Better Diagnosis of Functionally Significant Intermediate Sized Narrowings Using Intravascular Ultrasound-Minimal Lumen Area and Coronary Computed Tomographic Angiography-Based Myocardial Segmentation

Soo-Jin Kang; Dong Hyun Yang; Jihoon Kweon; Young-Hak Kim; June-Goo Lee; Joonho Jung; Namkug Kim; Gary S Mintz; Joon-Won Kang; Tae-Hwan Lim; Seong-Wook Park

doi:10.1016/j.amjcard.2016.01.022

Better Diagnosis of Functionally Significant Intermediate Sized Narrowings Using Intravascular Ultrasound-Minimal Lumen Area and Coronary Computed Tomographic Angiography-Based Myocardial Segmentation

Am J Cardiol. 2016 Apr 15;117(8):1282-8. doi: 10.1016/j.amjcard.2016.01.022. Epub 2016 Jan 28.

Authors

Affiliations

¹ Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
² Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
³ Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea. Electronic address: mdyhkim@amc.seoul.kr.
⁴ Cardiovascular Research Foundation, New York, New York.

PMID: 26892449
DOI: 10.1016/j.amjcard.2016.01.022

Abstract

Lesion morphology poorly predicts functional significance of intermediate coronary artery stenosis. The aim of this study was to determine whether a coronary artery-based myocardial segmentation method that quantifies subtended myocardium can improve the diagnostic accuracy of intravascular ultrasound (IVUS)-derived parameters for detecting ischemia-producing lesions. Coronary computed tomography angiography, IVUS, and fractional flow reserve (FFR) data were analyzed in 101 non-left main lesions (20% to 80% angiographic stenosis). Using the coronary artery-based myocardial segmentation method, total left ventricular myocardial volume (Vtotal), myocardial volume subtended by the stenotic coronary segment (Vsub), and Vratio (the ratio of the Vsub to the Vtotal) were assessed. Both Vsub >30.7 cm(3) and Vratio >25.4% were determinants of FFR ≤0.75 (area under the curve = 0.696 and 0.744). Overall, an IVUS-measured minimum lumen area (IVUS-MLA) ≤2.83 mm(2) predicted FFR ≤0.75 with a sensitivity 88% and specificity 73%. Among lesions with IVUS-MLA ≤2.83 mm(2) and FFR >0.75, 89% showed Vsub <30.7 cm(3). In 50 lesions with Vsub >30.7 cm(3), an IVUS-MLA ≤2.85 mm(2) predicted FFR ≤0.75 with sensitivity 85%, specificity 92%, positive predictive value 92%, and negative predictive value 85%. Conversely, in 51 lesions with a Vsub ≤30.7 cm(3), IVUS-MLA ≤2.67 mm(2) showed sensitivity 100%, specificity 69%, positive predictive value 38%, and negative predictive value 100% for predicting FFR ≤0.75. Body surface area, reference lumen diameter, and vessel area had modest correlations with Vsub. In those lesion subsets, IVUS-MLA ≈2.8 mm(2) accurately predicted an FFR ≤0.75, whereas the clinical relevance of assessing and treating lesions with a smaller myocardial territory may be limited (ClinicalTrials.gov number NCT1696006).

Trial registration: ClinicalTrials.gov NCT01696006.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Coronary Angiography / methods*
Coronary Stenosis / diagnosis*
Coronary Stenosis / physiopathology
Coronary Vessels / diagnostic imaging*
Echocardiography
Female
Fractional Flow Reserve, Myocardial / physiology*
Humans
Male
Middle Aged
Myocardium
Predictive Value of Tests
Registries*
Reproducibility of Results
Retrospective Studies
Risk Factors
Severity of Illness Index
Ultrasonography, Interventional / methods*

Associated data

ClinicalTrials.gov/NCT01696006