Association of Multimodal Intracoronary Imaging-Derived Plaque Morphology with the Pathophysiological Disease Patterns Assessed by the Quantitative Flow Ratio-Pullback Pressure Gradient
Abstract
AIMS: The quantitative flow ratio (QFR)-derived pullback pressure gradient (PPG) characterizes the pathophysiological patterns of coronary atherosclerosis. This study investigated the plaque morphologies associated with these disease patterns. METHODS: This study used the institutional QFR-PPG database registered in the University Hospital Medical Information Network Clinical Trials Registry (UMIN000056097). Patients who underwent elective stenting with pre-procedural optical coherence tomography and near-infrared spectroscopy intravascular ultrasound were included. Offline QFR and QFR-PPG analyses were performed, and the lesions were stratified into tertiles. RESULTS: A total of 168 de novo lesions were analyzed in this study. The QFR tertiles were defined as severe (＜0.61), moderate (0.61-0.71), and mild (＞0.71); the QFR-PPG tertiles were defined as diffuse (＜0.66), intermediate (0.66-0.79), and focal (＞0.79). The Severe QFR tertiles exhibited a smaller minimum lumen area (MLA) and higher frequencies of thin-cap fibroatheroma (TCFA) and layered plaque. In contrast, across the QFR-PPG tertiles, MLA and TCFA frequencies were similar, whereas the diffuse group exhibited more layered plaques and larger calcium angles. The maximum lipid-core burden index did not vary across the QFR-PPG tertiles. A multivariable analysis identified MLA and TCFA as independent predictors of QFR, while layered plaque and calcium angle independently predicted QFR-PPG. However, the lipidic features were not independent predictors of QFR. CONCLUSION: Multimodal intracoronary imaging demonstrated that QFR reflects luminal narrowing and the features of vulnerable plaques. Conversely, QFR-PPG reflects disease diffuseness, characterized by layered plaques and calcium burden rather than lipid-rich features.
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BibTeX
@article{usui2026association,
title = {{Association of Multimodal Intracoronary Imaging-Derived Plaque Morphology with the Pathophysiological Disease Patterns Assessed by the Quantitative Flow Ratio-Pullback Pressure Gradient}},
author = {Eisuke Usui and Yoshihisa Kanaji and Masahiro Hada and Tatsuhiro Nagamine and Hiroki Ueno and Kodai Sayama and Takumi Watanabe and Takahiro Watanabe and Hikaru Shimosato and Takashi Mineo and Riko Murakami and Kaisei Hosokawa and Taishi Yonetsu and Tetsuo Sasano and Tsunekazu Kakuta},
journal = {Journal of Atherosclerosis and Thrombosis},
year = {2026},
month = nov,
doi = {10.5551/jat.66164},
url = {https://www.jstage.jst.go.jp/article/jat/33/11/33_66164/_article},
note = {CC BY-NC-SA},
}
RIS
TY - JOUR
TI - Association of Multimodal Intracoronary Imaging-Derived Plaque Morphology with the Pathophysiological Disease Patterns Assessed by the Quantitative Flow Ratio-Pullback Pressure Gradient
AU - Eisuke Usui
AU - Yoshihisa Kanaji
AU - Masahiro Hada
AU - Tatsuhiro Nagamine
AU - Hiroki Ueno
AU - Kodai Sayama
AU - Takumi Watanabe
AU - Takahiro Watanabe
AU - Hikaru Shimosato
AU - Takashi Mineo
AU - Riko Murakami
AU - Kaisei Hosokawa
AU - Taishi Yonetsu
AU - Tetsuo Sasano
AU - Tsunekazu Kakuta
PY - 2026
DA - 2026/11/01
JO - Journal of Atherosclerosis and Thrombosis
DO - 10.5551/jat.66164
UR - https://www.jstage.jst.go.jp/article/jat/33/11/33_66164/_article
AB - AIMS: The quantitative flow ratio (QFR)-derived pullback pressure gradient (PPG) characterizes the pathophysiological patterns of coronary atherosclerosis. This study investigated the plaque morphologies associated with these disease patterns. METHODS: This study used the institutional QFR-PPG database registered in the University Hospital Medical Information Network Clinical Trials Registry (UMIN000056097). Patients who underwent elective stenting with pre-procedural optical coherence tomography and near-infrared spectroscopy intravascular ultrasound were included. Offline QFR and QFR-PPG analyses were performed, and the lesions were stratified into tertiles. RESULTS: A total of 168 de novo lesions were analyzed in this study. The QFR tertiles were defined as severe (＜0.61), moderate (0.61-0.71), and mild (＞0.71); the QFR-PPG tertiles were defined as diffuse (＜0.66), intermediate (0.66-0.79), and focal (＞0.79). The Severe QFR tertiles exhibited a smaller minimum lumen area (MLA) and higher frequencies of thin-cap fibroatheroma (TCFA) and layered plaque. In contrast, across the QFR-PPG tertiles, MLA and TCFA frequencies were similar, whereas the diffuse group exhibited more layered plaques and larger calcium angles. The maximum lipid-core burden index did not vary across the QFR-PPG tertiles. A multivariable analysis identified MLA and TCFA as independent predictors of QFR, while layered plaque and calcium angle independently predicted QFR-PPG. However, the lipidic features were not independent predictors of QFR. CONCLUSION: Multimodal intracoronary imaging demonstrated that QFR reflects luminal narrowing and the features of vulnerable plaques. Conversely, QFR-PPG reflects disease diffuseness, characterized by layered plaques and calcium burden rather than lipid-rich features.
SN - 1880-3873
SN - 1340-3478
ER -