Diagnostic accuracy of intravascular ultrasound‐derived minimal lumen area compared with fractional flow reserve—Meta‐analysis: Pooled accuracy of IVUS luminal area versus FFR

Abstract

Given its limited pooled accuracy, IVUS-MLA's impact on clinical decision in this scenario is low and may lead to misclassification in up to 20% of the lesions. Pooled analysis points toward lower MLA cutoffs than the ones used in current practice.

Intravascular Ultrasound for the Diagnosis and Treatment of Left Main Coronary Artery Disease

“…MLA had limited accuracy in non-LMCA lesions, whereas for intermediate LMCA lesions, the IVUSderived MLA had a 90% sensitivity and 90% specificity to predict an FFR of less than 0.8. 12 The greater agreement between IVUS-derived MLA and FFR for LMCA lesions compared with non-LMCA lesions may be owing to the limited variability in LMCA length, the greater size of the LMCA, and the limited variability in the amount of myocardium that the LMCA supplies.…”

“…On the other hand, the correlation between FFR and IVUS correlation for LMCA lesions is greater than for non-LMCA lesions, as noted. 12 An important advantage of IVUS compared with FFR for LMCA evaluation is the ability to obtain key morphologic information, such as characterization of the severity and extent of disease (eg, ostial LAD and/or ostial left circumflex involvement, calcification that may require atherectomy). Importantly, plaque burden was the only predictor of events at the 5-year follow-up for LMCA lesions left untreated.…”

Management of Left Main Coronary Artery Disease

“…Although IVUS and FFR correlate well, there are limitations to both techniques that may favor one modality over the other. For example, IVUS area measurements may be limited by distortion caused by minor differences in the rotational speed of the imaging element, a noncoaxial orientation of the catheter, or extensive arterial calcification.…”

Intravascular ultrasound‐derived morphological predictors of myocardial ischemia assessed by stress myocardial perfusion computed tomography

“…Intravascular ultrasound (IVUS) is generally used to evaluate coronary lesion morphology and stenosis severity, and its roles in device sizing and stent optimization have been emphasized . Even though IVUS assessment of stenosis severity has been compared to fractional flow reserve based on the distal to proximal pressure drop across the epicardial coronary artery stenosis . the morphological determinants of clinically relevant myocardial ischemia or ischemic size have not yet been studied.…”