Lots of interesting abstracts and cases were submitted for TCTAP 2025. Below are the accepted ones after a thorough review by our official reviewers. Don’t miss the opportunity to expand your knowledge and interact with authors as well as virtual participants by sharing your opinion in the comment section!

TCTAP A-055

Plaque Distribution in Functional Focal and Diffuse Coronary Artery Disease

By Koshiro Sakai, Ziad Ali, Takuya Mizukami, Hitoshi Matsuo, Toshiro Shinke, Hirohiko Ando, Tetsuya Amano, Thomas Engstrøm, Jeroen Sonck, Adriaan Wilgenhof, Divaka Perera, Masafumi Nakayama, William Fearon, Brian Ko, Javier Escaned, Daniel Munhoz, Bernard De Bruyne, Nils Johnson, Carlos Collet

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Presenter

Koshiro Sakai

Authors

Koshiro Sakai¹, Ziad Ali², Takuya Mizukami¹, Hitoshi Matsuo³, Toshiro Shinke¹, Hirohiko Ando⁴, Tetsuya Amano⁴, Thomas Engstrøm⁵, Jeroen Sonck⁶, Adriaan Wilgenhof⁶, Divaka Perera⁷, Masafumi Nakayama⁸, William Fearon⁹, Brian Ko¹⁰, Javier Escaned¹¹, Daniel Munhoz⁶, Bernard De Bruyne⁶, Nils Johnson¹², Carlos Collet⁶

Affiliation

Showa University, Japan¹, St Francis Hospital, USA², Gifu Heart Center, Japan³, Aichi Medical University, Japan⁴, University of Copenhagen, Denmark⁵, OLV Clinic, Belgium⁶, Kings College London, United Kingdom⁷, Tokyo D Tower Hospital, Japan⁸, Stanford University, USA⁹, Monash University, Australia¹⁰, Hospital Clinico San Carlos, Spain¹¹, UTHealth Houston, USA¹²

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TCTAP A-055

Invasive Imaging (IVUS, OCT, NIRS, VH, etc)

Plaque Distribution in Functional Focal and Diffuse Coronary Artery Disease

Background

The relationship betweencoronary artery hemodynamics and plaque distribution is not fully understood.The Pullback Pressure Gradient (PPG) is a novel metric that quantifies coronaryartery disease (CAD) patterns as either focal or diffuse based on coronaryphysiology. This study explored the association between PPG and plaque burden(PB) as determined by intravascular ultrasound (IVUS).

Methods

This pre-specified sub-analysis of the PPGGlobal study (NCT04789317). We included stable patients with hemodynamicallysignificant lesions (FFR ≤0.80) undergoing percutaneous coronary intervention(PCI) guided by IVUS. PPG was calculated by manual FFR pullbacks before PCI.Plaque burden was measured at minimal lumen area (MLA) and atheroma plaquevolume (APV) was assessed in the entire target vessel. Functional CAD patternswere classified as focal or diffuse based on the median PPG (0.62).

Results

A total of 261 patients (264vessels) with both PPG and IVUS were included. The mean age was 69 ± 11 years,77% were male, and 33% had diabetes mellitus. PPG and PB were significantlycorrelated (r = 0.53, 95% CI = 0.43 to 0.61, p<0.001). Vessels with focalCAD had significantly higher PB (83.2 ± 5.8% vs. 75.9 ± 8.2%, p <0.001),whereas APVwas similar between vessels with focal and diffuse CAD (466± 226mm³ vs 438 ± 158mm³, p=0.258). Theprevalence of attenuated plaque was significantly higher in vessels with highPPG compared to those with diffuse CAD (68.0 % vs. 38.7 %, p <0.001).Conversely, calcified plaques were more common in vessels with low PPG (59.5 %vs. 77.5 %, p =0.003).

Conclusion

In vessels with flow-limitingstenoses, high PPG is associated with a higher plaque burden. Vessels with highPPG (focal disease) had predominantly lipidic plaque plaques whereas vesselswith diffuse disease exhibited higher calcium burden. These findings enhancethe understanding of the relationship between functional and morphologicalatherosclerosis patterns.

E-Abstract

TCTAP A-055