European heart journal open · 2026
Association of physiological discordance between fractional flow reserve and non-hyperaemic pressure ratios with lipid-rich plaque burden.
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Aikawa Hirohiko, Murai Kota, Kataoka Yu, Nakaoku Yuriko, Ogata Soshiro, Mitsui Kentaro, Iwai Takamasa, Sawada Kenichiro, Matama Hideo, Miura Hiroyuki, Honda Satoshi, Fujino Masashi, Yoneda Shuichi, Nakao Kazuhiro, Takagi Kensuke, Asaumi Yasuhide, Nishimura Kunihiro, Noguchi Teruo
Аннотация
AIMS: Fractional flow reserve (FFR) and non-hyperaemic pressure ratios (NHPRs) frequently yield discordant results in clinical practice, yet the mechanisms underlying this mismatch remain uncertain. Plaque composition has been suggested to influence FFR, raising the possibility that discordance reflects the features of lipid-rich plaque (LRP). This study aimed to investigate whether physiological discordance between FFR and NHPR is associated with increased lipid burden.
METHODS AND RESULTS: We retrospectively analysed 217 intermediate coronary lesions from 189 patients who underwent FFR, NHPR, and near-infrared spectroscopy with intravascular ultrasound imaging. Lesions were classified using established cut-offs for FFR (0.80) and NHPR (0.89). Lipid burden was quantified by the maximum lipid core burden index within any 4-mm segment (maxLCBI4mm). Lipid-rich plaque was defined as maxLCBI4mm > 400. The clinical endpoint was 3-year target vessel failure (TVF). Physiological discordance occurred in 24.0% of lesions, predominantly as an FFR+/NHPR- pattern (19.8%). FFR was independently associated with maxLCBI4mm [β, 65.2; 95% confidence interval (CI), 29.0-101.5; P < 0.001], whereas NHPR was not (β, 16.5; 95% CI, -15.9 to 49.0; P = 0.316). The FFR+/NHPR- group demonstrated the highest maxLCBI4mm (525 ± 201) and the greatest prevalence of LRP (65.1%; both P < 0.001). In multivariable analysis, the FFR+/NHPR- pattern independently predicted LRP [adjusted odds ratio, 6.12; 95% CI, 1.20-31.28; P = 0.030]. TVF occurrences did not differ significantly across physiological groups.
CONCLUSION: FFR+/NHPR- lesions exhibit markedly greater lipid burden, suggesting that hyperaemia-based indices better capture plaque vulnerability than resting physiology. This pattern may serve as a marker of plaque vulnerability, suggesting that deferral of FFR+/NHPR- lesions could warrant caution given their higher lipid burden.
METHODS AND RESULTS: We retrospectively analysed 217 intermediate coronary lesions from 189 patients who underwent FFR, NHPR, and near-infrared spectroscopy with intravascular ultrasound imaging. Lesions were classified using established cut-offs for FFR (0.80) and NHPR (0.89). Lipid burden was quantified by the maximum lipid core burden index within any 4-mm segment (maxLCBI4mm). Lipid-rich plaque was defined as maxLCBI4mm > 400. The clinical endpoint was 3-year target vessel failure (TVF). Physiological discordance occurred in 24.0% of lesions, predominantly as an FFR+/NHPR- pattern (19.8%). FFR was independently associated with maxLCBI4mm [β, 65.2; 95% confidence interval (CI), 29.0-101.5; P < 0.001], whereas NHPR was not (β, 16.5; 95% CI, -15.9 to 49.0; P = 0.316). The FFR+/NHPR- group demonstrated the highest maxLCBI4mm (525 ± 201) and the greatest prevalence of LRP (65.1%; both P < 0.001). In multivariable analysis, the FFR+/NHPR- pattern independently predicted LRP [adjusted odds ratio, 6.12; 95% CI, 1.20-31.28; P = 0.030]. TVF occurrences did not differ significantly across physiological groups.
CONCLUSION: FFR+/NHPR- lesions exhibit markedly greater lipid burden, suggesting that hyperaemia-based indices better capture plaque vulnerability than resting physiology. This pattern may serve as a marker of plaque vulnerability, suggesting that deferral of FFR+/NHPR- lesions could warrant caution given their higher lipid burden.