The association between intravascular ultrasound-derived echo-attenuation and quantitative flow ratio in intermediate coronary lesions

Liang Geng; Yuan Yuan; Peizhao Du; Liming Gao; Yunkai Wang; Jiming Li; Wei Guo; Ying Huang; Qi Zhang

doi:10.21037/cdt-21-402

The association between intravascular ultrasound-derived echo-attenuation and quantitative flow ratio in intermediate coronary lesions

Cardiovasc Diagn Ther. 2021 Dec;11(6):1206-1216. doi: 10.21037/cdt-21-402.

Authors

Liang Geng^#^{1

2}, Yuan Yuan^#³, Peizhao Du⁴, Liming Gao¹, Yunkai Wang¹, Jiming Li¹, Wei Guo¹, Ying Huang¹, Qi Zhang¹

Affiliations

¹ Department of Cardiology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China.
² Department of Cardiology, JI'an Hospital, Shanghai East Hospital, Ji'an, China.
³ Department of Cardiology, Putuo District People's Hospital, Shanghai, China.
⁴ Department of Cardiology, Baoshan Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai, China.

^# Contributed equally.

Abstract

Background: The clinical relevance of moderate coronary stenosis is determined by its morphological characteristics and physiological significance. We investigated the relationship between high-risk plaque characteristics detected by intravascular ultrasound and functional significance assessed with quantitative flow ratio (QFR) in intermediate coronary lesions.

Methods: QFR was retrospectively analyzed in 352 intermediate lesions from 330 patients undergoing intravascular ultrasound examination. The functional significance was defined as QFR ≤0.8. High-risk plaque morphologies including plaque rupture, echo-lucent, echo-attenuation, and spotty calcification were identified, and attenuation indices including maximum angle, attenuation length, and superficial attenuation were determined. Clinically relevant echo-attenuation was defined as an attenuation with a minimum lumen area ≤4.0 mm² and plaque burden ≥70%.

Results: The prevalence of echo-attenuation was higher (63.0% vs. 37.6%, P=0.001) and attenuation length was longer (12.8±10.3 vs. 8.0±5.8 mm, P=0.015) in lesions with QFR ≤0.8 compared to those with QFR >0.8, associated with a higher rate of clinically relevant echo-attenuation (35.2% vs. 10.4%, P<0.001). On multivariable analysis, the presence of echo-attenuation was an independent predictor of QFR ≤0.8 [odds ratio (OR) 3.162, 95% confidence interval (CI): 1.263-7.917, P=0.014], whereas attenuation length was weakly correlated with QFR value (β=-0.185, B=-0.002, 95% CI: -0.004 to -0.001, P=0.001). Receiver-operating characteristic curve analysis revealed that the best cutoff of QFR in predicting clinically relevant echo-attenuation was 0.82 [area under the curve (AUC) =0.696, 95% CI: 0.616-0.775, P<0.001].

Conclusions: The presence of intravascular ultrasound-derived echo-attenuation confers an increased risk of QFR-defined functional significance in intermediate coronary lesions.

Keywords: Coronary artery disease; intermediate coronary lesion; quantitative flow ratio (QFR); intravascular ultrasound (IVUS); echo-attenuation.