Intravascular ultrasound lumen area parameters for assessment of physiological ischemia by fractional flow reserve in intermediate coronary artery stenosis.
Intravascular ultrasound lumen area parameters for assessment of physiological ischemia by fractional flow reserve in intermediate coronary artery stenosis.
- 2012
Available in print through MWHC library: 2002 - present
AIMS: We assessed IVUS measurement accuracy in defining functional ischemia by FFR. BACKGROUND: A fractional flow reserve (FFR) of <0.8 is currently used to guide revascularization in lesions with intermediate coronary stenosis. Whether there is an intravascular ultrasound (IVUS) measurement or a cutoff value that can reliably determine which of these intermediate lesions requires intervention is unclear. CONCLUSION: Anatomic measurements of intermediate coronary lesions obtained by IVUS show a moderate correlation to FFR values. The correlation was better for larger-diameter vessels. Vessel size should always be taken into account when determining the MLA associated with functional ischemia. Copyright 2012. Published by Elsevier Inc. METHODS: The analysis included 205 intermediate lesions (185 patients) located in vessel diameters >2.5 mm. Positive FFR was considered present at <0.8. IVUS measurements were correlated to the FFR findings in intermediate lesions with 40%-70% stenosis. Fifty-four (26.3%) lesions had FFR<0.8. RESULTS: There was moderate correlation between FFR and IVUS measurements, including minimum lumen area (MLA) (r=0.36, P<.001), minimum lumen diameter (MLD) (r=0.25, P=<.001), lesion length (r=-0.43, P<.001), and area stenosis (r=-0.33, P=.01). A receiver operating characteristic curve (ROC) identified MLA<3.09 mm(2) (sensitivity 69.2%, specificity 79.5%) as the best threshold value for FFR<0.8. The correlation between FFR and IVUS was better for large vessels compared to small vessels. ROC analysis identified the best threshold value for FFR<0.8 of MLA<2.4 mm(2) [area under curve (AUC)=0.74] in lesions with reference vessel diameters of 2.5-3 mm, MLA<2.7 mm(2) (AUC=0.77) in lesions with reference vessel diameters of 3-3.5 mm, and MLA<3.6 mm(2) (AUC=0.70) in lesions with reference vessel diameters >3.5 mm.
English
1878-0938
*Coronary Stenosis/us [Ultrasonography]
*Coronary Vessels/us [Ultrasonography]
*Fractional Flow Reserve, Myocardial
*Myocardial Ischemia/us [Ultrasonography]
*Ultrasonography, Interventional
Aged
Cardiac Catheterization
Chi-Square Distribution
Coronary Angiography
Coronary Stenosis/pp [Physiopathology]
Coronary Stenosis/ra [Radiography]
Coronary Vessels/pp [Physiopathology]
District of Columbia
Female
Humans
Linear Models
Logistic Models
Male
Middle Aged
Myocardial Ischemia/pp [Physiopathology]
Myocardial Ischemia/ra [Radiography]
Predictive Value of Tests
Prospective Studies
Registries
ROC Curve
Sensitivity and Specificity
Severity of Illness Index
MedStar Heart & Vascular Institute
Comparative Study
Journal Article
Available in print through MWHC library: 2002 - present
AIMS: We assessed IVUS measurement accuracy in defining functional ischemia by FFR. BACKGROUND: A fractional flow reserve (FFR) of <0.8 is currently used to guide revascularization in lesions with intermediate coronary stenosis. Whether there is an intravascular ultrasound (IVUS) measurement or a cutoff value that can reliably determine which of these intermediate lesions requires intervention is unclear. CONCLUSION: Anatomic measurements of intermediate coronary lesions obtained by IVUS show a moderate correlation to FFR values. The correlation was better for larger-diameter vessels. Vessel size should always be taken into account when determining the MLA associated with functional ischemia. Copyright 2012. Published by Elsevier Inc. METHODS: The analysis included 205 intermediate lesions (185 patients) located in vessel diameters >2.5 mm. Positive FFR was considered present at <0.8. IVUS measurements were correlated to the FFR findings in intermediate lesions with 40%-70% stenosis. Fifty-four (26.3%) lesions had FFR<0.8. RESULTS: There was moderate correlation between FFR and IVUS measurements, including minimum lumen area (MLA) (r=0.36, P<.001), minimum lumen diameter (MLD) (r=0.25, P=<.001), lesion length (r=-0.43, P<.001), and area stenosis (r=-0.33, P=.01). A receiver operating characteristic curve (ROC) identified MLA<3.09 mm(2) (sensitivity 69.2%, specificity 79.5%) as the best threshold value for FFR<0.8. The correlation between FFR and IVUS was better for large vessels compared to small vessels. ROC analysis identified the best threshold value for FFR<0.8 of MLA<2.4 mm(2) [area under curve (AUC)=0.74] in lesions with reference vessel diameters of 2.5-3 mm, MLA<2.7 mm(2) (AUC=0.77) in lesions with reference vessel diameters of 3-3.5 mm, and MLA<3.6 mm(2) (AUC=0.70) in lesions with reference vessel diameters >3.5 mm.
English
1878-0938
*Coronary Stenosis/us [Ultrasonography]
*Coronary Vessels/us [Ultrasonography]
*Fractional Flow Reserve, Myocardial
*Myocardial Ischemia/us [Ultrasonography]
*Ultrasonography, Interventional
Aged
Cardiac Catheterization
Chi-Square Distribution
Coronary Angiography
Coronary Stenosis/pp [Physiopathology]
Coronary Stenosis/ra [Radiography]
Coronary Vessels/pp [Physiopathology]
District of Columbia
Female
Humans
Linear Models
Logistic Models
Male
Middle Aged
Myocardial Ischemia/pp [Physiopathology]
Myocardial Ischemia/ra [Radiography]
Predictive Value of Tests
Prospective Studies
Registries
ROC Curve
Sensitivity and Specificity
Severity of Illness Index
MedStar Heart & Vascular Institute
Comparative Study
Journal Article