Lesion Length Improves Diagnostic Accuracy of Intravascular Ultrasound for Detecting Functional Intermediate Coronary Stenosis Evaluated With Coronary Angiography-Derived Fractional Flow Reserve in Non-left Main Artery

Objective: Intravascular ultrasound (IVUS) parameters, for example, minimal lumen area (MLA) and area stenosis (AS), poorly identified functional intermediate coronary stenosis (ICS). For detecting functional ICS defined by coronary angiography-derived fractional flow reserve (caFFR), our study aims to determine whether IVUS parameters integrated with lesion length (LL) by three-dimensional quantitative coronary analysis (3D-QCA) could improve diagnostic value.Methods: A total of 111 patients with 122 ICS lesions in the non-left main artery were enrolled. MLA and AS were calculated in all lesions by IVUS. Diameter stenosis (DS%) and LL were measured by 3D-QCA. caFFR was computed by the proprietary fluid dynamic algorithm, a caFFR ≤ 0.8 was considered as functional stenosis. Receiver-operating curve analyses were used to compare the diagnostic accuracy among indices to predict functional stenoses.Results: Mean caFFR values in all lesions were 0.86 ± 0.09. Lesions with caFFR ≤ 0.8 showed lower MLA and higher AS (MLA: 3.3 ± 0.8 vs. 4.1 ± 1.2, P = 0.002; AS: 71.3 ± 9.6% vs. 63.5 ± 1.3%, P = 0.007). DS% and LL were more severe in lesions with caFFR ≤ 0.8 (DS%: 45.5 ± 9.6% vs. 35.5 ± 8.2%, P < 0.001; LL: 31.6 ± 12.9 vs. 21.0 ± 12.8, P < 0.001). caFFR were correlated with MLA, AS, and LL (MLA: r = 0.36, P < 0.001; AS: r = −0.36, P < 0.001; LL: r = −0.41, P < 0.001). Moreover, a multiple linear regression analysis demonstrated that MLA (β = 0.218, P = 0.013), AS (β = −0.197, P = 0.029), and LL (β = −0.306, P > 0.001) contributed significantly to the variation in caFFR. The best cutoff value of MLA, AS, and LL for predicting caFFR ≤ 0.8 were 3.6 mm2, 73%, and 26 mm, with area under the curve (AUC) of 0.714, 0.688, and 0.767, respectively. Combined with MLA, AS, and LL for identifying functional ICS, the accuracy was the highest among study methods (AUC: 0.845, P < 0.001), and was significantly higher than each single method (All P < 0.05).Conclusion: Lesion length can improve the diagnostic accuracy of IVUS-derived parameters for detecting functional ICS.

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1157-42 Fractional flow reserve versus intravascular ultrasound for decision-making in equivocal left main coronary stenosis

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(04)90385-3 ◽

2004 ◽

Vol 43 (5) ◽

pp. A92 ◽

Cited By ~ 3

Author(s):

Venu Jasti ◽

Venkata Yalamanchili ◽

Eugene Ivan ◽

Barry Merrill ◽

Mukul Chandra ◽

...

Keyword(s):

Decision Making ◽

Intravascular Ultrasound ◽

Fractional Flow Reserve ◽

Coronary Stenosis ◽

Left Main ◽

Fractional Flow ◽

Flow Reserve

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TCT-421: A Comparative Study of the Effect of Lesion Length on the Assessment of the Significance of Intermediate Coronary Stenosis by Angiography, Fractional Flow Reserve and Intravascular Ultrasound

Journal of the American College of Cardiology ◽

10.1016/j.jacc.2010.08.491 ◽

2010 ◽

Vol 56 (13) ◽

pp. B96-B97

Keyword(s):

Comparative Study ◽

Intravascular Ultrasound ◽

Fractional Flow Reserve ◽

Coronary Stenosis ◽

Lesion Length ◽

Fractional Flow ◽

Flow Reserve

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P2720Diagnostic accuracy of Quantitative Flow Ratio (QFR) and Vessel Fractional Flow Reserve (vFFR) compared to Fractional Flow Reserve (FFR) based on 7.5 frames/second coronary angiography

European Heart Journal ◽

10.1093/eurheartj/ehz748.1037 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

C Y Jin ◽

A Ramasamy ◽

C V Bourantas ◽

H Safi ◽

Y Kilic ◽

...

Keyword(s):

Coronary Angiography ◽

Diagnostic Accuracy ◽

Fractional Flow Reserve ◽

Gold Standard ◽

Coronary Stenosis ◽

Flow Ratio ◽

Fractional Flow ◽

Flow Reserve ◽

Quantitative Flow Ratio ◽

Significant Coronary Stenosis

Abstract Background Fractional flow reserve (FFR) is the gold standard for the physiological assessment of intermediate coronary artery lesions. Recently, several novel methods for computation of FFR based on 3-dimensional quantitative coronary angiography have been developed. These techniques allow analyses to be performed retrospectively and do not require induction of hyperaemia. The development and validation of these techniques are based on good quality coronary angiography with high frames per second (15 fps) acquisition. The diagnostic accuracy of Quantitative Flow Ratio (QFR) and Vessel Fractional Flow Reserve (vFFR) in real world “radiation-save mode” coronary angiography has not been studied. Purpose To validate the accuracy of QFR and vFFR compared to FFR based on a series of coronary angiography acquired at 7.5 fps. Methods We retrospectively analyzed 134 vessels (102 patients) with intermediate coronary artery stenosis (30–90%) in whom an FFR measurement had been performed. All the coronary angiography were acquired at 7.5 fps. 33 vessels (20 patients) were excluded from the study due to unsuitable coronary anatomy, invalid FFR measurements, poor image quality and lack of 2 projections ≥25° apart. A total of 101 vessels (82 patients) were included in the final analysis. Contrast-QFR (cQFR), fixed-QFR (fQFR) and vFFR analysis were performed in these vessels by two independent trained experts blinded to the FFR readings. FFR measurements at hyperaemic steady state was taken as the gold standard reference. Results Good intra- and inter-observer reliability was noted for fQFR, cQFR and vFFR analysis (intra-observer mean difference for fQFR: 0.016±0.060, p=0.066; cQFR: 0.009±0.053, p=0.230; vFFR: 0.008±0.040, p=0.175; inter-observer mean difference for fQFR: 0.001±0.036, p=0.847; cQFR: −0.001±0.049; p=0.910, vFFR: −0.005±0.037, p=0.393). fQFR and cQFR showed good correlation with FFR (r=0.694, p<0.001 and r=0.674, p<0.001, respectively) while vFFR showed moderate correlation with FFR (r=0.388, p<0.001). Similarly, fQFR and cQFR showed good accuracy for the detection of functionally significant coronary stenosis (fQFR AUC 0.882 (95% CI 0.803–0.938) and cQFR AUC 0.886 (95% CI 0.807–0.940)) while vFFR showed moderate accuracy with AUC 0.719 (95% CI 0.621–0.804). For identifying functionally significant stenosis (FFR ≤0.80), the overall diagnostic accuracy were 81.2%, 85.2%, 75.3% for fQFR, cQFR and vFFR, repectively. The sensitivity and specificity were 72.7%, 89.9% (fQFR); 83.5%, 31.8% (cQFR) and 68.2%, 87.3% (vFFR). Conclusion Functional assessment of intermediate coronary stenosis based on 7.5 fps angiography-derived computational modelling is feasible. Our study shows that fQFR and cQFR have a better diagnostic accuracy for detecting functionally significant coronary stenosis compared to vFFR. At the lower radiation-save mode 7.5 fps angiography, cQFR does not appear to provide additional diagnostic accuracy compared to fQFR.

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