Diagnostic Accuracy of ASLA Score (A Novel CT Angiographic Index) and Aggregate Plaque Volume in the Assessment of Functional Significance of Coronary Stenosis

Background: Intravascular Ultrasound (IVUS) is a supportive tool for coronary angiography in evaluating intermediate coronary lesions. However, old cut-off value of 4mm2 of IVUS Minimal Lumen Area (MLA) has been proved very low diagnosic accuracy. Objective: We aimed to assess a new cut-off value of IVUS MLA and its diagnostic performance to predict ischemia, using fractional flow reserve (FFR) as gold standard. Methods: Denovo Intermediate lesions were evaluated with both IVUS and FFR. A total of 32 lesions were enrolled into the study. Results: Thirty two patients, who had denovo intermediate lesions distributing at prox-mid segment of RCA (31.3%), LAD (59.4%) and LCx (6.2%), were enrolled into this study, with average age: 63.97±11.59 (years), male: 71.9% and female: 28.1%, mean diameter stenosis: 50.68% ± 8.83 and mean reference diameter: 2.99 mm ± 0.61mm. IVUS MLA (r = 0.386, p < 0.014) correlated with FFR. The stenotic diameter (r = -0.159, p < 0.192), the length (r = -0.052, p = 0.389) and the plaque volume (r = -0.105, p = 0.284) didn’t well correlate with FFR. Best cut-off value (BCV) of IVUS MLA to define the functional significance (FFR ≤0.8) was 2.55 mm2 (AUC 0.776; 95% CI 0.607-0.946) with sensitivity and specitivity were 66.7% and 88.2% respectively. Conclusion: In this study, an IVUS MLA of 2.55 mm2 was the BCV to define the functional significance of denovo intermediate coronary stenosis. However, when IVUS MLA is used to determine the functional significance, both the lesion diameter and length should be considered. Key words: intermediate lesion, intravascular ultrasound (IVUS), Fractional Flow Reserve (FFR)

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Transesophageal dobutamine–atropine stress echocardiography: diagnostic accuracy for coronary stenosis detection and localization

International Journal of Cardiology ◽

10.1016/s0167-5273(96)02722-2 ◽

1996 ◽

Vol 56 (2) ◽

pp. 185-192

Author(s):

M Shahi

Keyword(s):

Diagnostic Accuracy ◽

Coronary Stenosis ◽

Stress Echocardiography ◽

Stenosis Detection ◽

Detection And Localization

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SALINE-INDUCED PD/PA RATIO CAN EASILY AND ACCURATELY EVALUATE FUNCTIONAL SIGNIFICANCE OF CORONARY STENOSIS

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(21)02377-9 ◽

2021 ◽

Vol 77 (18) ◽

pp. 1018

Author(s):

Ryo Takano ◽

Yoshiharu Fujimori ◽

Daisuke Yokota ◽

Naoki Koike ◽

Tomoko Baba ◽

...

Keyword(s):

Functional Significance ◽

Coronary Stenosis

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Differential impact of target vessel on the diagnostic performance of resting full-cycle ratio as non-hyperemic physiological assessment

European Heart Journal ◽

10.1093/ehjci/ehaa946.2480 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

H Takashima ◽

H Ohashi ◽

H Ando ◽

A Suzuki ◽

S Sakurai ◽

...

Keyword(s):

Coronary Artery ◽

Diagnostic Accuracy ◽

Functional Significance ◽

Diagnostic Performance ◽

Coronary Artery Stenosis ◽

Stable Condition ◽

Artery Stenosis ◽

Lesion Length ◽

Target Vessel ◽

Roc Curve Analysis

Abstract Background Recently, wire-based resting indices have been recognized as gold standard for evaluating physiological lesion assessment. The resting full-cycle ratio (RFR) is a unique resting index which is calculated as the point of absolutely lowest distal pressure to aortic pressure during entire cardiac cycle. It is unclear whether the diagnostic performance of RFR for detecting functional coronary artery stenosis is similar in each coronary artery. The aim of this study is to compare the diagnostic performance of RFR based on target coronary vessel. Method This study was a prospectively enrolled observational study. A total of 156 consecutive patients with 220 intermediate lesions were enrolled in this study. The RFR was measured after adequately waiting for stable condition, while FFR was measured after intravenous administration of ATP (180mcg/kg/min). Lesions with FFR ≤0.80 were considered functionally significant coronary artery stenosis. Results In all lesions, reference diameter, diameter stenosis, lesion length, RFR, and FFR were 3.0±0.7mm, 45±13%, 13.0±8.8mm, 0.90±0.09, and 0.82±0.10, respectively. Functional significance was observed in 88 lesions (40%) of all lesions. RFR showed a significant correlation with FFR in overall lesions (r=0.774, p<0.001). The ROC curve analysis of RFR showed good accuracy for predicting functional significance (AUC 0.87, diagnostic accuracy 81%) in all subjects. Regarding each target vessel, there were similar and significant positive correlation between RFR and FFR (LAD; r=0.733, p<0.001, LCX; r=0.771, p<0.001, RCA; r=0.769, p<0.001, respectively). The prevalence of discordant between RFR and FFR was significantly different among 3 vessels (LAD 26%, LCX 12%, RCA 13%, respectively, p<0.05 for among 3 groups). Regarding the comparison of ROC curves according to lesion location, AUC was significantly lower in LAD than in LCX and RCA (LAD 0.780, LCX 0.947, RCA 0.926, p<0.01 for LAD compared to LCX, p<0.01 for LAD compared to RCA, respectively). Furthermore, the diagnostic accuracy was significantly different according to target vessel (LAD 74%, LCX 88%, RCA 87%, respectively, p<0.05 for among 3 vessels). Conclusion RFR demonstrated better diagnostic accuracy for evaluating functional lesion severity. The diagnostic performance of RFR was different based on target vessel. RFR is a unique and useful resting index, and it may detect functionally significant coronary stenosis that cannot be detected with other resting indices in daily practice. Funding Acknowledgement Type of funding source: None

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Abstract 18795: Resting Patient- and Vessel-Specific Myocardial Perfusion Attenuation Patterns Improves Diagnostic Performance of Coronary Computed Tomographic Angiography

Circulation ◽

10.1161/circ.130.suppl_2.18795 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Guanglei Xiong ◽

Iksung Cho ◽

Heidi Gransar ◽

Deeksha Kola ◽

Kimberly Elmore ◽

...

Keyword(s):

Myocardial Perfusion ◽

Diagnostic Accuracy ◽

Coronary Stenosis ◽

Diagnostic Performance ◽

Ct Perfusion ◽

Quantitative Coronary Angiography ◽

High Grade ◽

Operating Characteristics ◽

Luminal Diameter ◽

Coronary Stenoses

Introduction: Coronary CT angiography (CCTA) demonstrates improved performance for diagnosis of high-grade coronary stenoses, but may be affected by artifacts and overestimation of stenosis severity. Whether the addition of resting myocardial perfusion attenuation patterns subtended by stenosis seen on CCTA improves diagnostic performance has not been examined to date. Methods: We evaluated 127 patients (mean age 53.0, 54.3% male) who underwent CCTA and ICA. Percentage of coronary stenosis was assessed by quantitative coronary angiography (QCA), which served as the reference comparator to CCTA. CCTA stenosis was categorized as 0%, 1-24%, 25-49%, 50-69%, 70-99%, and 100% luminal diameter reduction. Automated software (SmartHeart, Redwood City, CA) was used to measure resting CT perfusion attenuation patterns in myocardial segments by AHA 17-segment model. Segmental CT attenuation values were assigned to territories subtended by left anterior descending (LAD), left circumflex (LCX), and right coronary arteries (RCA). Per-patient and per-vessel analyses were based on highest severity (maximal stenosis, minimal attenuation). On both per-patient and per-vessel basis, logistic regression was devised for CCTA stenosis alone and for CCTA plus resting myocardial attenuation. Diagnostic accuracy and area under the receiver operating characteristics curve (AUC) were determined. Results: Diagnostic accuracy of CCTA alone was 84.0%, 85.5%, 90.4%, and 88.6%, at per-patient, per-LAD, per-LCX and per-RCA level, respectively. In comparison, the accuracy of CCTA plus myocardial attenuation were 89.6%, 91.9%, 95.2%, and 92.7%. The AUCs using CCTA alone to discriminate QCA-confirmed coronary stenoses >70% were 0.823 (95% CI: 0.737-0.909), 0.782 (95% CI: 0.667-0.898), 0.690 (95% CI: 0.503-0.878), and 0.793 (95% CI: 0.640-0.945) for per-patient, per-LAD, per-LCX, and per-RCA analysis, respectively. The AUCs using CCTA plus myocardial attenuation improved to 0.864 (95% CI: 0.765-0.962), 0.881 (95% CI: 0.793-0.968), 0.772 (95% CI: 0.535-1.000), and 0.820 (95% CI: 0.685-0.954). Conclusions: The addition of resting CT myocardial perfusion attenuation patterns improves identification and discrimination of high-grade coronary stenosis by CCTA.

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2231Improvement in diagnostic accuracy of single-vessel coronary stenosis by the analysis of post-systolic shortening derived from non-stress speckle tracking echocardiography

European Heart Journal ◽

10.1093/eurheartj/ehy565.2231 ◽

2018 ◽

Vol 39 (suppl_1) ◽

Author(s):

T Ishigaki ◽

T Asanuma ◽

N Yagi ◽

H Izumi ◽

S Shimizu ◽

...

Keyword(s):

Diagnostic Accuracy ◽

Coronary Stenosis ◽

Speckle Tracking ◽

Speckle Tracking Echocardiography ◽

Single Vessel

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TCT CONNECT-202 Diagnostic Accuracy of Novel Ultrasonic Flow Ratio in Identifying Hemodynamical Significance of Coronary Stenosis

Journal of the American College of Cardiology ◽

10.1016/j.jacc.2020.09.217 ◽

2020 ◽

Vol 76 (17) ◽

pp. B86

Author(s):

Wei Yu ◽

Toru Tanigaki ◽

Daixin Ding ◽

Peng Wu ◽

Haiyan Du ◽

...

Keyword(s):

Diagnostic Accuracy ◽

Coronary Stenosis ◽

Flow Ratio

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P6171Role of myocardial mass for identifying FFR-verified ischemia and determining therapeutic strategy

European Heart Journal ◽

10.1093/eurheartj/ehz746.0777 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

H Kawai ◽

S Motoyama ◽

K Miyajima ◽

M Hoshino ◽

M Ohta ◽

...

Keyword(s):

Myocardial Ischemia ◽

Coronary Stenosis ◽

Therapeutic Strategy ◽

Coronary Revascularization ◽

Plaque Burden ◽

Myocardial Mass ◽

Plaque Volume ◽

Coronary Cta ◽

Net Reclassification Improvement ◽

Minimal Lumen Area

Abstract Background Conventional noninvasive approach using coronary CT angiography (CTA) focusing on only coronary artery lesions remains mismatch in identifying functional ischemia and determining indication for coronary revascularization. Purpose We aimed to assess the usefulness of CT-verified myocardial mass for identifying FFR-verified myocardial ischemia and determining the indication of coronary revascularization after FFR examination. Methods We examined 244 vessels with intermediate stenoses (50 to 90% stenosis visually on CTA) in 216 patients (mean age 69.2±9.2, 166 men) who underwent both coronary CTA and invasive FFR. In addition to coronary stenosis severity and plaque characteristics on visual, minimal lumen diameter (MLD), minimal lumen area (MLA), plaque volume, the entire myocardial volume of the target vessel (MTV) and that exposed to ischemia (FFR ≤0.80) (myocardial volume of ischemia: MVI) were evaluated. Additionally, therapeutic strategy after FFR was recorded. Results Of 244 vessels, myocardial ischemia (FFR ≤0.80) was shown in 99 (40.6%). MTV was larger in the patients with FFR-verified ischemia than those without (53.3±19.2 vs. 41.5±21.6, P<0.001); MLA, plaque burden (PB) and percentage of aggregated plaque volume (%APV) were also associated with ischemia. The area under the curves (AUCs) of MLA, PB, %APV, and MTV were 0.69, 0.67, 0.64, and 0.71, respectively. Addition of MTV to a model with coronary stenosis on visual, MLA, PB, and %APV improved C-index (from 0.72 to 0.79, P<0.01), net reclassification improvement (NRI) (0.71, P<0.01), and integrated discrimination improvement (IDI) (0.10, P<0.01). Of 99 vessels with FFR ≤0.80, MVI was larger in the vessels with early revascularization after FFR than those without (38.8 vs. 29.1, P=0.01). Conclusions The measurement of myocardial mass improves the diagnostic performance of coronary CTA for the identification of coronary arteries with FFR-verified ischemia. Furthermore, it is associated with therapeutic strategy for the diseased vessels after FFR examination.

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