The role of intravascular ultrasound and quantitative angiography in the functional assessment of intermediate coronary lesions: Correlation with fractional flow reserve

Toru Naganuma, Azeem Latib, Charis Costopoulos, Kensuke Takagi, Charbel Naim, Katsumasa Sato, Tadashi Miyazaki, Masanori Kawaguchi, Vasileios F. Panoulas, Sandeep Basavarajaiah, Filippo Figini, Alaide Chieffo, Matteo Montorfano, Mauro Carlino, Antonio Colombo

Research output: Contribution to journalArticlepeer-review

17 Scopus citations

Abstract

Background: The correlation between fractional flow reserve (FFR) and intravascular ultrasound (IVUS) metrics including minimal lumen area (MLA), plaque burden and morphology remain a matter of debate. Methods: Between June 2008 and May 2013, 132 intermediate stenoses in 109 patients were assessed by FFR, IVUS and quantitative angiography. Receiver-operating characteristic (ROC) curve analyses were used to identify MLA/lesion length/plaque burden cut-off values predictive of FFR < 0.80. Results: FFR <0.80 was observed in 39 lesions. In the entire cohort, MLA value <2.70mm2 had 79.5% sensitivity, 76.3% specificity, 0.822 area under curve (AUC), 58.5% positive predictive value, 89.9% negative predictive value and 77.3% accuracy in predicting a positive FFR. In lesions with reference diameter vessel (RVD) ≥3.0mm, the MLA cut-off value was 2.84mm2 (sensitivity 72.2%, specificity 83.0%, AUC 0.842) whereas in lesions with RVD <3.0mm, 2.59mm2 (sensitivity 90.5%, specificity 69.6%, AUC 0.823). A moderate correlation was observed between MLA and FFR (r=0.429, p<0.001). The cut-off lesion length predictive of FFR <0.80 was 11.0mm with a weak correlation between the two (r=-0.348, p<0.001). Plaque morphology did not significantly affect FFR (p=0.485). On multivariable analysis, MLA (OR: 0.15; 95% CI: 0.05-0.40; p<0.001) and plaque burden (OR: 1.11; 95% CI: 1.04-1.20; p<0.003) were independent predictors of FFR <0.80. Conclusion: A modest, yet significant correlation was observed between MLA and FFR. The high negative predictive value of large MLAs (using afore-mentioned cut-off values) may provide some degree of confidence that the lesion in question is not functionally significant.

Original languageEnglish (US)
Pages (from-to)3-7
Number of pages5
JournalCardiovascular Revascularization Medicine
Volume15
Issue number1
DOIs
StatePublished - Jan 2014
Externally publishedYes

Keywords

  • Fractional flow reserve
  • Intermediate lesions
  • Intravascular ultrasound
  • Plaque morphology
  • Quantitative coronary angiography

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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