Document Detail


Correlations between fractional flow reserve and intravascular ultrasound in patients with an ambiguous left main coronary artery stenosis.
MedLine Citation:
PMID:  15492302     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Intravascular ultrasound (IVUS) is being used to assess the significance of a left main coronary artery stenosis (LMCS). However, the cutoff values of IVUS parameters at which to predict a fractional flow reserve (FFR) of 0.75 are unknown. METHODS AND RESULTS: In 55 patients with an angiographically ambiguous LMCS, a pressure guidewire was used to calculate FFR, and IVUS parameters were calculated after automatic pullback. FFR averaged 0.86+/-0.13 (range, 0.55 to 1.0). IVUS minimum lumen diameter (MLD), minimum lumen area (MLA), cross-sectional narrowing (CSN), and area stenosis (AS) were 3.8+/-0.61 mm, 7.65+/-2.9 mm2, 59+/-13%, and 47+/-19%, respectively. Regression analysis demonstrated strong correlations between FFR and MLD (r=0.79, P<0.0001) as well as between FFR and MLA (r=0.74, P<0.0001). There were inverse, moderate correlations between FFR and CSN (r=0.69, P<0.0001), followed by those between FFR and AS (r=0.54, P<0.0001). Compared with FFR as the "gold standard," an MLD of 2.8 mm had the highest sensitivity and specificity (93% and 98%, respectively) for determining the significance of an LMCS, followed by an MLA of 5.9 mm2 (93% and 95%, respectively). Based on an FFR <0.75 and an FFR > or =0.75, the 38-month survival and event-free survival estimates (EFSEs) were both 100% and 100% versus 90%, respectively (P=NS). CONCLUSIONS: We conclude that (1) an IVUS MLD and MLA of 2.8 mm and 5.9 mm2, respectively, strongly predict the physiological significance of an LMCS and (2) among patients with an LMCS, an FFR of 0.75 is a strong predictor of survival and EFSE.
Authors:
Venu Jasti; Eugen Ivan; Venkata Yalamanchili; Nattawut Wongpraparut; Massoud A Leesar
Publication Detail:
Type:  Journal Article     Date:  2004-10-18
Journal Detail:
Title:  Circulation     Volume:  110     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2004 Nov 
Date Detail:
Created Date:  2004-11-02     Completed Date:  2005-09-30     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2831-6     Citation Subset:  AIM; IM    
Affiliation:
Division of Cardiology, University of Louisville, Louisville, KY 40292, USA.
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MeSH Terms
Descriptor/Qualifier:
Adenosine / diagnostic use
Aged
Angioplasty, Transluminal, Percutaneous Coronary / statistics & numerical data
Cardiovascular Diseases / mortality
Coronary Angiography
Coronary Artery Bypass / statistics & numerical data
Coronary Stenosis / physiopathology,  ultrasonography*
Disease Progression
Disease-Free Survival
Female
Follow-Up Studies
Heart Catheterization
Hemodynamics*
Humans
Hyperemia / chemically induced,  physiopathology
Life Tables
Male
Middle Aged
Myocardial Infarction / epidemiology
Pressure
Single-Blind Method
Transducers, Pressure
Ultrasonography, Interventional*
Chemical
Reg. No./Substance:
58-61-7/Adenosine

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