TY - JOUR
T1 - Prospective, head-to-head comparison of quantitative coronary angiography, quantitative computed tomography angiography, and intravascular ultrasound for the prediction of hemodynamic significance in intermediate and severe lesions, using fractional flow reserve as reference standard (from the ATLANTA i and II Study)
AU - Voros, Szilard
AU - Rinehart, Sarah
AU - Vazquez-Figueroa, Jesus G.
AU - Kalynych, Anna
AU - Karmpaliotis, Dimitri
AU - Qian, Zhen
AU - Joshi, Parag H.
AU - Anderson, Hunt
AU - Murrieta, Laura
AU - Wilmer, Charles
AU - Carlson, Harold
AU - Ballard, William
AU - Brown, Charles
N1 - Funding Information:
Dr. Voros received research grants from Abbott Vascular , Volcano Inc. , Siemens Medical Solutions , Vital Images , Toshiba America Medical Systems , Merck Inc. , and Abbott Laboratories . Dr Voros has Speaker's Bureau, Consulting, and Advisory Board memberships in Vital Images, Toshiba America Medical Systems, and Merck Inc. He is the owner, president, and CEO of Integrated Cardiovascular Research Group, LLC; the CEO of Global Genomics Group; and the Chief Academic Officer of HDL, Inc. Dr Rinehart received research grants from Abbott Vascular, Volcano Inc., Siemens Medical Solutions, Vital Images, and Toshiba America Medical Systems. Dr Karmpaliotis received grant support from Medtronic and has Speaker's Bureau and Consulting memberships in Abbott Vascular and Bridgepoint Medical.
PY - 2014/1/1
Y1 - 2014/1/1
N2 - The objective of this study was to compare the diagnostic accuracy of quantitative coronary angiography (QCA), coronary computed tomography angiography (CTA), and intravascular ultrasound (IVUS) with fractional flow reserve (FFR) measurements. Eighty-five lesions (40% to 99% diameter stenosis) in 85 patients were prospectively interrogated by QCA, CTA, IVUS, and FFR. Minimal lumen diameter (MLD), percent diameter stenosis (%DS), minimal lumen area (MLA), and percent area stenosis (%AS) were measured. Correlation, receiver operating characteristic analysis, kappa statistics, and multivariable logistic regression was used to assess relation between anatomic measurements and FFR. Average age was 61.3 ± 7.8; 62% were men. QCA-derived mean %DS was 55.3% ± 19.5%; mean FFR 0.81 ± 0.17; 27% had FFR ≤0.75. QCA had the strongest correlation, followed by CTA and then IVUS for MLD (r = 0.67, 0.47, and 0.29, respectively) and for %DS (r = -0.63, -0.52, and -0.22, respectively); QCA-derived MLD had area under the curve of 0.96, with 95% sensitivity and 82% specificity. Cut-point, area under the curve, sensitivity, and specificity for CTA-MLA and IVUS-MLA were 3.11 mm2, 0.86, 81%, and 81% and 2.68 mm2, 0.75, 70%, and 80%. In multivariable analysis for each modality, MLD on QCA (odds ratio [OR]: 0.002), %AS on CTA (OR: 1.09) and MLA on IVUS (OR: 0.28) remained independent predictors. In conclusion, in intermediate-to-severe lesions, QCA-, CTA-, and IVUS-derived quantitative anatomic measurements correlated with FFR. CTA-derived cut-points were similar to respective measurements on QCA and IVUS and had similar or better diagnostic performance compared with IVUS.
AB - The objective of this study was to compare the diagnostic accuracy of quantitative coronary angiography (QCA), coronary computed tomography angiography (CTA), and intravascular ultrasound (IVUS) with fractional flow reserve (FFR) measurements. Eighty-five lesions (40% to 99% diameter stenosis) in 85 patients were prospectively interrogated by QCA, CTA, IVUS, and FFR. Minimal lumen diameter (MLD), percent diameter stenosis (%DS), minimal lumen area (MLA), and percent area stenosis (%AS) were measured. Correlation, receiver operating characteristic analysis, kappa statistics, and multivariable logistic regression was used to assess relation between anatomic measurements and FFR. Average age was 61.3 ± 7.8; 62% were men. QCA-derived mean %DS was 55.3% ± 19.5%; mean FFR 0.81 ± 0.17; 27% had FFR ≤0.75. QCA had the strongest correlation, followed by CTA and then IVUS for MLD (r = 0.67, 0.47, and 0.29, respectively) and for %DS (r = -0.63, -0.52, and -0.22, respectively); QCA-derived MLD had area under the curve of 0.96, with 95% sensitivity and 82% specificity. Cut-point, area under the curve, sensitivity, and specificity for CTA-MLA and IVUS-MLA were 3.11 mm2, 0.86, 81%, and 81% and 2.68 mm2, 0.75, 70%, and 80%. In multivariable analysis for each modality, MLD on QCA (odds ratio [OR]: 0.002), %AS on CTA (OR: 1.09) and MLA on IVUS (OR: 0.28) remained independent predictors. In conclusion, in intermediate-to-severe lesions, QCA-, CTA-, and IVUS-derived quantitative anatomic measurements correlated with FFR. CTA-derived cut-points were similar to respective measurements on QCA and IVUS and had similar or better diagnostic performance compared with IVUS.
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U2 - 10.1016/j.amjcard.2013.09.010
DO - 10.1016/j.amjcard.2013.09.010
M3 - Article
C2 - 24238960
AN - SCOPUS:84890437241
SN - 0002-9149
VL - 113
SP - 23
EP - 29
JO - American Journal of Cardiology
JF - American Journal of Cardiology
IS - 1
ER -