Relationship between intravascular ultrasound parameters and fractional flow reserve in intermediate coronary artery stenosis of left anterior descending artery: Intravascular ultrasound volumetric analysis

Yang, Hyoung‐Mo; Tahk, Seung‐Jea; Lim, Hong–Seok; Yoon, Myeong‐Ho; Choi, So‐Yeon; Choi, Byoung‐Joo; Jin, Xiong; Hwang, Gyo‐Seung; Park, Jin-Sun; Shin, Joon-Han

doi:10.1002/ccd.25088

Cited by 38 publications

(27 citation statements)

References 20 publications

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“…This finding might be explained by the fact that our study included only lesions of the left anterior descending artery, which is already known to have good correlation between anatomic and functional indices. 13,19,21,22 In addition, the present study showed that FFR OCT was better at discriminating the functional significance than were the anatomic parameters of QCA; it was also slightly better than those of OCT. These findings may be explained by the application of mean flow velocity, which was obtained by averaging velocities on coronary angiography using the Thrombolysis in Myocardial Infarction frame count and the mean blood pressure.…”

Section: Discussionsupporting

confidence: 49%

“…Based on previous observations, we assessed the clinical relevance of FFR OCT in lesions of the left anterior descending artery to minimize possible confounding factors. 21,22 Another limitation to application in clinical practice is the rather low sensitivity of FFR OCT. However, its high specificity could provide clinically useful information for exclusion of functionally significant ischemia.…”

Section: Limitationsmentioning

confidence: 99%

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Assessing Computational Fractional Flow Reserve From Optical Coherence Tomography in Patients With Intermediate Coronary Stenosis in the Left Anterior Descending Artery

Kim

Lim

et al. 2016

Circ: Cardiovascular Interventions

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Background-Intravascular optical coherence tomography (OCT) imaging provides limited information on the functional assessment of coronary stenosis. We evaluated a new approach to OCT image-based computation modeling, which can be used to estimate the fractional flow reserve (FFR) 14 The objective of this study was to present a new approach for estimating invasive FFR using OCT lumen contour-based 3D coronary models (FFR OCT ) and CFD algorithms. In addition, the clinical usefulness of FFR OCT was evaluated with pressure wire-based FFR in patients with ambiguous intermediate diameter stenosis in the left anterior descending artery. MethodsA total of 100 consecutive patients who underwent both OCT and FFR evaluation of intermediate stenosis in the left anterior descending artery between November 2013 and January 2015 were retrospectively enrolled. Eight patients were excluded because of poor reconstruction of the 3D OCT images. A total of 92 patients were finally included in the analysis. The inclusion criteria included (1) clinical presentation of angina, (2) intermediate diameter stenosis (40%-70%) in de novo lesions proximal to the mid-portion of the left anterior descending artery, and (3) visual angiographic lesions of <20 mm in length. The exclusion criteria included: (1) clinical presentation of acute myocardial infarction, (2) previous history of myocardial infarction, (3) presence of regional wall motion abnormality in the territory of the left anterior descending artery, (4) significant stenosis (≥50% diameter stenosis) distal to the target lesion, (5) angiographic thrombus, and (6) contraindication to adenosine. This study was approved by the institutional review board at our institution. Written informed consent was obtained from all patients.An off-line quantitative coronary angiographic system (CAAS system; Pie Medical Instruments, Maastricht, Netherlands) was used to perform QCA analysis in an independent core laboratory (Cardiovascular Research Center, Seoul, Korea). Using the guiding catheter for magnification calibration, the reference vessel diameter and minimum luminal diameter (MLD) were measured from diastolic frames in a single, matched view showing the smallest MLD ( Figure 1A). OCT Imaging and Reconstruction of 3D Coronary Artery GeometryTarget lesion imaging was performed using a frequency-domain OCT system (C7-XR OCT imaging system; LightLab Imaging, Inc./ St. Jude Medical, St. Paul, MN). The OCT cross-sectional images were generated at a rotational speed of 100 frames/s. The fiber probe was withdrawn at 20 mm/s within the stationary imaging sheath. All OCT images were analyzed at the core laboratory (Cardiovascular Research Center) by analysts who were blinded to patient and procedural information. The minimal luminal area (MLA) was identified at the segment with the smallest lumen area by OCT analysis. Area stenosis was calculated as follows: [(mean reference lumen area−minimum lumen area)÷mean reference lumen area] ×100. The reference lumen area was the region within the same segme...

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Section: Discussionsupporting

confidence: 49%

Section: Limitationsmentioning

confidence: 99%

Assessing Computational Fractional Flow Reserve From Optical Coherence Tomography in Patients With Intermediate Coronary Stenosis in the Left Anterior Descending Artery

Kim

Lim

et al. 2016

Circ: Cardiovascular Interventions

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“…However, the majority of these studies documented the relationship between the FFR value and the QCA and IVUS parameters based on 2-dimensional analysis, such as stenosis length and minimum luminal area [18,19]. Recently, Yang et al [20] assessed the relationship between volumetric IVUS parameters and the FFR value and found the positive correlation between plaque volume and the FFR value. In the present study, the lesion length measured by IVUS, minimum luminal area, and PV were significantly correlated with the FFR value in the simple regression model, consistent with the findings of a previous report.…”

Section: Discussionmentioning

confidence: 96%

Influence of plaque characteristics on fractional flow reserve for coronary lesions with intermediate to obstructive stenosis: insights from integrated-backscatter intravascular ultrasound analysis

Sakurai

Takashima

Waseda

et al. 2015

Int J Cardiovasc Imaging

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The aim of this study was to determine the correlation between the fractional flow reserve (FFR) values and volumetric intravascular ultrasound (IVUS) parameters derived from classic gray-scale IVUS and integrated backscatter (IB)-IVUS, taking into account known confounding factors. Patients with unstable angina pectoris with the frequent development of vulnerable plaques often showed the discrepancy between the FFR value and the quantitative coronary angiography findings. Our target population was 107 consecutive subjects with 114 isolated lesions who were scheduled for elective coronary angiography. The FFR was calculated as the mean distal coronary pressure divided by the mean aortic pressure during maximal hyperemia. Various volumetric parameters such as lipid plaque volume (LPV) and percentage of LPV (%LPV) were measured using IB-IVUS. Simple and multivariate linear regression analysis was employed to evaluate the correlation between FFR values and various classic gray-scale IVUS and IB-IVUS parameters. The Akaike information criterion (AIC) was used to compare the goodness of fit in an each model. Both the %LPV (r = -0.24; p = 0.01) and LPV (r = -0.40; p < 0.01) were significantly correlated with the FFR value. Only the LPV (AIC = -147.0; p = 0.006) and %LPV (AIC = -152.9; p = 0.005) proved to be independent predictors for the FFR value even after the adjustment of known confounding factors. The volumetric assessment by IB-IVUS could provide better information in terms of the relationship between plaque morphology and the FFR values as compared to the classic IVUS 2-dimensional gray-scale analysis.

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“…48 However, although MLA of >4 mm 2 in non-left main lesions predicted an FFR of >0.80 in 91% of cases, MLA of <4 mm 2 correlated poorly to FFR, with most studies reporting FFR of <0.8 in ≈50% of cases. [61][62][63] IVUS thresholds are also dependent on lesion location, 62,64 whereas the FFR threshold is not. The major reason why location strongly influences the IVUS/FFR relationship is that both the size of the reference vessel and the flow volume of the myocardial bed subtended by the stenotic vessel are important variables needed to compute the trans-stenotic pressure loss.…”

Section: Should Abnormal Ffr Direct Revascularization Decisions?mentioning

confidence: 99%

Prognostic Determinants of Coronary Atherosclerosis in Stable Ischemic Heart Disease

Ahmadi

Stone

Leipsic

et al. 2016

Circulation Research

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Risk stratification in patients with stable ischemic heart disease is essential to guide treatment decisions. In this regard, whether coronary anatomy, physiology, or plaque morphology is the best determinant of prognosis (and driver an effective therapeutic risk reduction) remains one of the greatest ongoing debates in cardiology. In the present report, we review the evidence for each of these characteristics and explore potential algorithms that may enable a practical diagnostic and therapeutic strategy for the management of patients with stable ischemic heart disease.

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Relationship between intravascular ultrasound parameters and fractional flow reserve in intermediate coronary artery stenosis of left anterior descending artery: Intravascular ultrasound volumetric analysis

Abstract: IVUS parameters representing severity and extent of atheromatous plaque correlated with functional significance in LAD lesions with intermediate stenosis.

Cited by 38 publications

References 20 publications

Assessing Computational Fractional Flow Reserve From Optical Coherence Tomography in Patients With Intermediate Coronary Stenosis in the Left Anterior Descending Artery

Assessing Computational Fractional Flow Reserve From Optical Coherence Tomography in Patients With Intermediate Coronary Stenosis in the Left Anterior Descending Artery

Influence of plaque characteristics on fractional flow reserve for coronary lesions with intermediate to obstructive stenosis: insights from integrated-backscatter intravascular ultrasound analysis

Prognostic Determinants of Coronary Atherosclerosis in Stable Ischemic Heart Disease

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