Cargando…

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...

Descripción completa

Detalles Bibliográficos
Autores principales: Li, Menghuan, Cheang, Iokfai, He, Yuan, Liao, Shengen, Wang, Hui, Kong, Xiangqing
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8514684/
https://www.ncbi.nlm.nih.gov/pubmed/34660717
http://dx.doi.org/10.3389/fcvm.2021.715514
_version_ 1784583446043033600
author Li, Menghuan
Cheang, Iokfai
He, Yuan
Liao, Shengen
Wang, Hui
Kong, Xiangqing
author_facet Li, Menghuan
Cheang, Iokfai
He, Yuan
Liao, Shengen
Wang, Hui
Kong, Xiangqing
author_sort Li, Menghuan
collection PubMed
description 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 mm(2), 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.
format Online
Article
Text
id pubmed-8514684
institution National Center for Biotechnology Information
language English
publishDate 2021
publisher Frontiers Media S.A.
record_format MEDLINE/PubMed
spelling pubmed-85146842021-10-15 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 Li, Menghuan Cheang, Iokfai He, Yuan Liao, Shengen Wang, Hui Kong, Xiangqing Front Cardiovasc Med Cardiovascular Medicine 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 mm(2), 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. Frontiers Media S.A. 2021-09-30 /pmc/articles/PMC8514684/ /pubmed/34660717 http://dx.doi.org/10.3389/fcvm.2021.715514 Text en Copyright © 2021 Li, Cheang, He, Liao, Wang and Kong. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Cardiovascular Medicine
Li, Menghuan
Cheang, Iokfai
He, Yuan
Liao, Shengen
Wang, Hui
Kong, Xiangqing
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
title 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
title_full 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
title_fullStr 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
title_full_unstemmed 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
title_short 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
title_sort 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
topic Cardiovascular Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8514684/
https://www.ncbi.nlm.nih.gov/pubmed/34660717
http://dx.doi.org/10.3389/fcvm.2021.715514
work_keys_str_mv AT limenghuan lesionlengthimprovesdiagnosticaccuracyofintravascularultrasoundfordetectingfunctionalintermediatecoronarystenosisevaluatedwithcoronaryangiographyderivedfractionalflowreserveinnonleftmainartery
AT cheangiokfai lesionlengthimprovesdiagnosticaccuracyofintravascularultrasoundfordetectingfunctionalintermediatecoronarystenosisevaluatedwithcoronaryangiographyderivedfractionalflowreserveinnonleftmainartery
AT heyuan lesionlengthimprovesdiagnosticaccuracyofintravascularultrasoundfordetectingfunctionalintermediatecoronarystenosisevaluatedwithcoronaryangiographyderivedfractionalflowreserveinnonleftmainartery
AT liaoshengen lesionlengthimprovesdiagnosticaccuracyofintravascularultrasoundfordetectingfunctionalintermediatecoronarystenosisevaluatedwithcoronaryangiographyderivedfractionalflowreserveinnonleftmainartery
AT wanghui lesionlengthimprovesdiagnosticaccuracyofintravascularultrasoundfordetectingfunctionalintermediatecoronarystenosisevaluatedwithcoronaryangiographyderivedfractionalflowreserveinnonleftmainartery
AT kongxiangqing lesionlengthimprovesdiagnosticaccuracyofintravascularultrasoundfordetectingfunctionalintermediatecoronarystenosisevaluatedwithcoronaryangiographyderivedfractionalflowreserveinnonleftmainartery