Author + information
- Received December 28, 2015
- Revision received March 25, 2016
- Accepted April 7, 2016
- Published online August 8, 2016.
- Hyung Yoon Kim, MDa,
- Hong-Seok Lim, MD, PhDb,
- Joon-Hyung Doh, MD, PhDc,
- Chang-Wook Nam, MD, PhDd,
- Eun-Seok Shin, MD, PhDe,
- Bon-Kwon Koo, MD, PhDf,
- Myeong-Ho Yoon, MD, PhDb,
- Seung-Jea Tahk, MD, PhDb,
- Doo Kyoung Kang, MD, PhDg,
- Young Bin Song, MD, PhDa,
- Joo-Yong Hahn, MD, PhDa,
- Seung Hyuk Choi, MD, PhDa,
- Hyeon-Cheol Gwon, MD, PhDa,
- Sang-Hoon Lee, MD, PhDa,
- Eun-Kyoung Kim, MDa,
- Sung Mok Kim, MD, PhDh,
- Yeonhyeon Choe, MD, PhDh and
- Jin-Ho Choi, MD, PhDa,i,∗ ()
- aDepartment of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- bDepartment of Cardiology, Ajou University School of Medicine, Suwon, Korea
- cDepartment of Medicine, Inje University Ilsan-Paik Hospital, Goyang, Korea
- dDepartment of Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea
- eDepartment of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea
- fDepartment of Medicine, Seoul National University Hospital, Seoul, Korea
- gDepartment of Radiology, Ajou University School of Medicine, Suwon, Korea
- hDepartment of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- iDepartment of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- ↵∗Reprint requests and correspondence:
Dr. Jin-Ho Choi, Sungkyunkwan University School of Medicine, Departments of Internal Medicine and Emergency Medicine, Samsung Medical Center, 81 Irwon-Ro, Gangnam-Ku, Seoul 135-710, Korea.
Objectives This study investigated the role of fractional myocardial mass (FMM), a vessel-specific myocardial mass, in the evaluation of physiological severity of stenosis. Using computed tomography angiography, the study investigated fractional myocardial mass, a concept of myocardial mass subtended by specific vessel, which could reduce anatomical-physiological mismatch.
Background Discordance between anatomical stenosis and physiological severity is common but remains poorly understood.
Methods This multicenter study enrolled 463 patients with 724 lesions, who underwent coronary computed tomography angiography (CCTA) and invasive coronary angiography with fractional flow reserve (FFR) measurement. FMM was assessed by allometric scaling analysis of arterial tree length and myocardial mass from CCTA.
Results FFR <0.80, a criteria for vessel-specific physiological stenosis, was found in 281 vessels (39%). FMM decreased consistently according to the vessel downstream (p < 0.001, all). The frequency of FFR <0.80 increased in proportion to FMM and inverse proportion to angiographic minimal luminal diameter (MLD) (p < 0.001). In per-vessel analysis, FMM per MLD (FMM/MLD) showed good correlation with FFR (r = 0.61) and was superior to diameter stenosis (DS) for FFR <0.80 by receiver operating characteristic and reclassification analysis (C-statistics = 0.84 versus 0.74, net reclassification improvement [NRI] = 0.63, integrated discrimination improvement [IDI] = 0.18; p < 0.001, all). The optimal cutoff of FMM/MLD was 29 g/mm, with sensitivity = 75%, specificity = 77%, positive predictive value = 68%, negative predictive value = 83%, and accuracy = 77%. Addition of FMM/MLD to DS could further discriminate vessels with FFR <0.80 (C-statistic = 0.86 vs. 0.84, NRI = 0.34, IDI = 0.03; p < 0.005, all). In per-range classification analysis, agreement between FFR and FMM/MLD maintained >80% when the severity of disease was away from cutoff.
Conclusions FMM/MLD could find physiological severity of coronary artery with higher accuracy than anatomical stenosis. FMM may explain the anatomical-physiological discordance.
- anatomical-physiological discordance
- coronary artery physiology
- fractional flow reserve
- fractional myocardial mass
This study was supported by Korean Society of Interventional Cardiology grant 2014-1 and Samsung Biomedical Research Institute grant GL1B33211, and by the Heart Vascular and Stroke Institute of Samsung Medical Center. The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received December 28, 2015.
- Revision received March 25, 2016.
- Accepted April 7, 2016.
- American College of Cardiology Foundation