Document Detail


Prospective, head-to-head comparison of quantitative coronary angiography, quantitative computed tomography angiography, and intravascular ultrasound for the prediction of hemodynamic significance in intermediate and severe lesions, using fractional flow reserve as reference standard (from the ATLANTA I and II Study).
MedLine Citation:
PMID:  24238960     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The objective of this study was to compare the diagnostic accuracy of quantitative coronary angiography (QCA), coronary computed tomography angiography (CTA), and intravascular ultrasound (IVUS) with fractional flow reserve (FFR) measurements. Eighty-five lesions (40% to 99% diameter stenosis) in 85 patients were prospectively interrogated by QCA, CTA, IVUS, and FFR. Minimal lumen diameter (MLD), percent diameter stenosis (%DS), minimal lumen area (MLA), and percent area stenosis (%AS) were measured. Correlation, receiver operating characteristic analysis, kappa statistics, and multivariable logistic regression was used to assess relation between anatomic measurements and FFR. Average age was 61.3 ± 7.8; 62% were men. QCA-derived mean %DS was 55.3% ± 19.5%; mean FFR 0.81 ± 0.17; 27% had FFR ≤0.75. QCA had the strongest correlation, followed by CTA and then IVUS for MLD (r = 0.67, 0.47, and 0.29, respectively) and for %DS (r = -0.63, -0.52, and -0.22, respectively); QCA-derived MLD had area under the curve of 0.96, with 95% sensitivity and 82% specificity. Cut-point, area under the curve, sensitivity, and specificity for CTA-MLA and IVUS-MLA were 3.11 mm(2), 0.86, 81%, and 81% and 2.68 mm(2), 0.75, 70%, and 80%. In multivariable analysis for each modality, MLD on QCA (odds ratio [OR]: 0.002), %AS on CTA (OR: 1.09) and MLA on IVUS (OR: 0.28) remained independent predictors. In conclusion, in intermediate-to-severe lesions, QCA-, CTA-, and IVUS-derived quantitative anatomic measurements correlated with FFR. CTA-derived cut-points were similar to respective measurements on QCA and IVUS and had similar or better diagnostic performance compared with IVUS.
Authors:
Szilard Voros; Sarah Rinehart; Jesus G Vazquez-Figueroa; Anna Kalynych; Dimitri Karmpaliotis; Zhen Qian; Parag H Joshi; Hunt Anderson; Laura Murrieta; Charles Wilmer; Harold Carlson; William Ballard; Charles Brown
Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't     Date:  2013-10-02
Journal Detail:
Title:  The American journal of cardiology     Volume:  113     ISSN:  1879-1913     ISO Abbreviation:  Am. J. Cardiol.     Publication Date:  2014 Jan 
Date Detail:
Created Date:  2013-12-16     Completed Date:  2014-02-13     Revised Date:  2014-05-07    
Medline Journal Info:
Nlm Unique ID:  0207277     Medline TA:  Am J Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  23-9     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2014 Elsevier Inc. All rights reserved.
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MeSH Terms
Descriptor/Qualifier:
Cardiac Catheterization
Coronary Angiography / methods*
Coronary Stenosis / diagnosis*,  physiopathology
Female
Follow-Up Studies
Fractional Flow Reserve, Myocardial / physiology*
Hemodynamics*
Humans
Male
Middle Aged
Prognosis
Prospective Studies
ROC Curve
Reproducibility of Results
Severity of Illness Index
Tomography, X-Ray Computed / methods*
Ultrasonography, Interventional / methods*
Grant Support
ID/Acronym/Agency:
T32 HL007227/HL/NHLBI NIH HHS
Comments/Corrections

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