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The appropriate criteria for revascularization of intermediate coronary lesions have been under debate. FFR is considered the gold standard for assessing such lesions. IVUS has become the more accurate standard for defining the anatomy of atherosclerosis in vivo. To date, available data regarding the relationship between anatomic IVUS parameters and functional FFR results have been from retrospective data analyses and are variable.
This study aimed to determine the optimal minimum lumen area (MLA) by intravascular ultrasound (IVUS) that correlates with fractional flow reserve (FFR) and to assess the correlation between two modalities in assessing intermediate coronary stenosis.
Among patients who underwent elective diagnostic coronary angiography in the cath lab of Wady El Nile Hospital from September 2012 to April 2015, we enrolled 58 patients with an intermediate coronary lesion defined as 40% to 70% diameter stenosis by visual assessment via angiography . They underwent IVUS and FFR assessment to assess the significance of coronary stenting and to determine the optimal MLA that correlates with FFR.
Overall, an MLA < 3.9 mm2 (84.2% sensitivity, 80% specificity) was the best threshold value for identifying FFR <0.8.
Anatomic measurements of intermediate coronary lesions obtained by IVUS show a moderate correlation with FFR measurements. MLA ≤ 3.9 mm2 (sensitivity 84.2%, specificity 80 %) was the best cut off value for identifying FFR < 0.8. Different MLA cutoffs should be used for different vessel sizes.