Author + information
- Received May 9, 2011
- Revision received August 8, 2011
- Accepted August 9, 2011
- Published online November 1, 2011.
- Soo-Jin Kang, MD, PhD⁎,
- Jong-Young Lee, MD⁎,
- Jung-Min Ahn, MD⁎,
- Hae Geun Song, MD⁎,
- Won-Jang Kim, MD⁎,
- Duk-Woo Park, MD, PhD⁎,
- Sung-Cheol Yun, PhD‡,
- Seung-Whan Lee, MD, PhD⁎,
- Young-Hak Kim, MD, PhD⁎,
- Gary S. Mintz, MD†,
- Cheol Whan Lee, MD, PhD⁎,
- Seong-Wook Park, MD, PhD⁎ and
- Seung-Jung Park, MD, PhD⁎,⁎ ()
- ↵⁎Reprint requests and correspondence:
Dr. Seung-Jung Park, Asan Medical Center, 388-1 Poongnap-dong, Songpa-gu 138-736, Seoul, South Korea
Objectives The aim of this study was to determine the best intravascular ultrasound (IVUS) criteria for predicting physiological significance of left main (LM) stenosis with fractional flow reserve (FFR) as the standard.
Background For identifying significant LM disease, optimal cutoff of minimal lumen area (MLA) and its accuracy remain debatable.
Methods We identified 55 patients (31 stable and 24 unstable angina) with an isolated LM lesion of 30% to 80% angiographic diameter stenosis who underwent IVUS and invasive physiological assessment before intervention.
Results The FFR at maximum hyperemia significantly correlated with IVUS-measured MLA within the LM (r = 0.623, p < 0.001), plaque burden (r = −0.548, p < 0.001), angiographic diameter stenosis (r = −0.449, p = 0.002), and angiographic length of the lesion (r = −0.292, p = 0.046). The FFR was significantly lower in 18 lesions with plaque rupture than 37 lesions without plaque rupture (0.76 ± 0.09 vs. 0.82 ± 0.09, p = 0.018). The independent determinants of FFR as a continuous variable were MLA (beta = 0.598, p < 0.001) and plaque rupture (beta = −0.255, p = 0.038). Furthermore, the MLA within the LM was the only independent determinant for FFR <0.80 (adjusted odds ratio: 0.312, p < 0.001) and for FFR <0.75 (adjusted odds ratio: 0.196, p = 0.001). The IVUS MLA value within the LM that best predicted FFR <0.80 was <4.8 mm2 (89% sensitivity, 83% specificity). In addition, the cutoff value of plaque burden to predict FFR <0.80 was ≥72% (73% sensitivity, 79% specificity). The best cutoff values of the MLA and plaque burden for predicting FFR <0.75 were <4.1 mm2 (95% sensitivity, 83% specificity) and ≥76% (79% sensitivity, 80% specificity), respectively.
Conclusions In isolated LM disease, an IVUS-derived MLA <4.8 mm2 is a useful criterion for predicting FFR <0.80.
Dr. Mintz has received grant support/honoraria from Boston Scientific and Volcano. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received May 9, 2011.
- Revision received August 8, 2011.
- Accepted August 9, 2011.
- American College of Cardiology Foundation