Research Centre for Advanced Imaging and Core Laboratory, University of Galway , University Road, Galway, H91 TK33 ,

    CORRIB Research Centre for Advanced Imaging and Core Laboratory. University of Galway, Ireland