Skip to main content
SpringerLink
Log in

Intravascular Ultrasound-Based Fractional Flow Reserve for Predicting Prognosis after Percutaneous Coronary Intervention

  • Original Article
  • Published:
Journal of Cardiovascular Translational Research Aims and scope Submit manuscript

Abstract

AccuFFRivus is an alternative to fractional flow reserve (FFR) based on intravascular ultrasound (IVUS) images for functional assessment of coronary stenosis. However, its prognostic impact in patients undergoing percutaneous coronary intervention (PCI) is still unclear. This retrospective study aimed to investigate the capability of AccuFFRivus in predicting prognosis. AccuFFRivus was calculated based on postoperative angiographic and IVUS images. Vessel-oriented clinical events (VOCE) at 2 years were recorded and analyzed. A total of 131 participants with 131 vessels were included in the study. VOCE occurred in 15 patients during 2-year follow-up. AccuFFRivus after PCI (post-AccuFFRivus) was significantly higher in the non-VOCE group than in the VOCE group (0.95 ± 0.03 vs. 0.91 ± 0.02, p < 0.001). Multivariate Cox regression showed that AccuFFRivus ≤ 0.94 was a strong independent predictor of VOCE during 2-year follow-up (hazard ratio 23.76, 95% confidence interval: 3.04–185.81, p < 0.001).

Graphical Abstract

The left panel displays the Receiver operating characteristics (ROC) curves of postoperative parameters (post-AccuFFRivus and post-MLA) versus vessel-oriented clinical events (VOCE) occurrence within 2-year follow-up. The right panel demonstrates Kaplan–Meier curves of VOCE stratified by the optimal cut-off of post-AccuFFRivus.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Data Availability

The datasets that support the findings of this study are available from the corresponding author on reasonable request.

Abbreviations

AUC:

Area under the curve

CCTA:

Coronary computed tomographic angiography

CFD:

Computational fluid dynamic

DES:

Drug-eluting stent

DS:

Diameter stenosis

ESC:

European Society of Cardiology

FFR:

Fractional flow reserve

ICA:

Invasive coronary angiography

IVUS:

Intravascular ultrasound

MI:

Myocardial infarction

MLA:

Minimal lumen area

PCI:

Percutaneous coronary intervention

ROC:

Receiver operating characteristic

RVD:

Reference vessel diameter

TIMI:

Thrombolysis in myocardial infarction

TVR:

Target vessel revascularization

VOCE:

Vessel-oriented clinical event

References

  1. Klersy C, Ferlini M, Raisaro A, Scotti V, Balduini A, Curti M, Bramucci E, De Silvestri A. Use of IVUS guided coronary stenting with drug eluting stent: a systematic review and meta-analysis of randomized controlled clinical trials and high quality observational studies. Int J Cardiol. 2013;170:54–63. https://doi.org/10.1016/j.ijcard.2013.10.002.

    Article  PubMed  Google Scholar 

  2. Steinvil A, Zhang YJ, Lee SY, Pang S, Waksman R, Chen SL, Garcia-Garcia HM. Intravascular ultrasound-guided drug-eluting stent implantation: an updated meta-analysis of randomized control trials and observational studies. Int J Cardiol. 2016;216:133–9. https://doi.org/10.1016/j.ijcard.2016.04.154.

    Article  PubMed  Google Scholar 

  3. Collet JP, Thiele H, Barbato E, et al. 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J. 2021;42:1289–367. https://doi.org/10.1093/eurheartj/ehaa575.

    Article  PubMed  Google Scholar 

  4. Tonino PAL, De Bruyne B, Pijls NHJ, Siebert U, Ikeno F, van’ t Veer M, Klauss V, Manoharan G, Engstrøm T, Oldroyd KG, Ver Lee PN, MacCarthy PA, Fearon WF, FAME Study Investigators. Fractional flow reserve versus angiography for guiding percutaneous coronary intervention. N Engl J Med. 2009;360:213–24. https://doi.org/10.1056/NEJMoa0807611.

    Article  CAS  PubMed  Google Scholar 

  5. De Bruyne B, Pijls NHJJ, Kalesan B, et al. Fractional flow reserve-guided PCI versus medical therapy in stable coronary disease. N Engl J Med. 2012;367:991–1001. https://doi.org/10.1056/nejmoa1205361.

    Article  PubMed  Google Scholar 

  6. Tu S, Barbato E, Köszegi Z, Yang J, Sun Z, Holm NR, Tar B, Li Y, Rusinaru D, Wijns W, Reiber JHC. Fractional flow reserve calculation from 3-dimensional quantitative coronary angiography and TIMI frame count: a fast computer model to quantify the functional significance of moderately obstructed coronary arteries. JACC Cardiovasc Interv. 2014;7:768–77. https://doi.org/10.1016/j.jcin.2014.03.004.

    Article  PubMed  Google Scholar 

  7. Koo B-K, Erglis A, Doh J-H, Daniels DV, Jegere S, Kim H-S, Dunning A, DeFrance T, Lansky A, Leipsic J, Min JK. Diagnosis of ischemia-causing coronary stenoses by noninvasive fractional flow reserve computed from coronary computed tomographic angiograms. Results from the prospective multicenter DISCOVER-FLOW (Diagnosis of Ischemia-Causing Stenoses Obtained Via Noni. J Am Coll Cardiol. 2011;58:1989–97. https://doi.org/10.1016/j.jacc.2011.06.066.

    Article  PubMed  Google Scholar 

  8. Jiang J, Feng L, Li C, Xia Y, He J, Leng X, Dong L, Hu X, Wang J, Xiang J. Fractional flow reserve for coronary stenosis assessment derived from fusion of intravascular ultrasound and X-ray angiography. Quant Imaging Med Surg. 2021;11:4543–55. https://doi.org/10.21037/qims-20-1324.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Liu L, Ding F, Gutiérrez-Chico JL, Zhu J, Zhu Z, Du R, Yang Z, Hu J, Tu S, Zhang R. Prognostic value of post-procedural μQFR for drug-coated balloons in the treatment of in-stent restenosis. Cardiol J. 2021;XX:1–11. https://doi.org/10.5603/CJ.a2021.0154.

    Article  Google Scholar 

  10. Kirigaya H, Okada K, Hibi K, Maejima N, Iwahashi N, Matsuzawa Y, Minamimoto Y, Kosuge M, Ebina T, Tamura K, Kimura K. Post-procedural quantitative flow ratio gradient and target lesion revascularization after drug-coated balloon or plain-old balloon angioplasty. J Cardiol. 2022. https://doi.org/10.1016/j.jjcc.2022.07.007.

    Article  PubMed  Google Scholar 

  11. Dong L, Jiang W, Lu W, Jiang J, Zhao Y, Song X, Leng X, Zhao H, Wang J, Li C, Xiang J. Automatic segmentation of coronary lumen and external elastic membrane in intravascular ultrasound images using 8-layer U-Net. Biomed Eng Online. 2021;20:1–9. https://doi.org/10.1186/s12938-021-00852-0.

    Article  CAS  Google Scholar 

  12. Gibson CM, Cannon CP, Daley WL, Dodge JT, Alexander B, Marble SJ, McCabe CH, Raymond L, Fortin T, Poole WK, Braunwald E. TIMI frame count: a quantitative method of assessing coronary artery flow. Circulation. 1996;93:879–88. https://doi.org/10.1161/01.cir.93.5.879.

    Article  CAS  PubMed  Google Scholar 

  13. Thygesen K, Alpert JS, Jaffe AS, Chaitman BR, Bax JJ, Morrow DA, White HD. Fourth universal definition of myocardial infarction (2018). J Am Coll Cardiol. 2018;72:2231–64. https://doi.org/10.1016/j.jacc.2018.08.1038.

    Article  PubMed  Google Scholar 

  14. Garcia-Garcia HM, McFadden EP, Farb A, Mehran R, Stone GW, Spertus J, Onuma Y, Morel MA, Van Es GA, Zuckerman B, Fearon WF, Taggart D, Kappetein AP, Krucoff MW, Vranckx P, Windecker S, Cutlip D, Serruys PW. Standardized end point definitions for coronary intervention trials. Eur Heart J. 2018;39:2192–207. https://doi.org/10.1093/eurheartj/ehy223.

    Article  PubMed  Google Scholar 

  15. Ono M, Kawashima H, Hara H, et al. Advances in IVUS/OCT and future clinical perspective of novel hybrid catheter system in coronary imaging. Front Cardiovasc Med. 2020;7:1–16. https://doi.org/10.3389/fcvm.2020.00119.

    Article  Google Scholar 

  16. Hong SJ, Kim BK, Shin DH, et al. Effect of intravascular ultrasound-guided vs angiography- guided everolimus-eluting stent implantation: the IVUS-XPL randomized clinical trial. JAMA - J Am Med Assoc. 2015;314:2155–63. https://doi.org/10.1001/jama.2015.15454.

    Article  CAS  Google Scholar 

  17. Zhang J, Gao X, Kan J, et al. Intravascular ultrasound versus angiography-guided drug-eluting stent implantation: the ULTIMATE Trial. J Am Coll Cardiol. 2018;72:3126–37. https://doi.org/10.1016/j.jacc.2018.09.013.

    Article  PubMed  Google Scholar 

  18. Neumann FJ, Sousa-Uva M, Ahlsson A, et al. 2018 ESC/EACTS Guidelines on myocardial revascularization. Eur Heart J. 2019;40:87–165. https://doi.org/10.1093/eurheartj/ehy394.

    Article  PubMed  Google Scholar 

  19. Kang SJ, Lee JY, Ahn JM, Mintz GS, Kim WJ, Park DW, Yun SC, Lee SW, Kim YH, Lee CW, Park SW, Park SJ. Validation of intravascular ultrasound-derived parameters with fractional flow reserve for assessment of coronary stenosis severity. Circ Cardiovasc Interv. 2011;4:65–71. https://doi.org/10.1161/CIRCINTERVENTIONS.110.959148.

    Article  PubMed  Google Scholar 

  20. Waksman R, Legutko J, Singh J, Orlando Q, Marso S, Schloss T, Tugaoen J, Devries J, Palmer N, Haude M, Swymelar S, Torguson R. FIRST: fractional flow reserve and intravascular ultrasound relationship study. J Am Coll Cardiol. 2013;61:917–23. https://doi.org/10.1016/j.jacc.2012.12.012.

    Article  PubMed  Google Scholar 

  21. Naganuma T, Latib A, Costopoulos C, Takagi K, Naim C, Sato K, Miyazaki T, Kawaguchi M, Panoulas VF, Basavarajaiah S, Figini F, Chieffo A, Montorfano M, Carlino M, Colombo A. The role of intravascular ultrasound and quantitative angiography in the functional assessment of intermediate coronary lesions: correlation with fractional flow reserve. Cardiovasc Revascularization Med. 2014;15:3–7. https://doi.org/10.1016/j.carrev.2013.11.002.

    Article  Google Scholar 

  22. Yu W, Tanigaki T, Ding D, Wu P, Du H, Ling L, Huang B, Li G, Yang W, Zhang S, Yan F, Okubo M, Xu B, Matsuo H, Wijns W, Tu S. Accuracy of intravascular ultrasound-based fractional flow reserve in identifying hemodynamic significance of coronary stenosis. Circ Cardiovasc Interv. 2021;14:E009840. https://doi.org/10.1161/CIRCINTERVENTIONS.120.009840.

    Article  CAS  PubMed  Google Scholar 

  23. Klauss V, Erdin P, Rieber J, Leibig M, Stempfle HU, König A, Baylacher M, Theisen K, Haufe MC, Sroczynski G, Schiele T, Siebert U. Fractional flow reserve for the prediction of cardiac events after coronary stent implantation: results of a multivariate analysis. Heart. 2005;91:203–6. https://doi.org/10.1136/hrt.2003.027797.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Johnson NP, Tóth GG, Lai D, et al. Prognostic value of fractional flow reserve: linking physiologic severity to clinical outcomes. J Am Coll Cardiol. 2014;64:1641–54. https://doi.org/10.1016/j.jacc.2014.07.973.

    Article  PubMed  Google Scholar 

  25. Tang J, Hou H, Chu J, Chen F, Yao Y, Gao Y, Ye Z, Zhuang S, Lai Y, Liu X. Clinical implication of quantitative flow ratio to predict clinical events after drug-coated balloon angioplasty in patients with in-stent restenosis. Clin Cardiol. 2021;44:978–86. https://doi.org/10.1002/clc.23630.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Cai X, Tian F, Jing J, Jin Q, Zhou S, Yin W, Chen Y, Wu Q, Fu Z, Chen Y. Prognostic value of quantitative flow ratio measured immediately after drug-coated balloon angioplasty for in-stent restenosis. Catheter Cardiovasc Interv. 2021;97:1048–54. https://doi.org/10.1002/ccd.29640.

    Article  PubMed  Google Scholar 

  27. Byrne RA, Joner M, Kastrati A. Stent thrombosis and restenosis: What have we learned and where are we going? the Andreas Grüntzig Lecture ESC 2014. Eur Heart J. 2015;36:3320–31. https://doi.org/10.1093/eurheartj/ehv511.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Tindale A, Panoulas V. Real-world intravascular ultrasound (IVUS) use in percutaneous intervention-naïve patients is determined predominantly by operator, patient, and lesion characteristics. Front Cardiovasc Med. 2022;9:1–11. https://doi.org/10.3389/fcvm.2022.974161.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Cardiology, The First People’s Hospital of Xiaoshan District, Hangzhou, China

    Jianzhen Huang, Huibin Li & Wenjuan Wei

  2. ArteryFlow Technology Co., Ltd., Hangzhou, China

    Xinyi Yang, Yumeng Hu, Xiaochang Leng & Jianping Xiang

Authors
  1. Jianzhen Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Xinyi Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yumeng Hu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Huibin Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Xiaochang Leng
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jianping Xiang
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Wenjuan Wei
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Conception and design: all authors; Project administration: Jianzhen Huang, Huibin Li; Analysis and interpretation of data: Jianzhen Huang, Xinyi Yang, Yumeng Hu; Writing—original draft preparation: Xinyi Yang, Writing—review and editing: Yumeng Hu, Jianzhen Huang, Xiaochang Leng; supervision: Wenjuan Wei, Jianping Xiang; and final approval of the manuscript: all authors.

Corresponding author

Correspondence to Wenjuan Wei.

Ethics declarations

Ethics Approval

The study was conducted in accordance with the Declaration of Helsinki and Good Clinical Practice. The study was approved by the instutional review board of The First People's Hospital of Xiaoshan District, and individual consent for this retrospective study was waived.

Conflicts of Interest

All authors have completed the ICMJE uniform disclosure form. Xinyi Yang and Yumeng Hu are employees of ArteryFlow. Xiaochang Leng is a cofounder of ArteryFlow. Jianping Xiang is the chief executive officer of ArteryFlow. The other authors have no conflicts of interest to declare.

Additional information

Editor-in-Chief Enrique Lara-Pezzi oversaw the review of this article

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Huang, J., Yang, X., Hu, Y. et al. Intravascular Ultrasound-Based Fractional Flow Reserve for Predicting Prognosis after Percutaneous Coronary Intervention. J. of Cardiovasc. Trans. Res. 16, 1417–1424 (2023). https://doi.org/10.1007/s12265-023-10409-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12265-023-10409-2

Keywords

Search

Navigation