Vessel fractional flow reserve (vFFR) vs. optical coherence tomography in chronic coronary syndromes (VISION-FFR).

BACKGROUND: Fractional flow reserve (FFR) is the gold standard for evaluating the functional significance of coronary stenosis. With advances in methods based on computational fluid dynamics and three-dimensional vessel reconstructions, non-invasive assessment using indices such as vessel FFR (vFFR) has become feasible. OBJECTIVES: To evaluate the association between vFFR and optical coherence tomography (OCT)-derived parameters in patients with chronic coronary syndromes (CCS). METHODS: In this single-center, prospective, observational study, patients with CCS and intermediate coronary stenoses (40-80% lesions in coronary angiography), undergoing FFR, vFFR, and OCT assessments were enrolled. FFR and vFFR ≤ 0.8 was considered hemodynamically significant. RESULTS: A total of 106 patients with 120 lesions were enrolled. Sixty-two patients had vFFR ≤ 0.8, and 44 patients presented with vFFR > 0.8. The median vFFR in the vFFR-positive group was 0.72 (0.70-0.77) and in the vFFR-negative group 0.88 (0.85-0.92), p < 0.001. The sensitivity of vFFR for identifying FFR-positive lesions was 88.5% with 92.5% specificity, the area under curve was 0.905. On OCT analysis lesions with vFFR ≤ 0.8 had smaller minimal lumen area (MLA) (1.83 ± 0.92 mm2 vs. 2.53 ± 1.33 mm2, p = 0.001) and were longer (16.38 ± 9.66 mm vs. 10.79 ± 6.41 mm, p < 0.001). Multivariate analysis adjusted for gender, age, and left anterior descending artery location revealed that lower vFFR value was an independent predictor of smaller MLA (Exp(B) for logMLA = 0.92, p < 0.001). CONCLUSIONS: vFFR cutoff value of 0.8 presents high accuracy associated with longer and more severe stenosis assessed by OCT in patients with chronic coronary syndromes. TRIAL REGISTRATION: ClinicalTrials.gov ID: NCT06844942.