Usefulness of Minimal Luminal Coronary Area Determined by Intravascular Ultrasound to Predict Functional Significance in Stable and Unstable Angina Pectoris

Kang, Soo–Jin; Ahn, Jung‐Min; Song, Hae-Geun; Kim, Won-Jang; Lee, Jong‐Young; Park, Duk‐Woo; Yun, Sung‐Cheol; Lee, Seung-Whan; Kim, Young‐Hak; Lee, Cheol Whan; Park, Seong-Wook; Park, Seung‐Jung

doi:10.1016/j.amjcard.2011.11.024

Cited by 73 publications

(34 citation statements)

References 24 publications

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“…This finding may elucidate some of the reasons why different cut-offs have been proposed by different groups [4,5,6,7,8,9]. As the physiological significance of coronary stenosis is determined not only by lesion severity but also by demand for blood flow, we postulate that different ethnicities with different BMI and myocardial mass would have different MLA cut-off values.…”

Section: Discussionmentioning

confidence: 90%

“…A later study conducted in the USA identified a MLA of <3.09 mm 2 [6]. By contrast, two studies performed in Korea suggested a smaller MLA of 2.4 and 2.75 mm 2 to predict FFR of <0.8 [7,8]. Recently, the FIRST (Fractional Flow Reserve and Intravascular Ultrasound Relationship) study, based on a multicenter, prospective registry in the USA and Europe proposed 3.07 mm 2 as a BCV to define the presence of myocardial ischemia [9].…”

Section: Discussionmentioning

confidence: 99%

“…In contrast, intravascular ultrasound (IVUS) is the widely adopted invasive imaging modality to evaluate the anatomy of coronary stenosis. In an effort to integrate the physiology and the anatomy of coronary artery disease, several studies have investigated the relationship between FFR and minimal lumen area (MLA) measured by IVUS [4,5,6,7,8,9]. However, each study has suggested different cut-off values of MLA to predict the presence of ischemia (FFR 0.75-0.8).…”

Section: Introductionmentioning

confidence: 99%

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Optimal Intravascular Ultrasound Criteria for Defining the Functional Significance of Intermediate Coronary Stenosis: An International Multicenter Study

et al. 2014

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Objective: We aimed to assess the ideal cut-off value of minimal lumen area (MLA) by intravascular ultrasound (IVUS) and its diagnostic performance to predict ischemia, using a large-scale, pooled analysis. Methods: Eleven centers worldwide were invited to provide their clinical, IVUS and fractional flow reserve (FFR) data. A total of 881 lesions were enrolled. Results: Angiographic % diameter stenosis (r = -0.373, p < 0.0001) and IVUS MLA (r = 0.289, p < 0.0001) correlated with FFR. Best cut-off value (BCV) of IVUS MLA to define the functional significance (FFR <0.8) was 2.75 mm² (AUC 0.646, 95% CI 0.609-0.684). When the diagnostic performance of IVUS MLA was tested according to the lesion location, BCV could be found only in lesions in the proximal artery and the mid-left anterior descending artery. Interestingly, Asians (n = 623) and Westerners (n = 258) showed different demographic and lesion characteristics as well as different BCVs to define ischemia. The BCV for the proximal/mid-left anterior descending artery lesions was 2.75 mm² (AUC 0.688, 95% CI 0.635-0.742) in Asians and 3.0 mm² (AUC 0.695, 95% CI 0.605-0.786) in Westerners. Conclusion: In this pooled analysis, an IVUS MLA of 2.75 mm² was the BCV to define the functional significance of intermediate coronary stenosis. However, when IVUS MLA is used to determine the functional significance, both the lesion and patient characteristics should be considered.

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Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Optimal Intravascular Ultrasound Criteria for Defining the Functional Significance of Intermediate Coronary Stenosis: An International Multicenter Study

et al. 2014

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“…Similarly, Koren and Shahar reported a case of xiphodynia masking acute myocardial infarction, suggesting that xiphodynia should be considered a second-line assumption after thoroughly ruling out more dangerous conditions (8). Moreover, Kang et al reported that an MLA less than 2.6 mm 2 in the proximal left ascending artery predicts functional ischemia (9). In the present case, PCI was performed due to the presence of severe stenosis with an MLA of 0.8 mm 2 , despite a stress test not being performed.…”

Section: Discussionmentioning

confidence: 99%

Xiphodynia Mimicking Acute Coronary Syndrome

et al. 2015

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A 79-year-old man with diabetes and partial gastrectomy visited our hospital due to gradually worsening epigastric pain on exertion. Unstable angina was suspected and coronary angiography was performed, which revealed severe stenosis of the left ascending artery. Despite successful intervention, the pain persisted. A careful physical examination finally revealed the point of tenderness on the xiphoid process, and the patient was diagnosed with xiphodynia. The severe epigastric pain resolved immediately after xiphoidectomy. This case demonstrates that symptoms of xiphodynia may mimic those of various types of disorders, such as angina, and that careful palpation is warranted during routine physical examinations.

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“…OCT has better efficiency and sensitivity although it has a lower penetration depth than IVUS. 17) The ILUMEIN system (St. Jude) used in this study combines FD-OCT imaging and pressure derived FFR into one platform which helps optimise the use of percutaneous coronary intervention when treating patients suffering from ischemia. This system features pressure wire TM Aeris, a wireless instrument that measures FFR to assess the stenosis severity, Wi-Box TM , a wireless device that receives aortic pressure readings wirelessly, and the FD-OCT imaging system (C7-XR TM ) which provides high resolution images up to 10 μm, image acquisition rate up to 0.25 cm/sec, frame rate of 100 frames/s, and scan diameter of 10 mm.…”

Section: Discussionmentioning

confidence: 99%

Feasibility of Intracoronary Frequency Domain Optical Coherence Tomography Derived Fractional Flow Reserve for the Assessment of Coronary Artery Stenosis

2014

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SummaryFrequency domain optical coherence tomography (FD-OCT) provides cross-sectional images of coronary arteries and deployed stents with micron resolution and measures lumen dimensions with excellent reproducibility. FD-OCT combined with a blood flow resistances model can overcome many limitations of conventional measures of stenosis severity based on quantitative coronary angiography (QCA) and intravascular ultrasound (IVUS). The aim of this feasibility study was to investigate the relationship between pressure derived fractional flow reserve (FFR) and FD-OCT derived FFR, a new method for quantitative measure of stenosis severity that estimates the blood flow resistance and microvascular resistance of the vessel segments imaged by FD-OCT. A total of 26 coronary stenoses in 20 patients were studied consecutively with QCA, pressure derived FFR, and FD-OCT. There was a moderate but significant correlation between pressure derived FFR and FD-OCT derived FFR (r = 0.69, P < 0.001). Bland-Altman analysis showed that the mean differences between pressure derived FFR and FD-OCT derived FFR were 0.05 ± 0.14 (limits of agreement: -0.09 to 0.19). The root mean square error (RMSE) between FD-OCT derived FFR and pressure derived FFR was found to be ± 0.087 FFR units. FD-OCT derived FFR has the potential to become a valuable tool for the assessment of coronary artery stenosis. ( 1-4) Intracoronary optical coherence tomography (OCT) provides cross-sectional images of coronary arteries and deployed stents with resolution 10-15 times higher than intravascular ultrasound (IVUS). OCT is used for anatomic and morphological assessment of coronary stenosis and provides lumen measurements with excellent reproducibility. [5][6][7][8] OCT also provides information about plaque vulnerability, calcification, and other parameters which helps in guiding the procedure along with diagnostics. The frequency domain OCT (FD-OCT) systems provide faster image acquisition speeds, higher frame rates, and greater scan depths as compared to time domain OCT (TD-OCT) systems. FD-OCT combined with a blood flow model can overcome many limitations of conventional measures of stenosis severity based on QCA and IVUS. The main objective of this feasibility study was to investigate the potential of FD-OCT derived FFR for the assessment of coronary artery stenosis. Through the volumetric analysis of FD-OCT images, FFR was calculated from the blood flow resistance and the microvascular resistance. A comparison between FD-OCT derived FFR and pressure derived FFR was also conducted in this study. MethodsA total of 26 coronary stenoses in 20 patients with stable angina and/or ischemia documented on exercise stress test were studied consecutively with QCA, pressure derived FFR, and FD-OCT during diagnostic coronary angiography. The study was approved by Galway clinical research ethics committee and informed consent for all procedures was obtained from each patient. Eligible patients had a single de novo stenosis in a native coronary artery with diameter stenosis...

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Usefulness of Minimal Luminal Coronary Area Determined by Intravascular Ultrasound to Predict Functional Significance in Stable and Unstable Angina Pectoris

Cited by 73 publications

References 24 publications

Optimal Intravascular Ultrasound Criteria for Defining the Functional Significance of Intermediate Coronary Stenosis: An International Multicenter Study

Optimal Intravascular Ultrasound Criteria for Defining the Functional Significance of Intermediate Coronary Stenosis: An International Multicenter Study

Xiphodynia Mimicking Acute Coronary Syndrome

Feasibility of Intracoronary Frequency Domain Optical Coherence Tomography Derived Fractional Flow Reserve for the Assessment of Coronary Artery Stenosis

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