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Usefulness of combined intravascular ultrasound parameters to predict functional significance of coronary artery stenosis and determinants of mismatch

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Author(s)
Cho YKNam CWHan JKKoo BKDoh JHBen-Dor IWaksman RPichard AMurata NTanaka NLee CHGonzalo NEscaned JCosta MAKubo TAkasaka THu XWang JAYang HMYoon MHTahk SJYoon HJChung ISHur SHKim KB
Keimyung Author(s)
Cho, Yun KyeongNam, Chang WookYoon, Hyuck JunHur, Seung HoKim, Kwon BaeChung, In Sung
Department
Dept. of Internal Medicine (내과학)
Dept. of Preventive Medicine (예방의학)
Journal Title
EuroIntervention
Issued Date
2015
Volume
11
Issue
2
Abstract
Aims: Efficacy of combined intravascular ultrasound (IVUS) parameters in functional significance prediction and discrepancy between IVUS and fractional flow reserve (FFR) have not been well defined. This study therefore aimed to: 1) evaluate the diagnostic accuracy of combined IVUS parameters, namely minimal lumen area (MLA) and percent plaque burden (%PB), in functional significance prediction of coronary artery stenosis; and 2) define factors that affect the relation between FFR value and IVUS parameters.Methods and results: At 11 international centres, IVUS and FFR measurements were concurrently performed in 945 major epicardial coronary artery lesions (886 patients). Functional significance was defined as FFR ≤0.8. MLA and FFR correlated weakly (r=0.289, p<0.001). Diagnostic accuracy of MLA ≤4.0 mm2, %PB >70% and their combination were 50%, 47% and 51%, respectively, with similar area under the curve (AUC) of 0.561, 0.511 and 0.516, respectively. The best cut-off values (BCV) were MLA ≤3.0 mm2 and %PB >75%, with accuracy of 60% for MLA, 50% for %PB and 56% for their combination, and AUC of 0.618, 0.511 and 0.533, respectively. MLA BCV ≤3.0 mm2 had higher predictive power than %PB BCV >75% or their combination. Independent predictors of functional significance were male gender (odds ratio 1.76 [95% confidence interval: 1.19-2.62]), left ventricular ejection fraction (LVEF, 0.98 [0.96-0.99]), LAD lesion (2.52 [1.73-3.67]), reference vessel diameter (0.60 [0.41-0.86]), lesion length (1.04 [1.02-1.06]) and MLA (0.79 [0.69-0.92]). False negative lesion incidence was 24.4% in association with race (for Asians, 0.391 [0.219-0.698]), LAD lesion (2.677 [1.709-4.191]) and LVEF (0.977 [0.957-0.997]). False positive lesion incidence was 17.0% in association with non-LAD lesion (2.444 [1.620-3.686]).Conclusions: Combined IVUS parameters did not improve the accuracy of functional significance prediction. Discrepancy between IVUS and FFR, which was not rare, should be taken into account in clinical decision making. - See more at: http://www.pcronline.com/eurointervention/85th_issue/volume-11/number-2/30/usefulness-of-combined-intravascular-ultrasound-parameters-to-predict-functional-significance-of-coronary-artery-stenosis-and-determinants-of-mismatch.html#sthash.17OURyH9.dpuf
Keimyung Author(s)(Kor)
조윤경
남창욱
윤혁준
허승호
김권배
정인성
Publisher
School of Medicine
Citation
Cho YK et al. (2015). Usefulness of combined intravascular ultrasound parameters to predict functional significance of coronary artery stenosis and determinants of mismatch. EuroIntervention, 11(2), 163–170.
Type
Article
ISSN
1774-024x
Source
https://www.pcronline.com/eurointervention/85th_issue/volume-11/number-2/30/usefulness-of-combined-intravascular-ultrasound-parameters-to-predict-functional-significance-of-coronary-artery-stenosis-and-determinants-of-mismatch.html
URI
https://kumel.medlib.dsmc.or.kr/handle/2015.oak/35665
Appears in Collections:
1. School of Medicine (의과대학) > Dept. of Internal Medicine (내과학)
1. School of Medicine (의과대학) > Dept. of Preventive Medicine (예방의학)
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