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Multicenter Study
. 2024 Jun 3;20(11):e699-e706.
doi: 10.4244/EIJ-D-23-00713.

Impact of hyperaemic stenosis resistance on long-term outcomes of stable angina in the ILIAS Registry

Coen K M Boerhout  1 , Mauro Echavarría-Pinto  2 , Guus A de Waard  3 , Joo Myung Lee  4 , Hernán Mejía-Rentería  5 , Seung Hun Lee  6 , Ji-Hyun Jung  7 , Masahiro Hoshino  8 , Hitoshi Matsuo  8 , Maribel Madera-Cambero  9 , Ashkan Eftekhari  10 , Mohamed A Effat  11 , Tadashi Murai  12 , Koen Marques  1 , Joon-Hyung Doh  13 , Evald H Christiansen  14 , Rupak Banerjee  15 , Chang-Wook Nam  16 , Giampaolo Niccoli  17 , Masafumi Nakayama  18   19 , Nobuhiro Tanaka  20 , Eun-Seok Shin  21 , Marcel A M Beijk  1 , Niels van Royen  3 , Paul Knaapen  1 , Javier Escaned  5 , Tsunekzu Kakuta  12 , Bon-Kwon Koo  22 , Jan J Piek  1 , Tim P van de Hoef  1   23 , Martijn Meuwissen  24
Affiliations
Multicenter Study

Impact of hyperaemic stenosis resistance on long-term outcomes of stable angina in the ILIAS Registry

Coen K M Boerhout et al. EuroIntervention. .

Abstract

Background: The hyperaemic stenosis resistance (HSR) index was introduced to provide a more comprehensive indicator of the haemodynamic severity of a coronary lesion. HSR combines both the pressure drop across a lesion and the flow through it. As such, HSR overcomes the limitations of the more traditional fractional flow reserve (FFR) or coronary flow reserve (CFR) indices.

Aims: We aimed to identify the diagnostic and prognostic value of HSR and evaluate the clinical implications.

Methods: Patients with chronic coronary syndromes (CCS) and obstructive coronary artery disease were selected from the multicentre ILIAS Registry. For this study, only patients with combined Doppler flow and pressure measurements were included.

Results: A total of 853 patients with 1,107 vessels were included. HSR more accurately identified the presence of inducible ischaemia compared to FFR and CFR (area under the curve 0.71 vs 0.66 and 0.62, respectively; p<0.005 for both). An abnormal HSR measurement was an independent and important predictor of target vessel failure at 5-year follow-up (hazard ratio 3.80, 95% confidence interval: 2.12-6.73; p<0.005). In vessels deferred from revascularisation, HSR seems to identify more accurately those vessels that may benefit from revascularisation rather than FFR and/or CFR.

Conclusions: The present study affirms the theoretical advantages of the HSR index for the detection of ischaemia-Âinducing coronary lesions in a large CCS population. (Inclusive Invasive Physiological Assessment in Angina Syndromes Registry [ILIAS Registry], ClinicalTrials.gov: NCT04485234).

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Conflict of interest statement

T.P. van de Hoef has received speaker fees and institutional research grants from Abbott and Philips. J.M. Lee has received research grants from Abbott and Philips. M. Echavarría-Pinto has received speaker fees from Abbott and Philips. C-W. Nam has received institutional research grants from Abbott. B-K. Koo has received institutional research grants from Abbott and Philips/Volcano. J.J. Piek has received support as a consultant for Philips/Volcano; and has received institutional research grants from Philips. The other authors have no conflicts of interest to declare related to this work.

Figures

Figure 1
Figure 1. Receiver-operating characteristic (ROC) curves for HSR, FFR and CFR for the presence of inducible ischaemia on non-invasive modalities.
CFR: coronary flow reserve; FFR: fractional flow reserve; HSR: hyperaemic stenosis resistance
Figure 2
Figure 2. Kaplan-Meier curves for the cumulative incidence of target vessel failure (TVF) at 5-year follow-up.
The curves show the TVF rate stratified by HSR (A), FFR (B) and CFR (C). CFR: coronary flow reserve; CI: confidence interval; FFR: fractional flow reserve; HR: hazard ratio; HSR: hyperaemic stenosis resistance
Figure 3
Figure 3. Kaplan-Meier curves for the cumulative incidence of target vessel failure (TVF) at 5-year follow-up.
The curves show the TVF rate stratified by the concordance between FFR and HSR (A), and CFR and HSR (B). CFR: coronary flow reserve; FFR: fractional flow reserve; HSR: hyperaemic stenosis resistance
Central illustration
Central illustration. Clinical value of hyperaemic stenosis resistance in stable angina.
A general overview of the results of this study. A) Hyperaemic stenosis resistance (HSR) is derived from the ratio between the pressure drop across a stenosis and the flow through it. B) The HSR has a significant higher predictive power to detect ischaemia, is a strong and independent predictor of TVF (C) , and seems to have additional clinical value for risk stratification in vessels deferred from revascularisation (D). CFR: coronary flow reserve; FFR: fractional flow reserve; hAPV: hyperaemic average peak flow velocity; Pa: aortic pressure; Pd: distal pressure; ROC: receiver-operating characteristic; TVF: target vessel failure
See this image and copyright information in PMC

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