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)

Szilard Voros, Sarah Rinehart, Jesus G. Vazquez-Figueroa, Anna Kalynych, Dimitri Karmpaliotis, Zhen Qian, Parag H. Joshi, Hunt Anderson, Laura Murrieta, Charles Wilmer, Harold Carlson, William Ballard, Charles Brown

Research output: Contribution to journalArticle

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Abstract

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.

Original languageEnglish (US)
Pages (from-to)23-29
Number of pages7
JournalAmerican Journal of Cardiology
Volume113
Issue number1
DOIs
StatePublished - Jan 1 2014

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Coronary Angiography
Hemodynamics
Pathologic Constriction
Odds Ratio
Area Under Curve
Sensitivity and Specificity
Computed Tomography Angiography
ROC Curve
Logistic Models

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

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). / Voros, Szilard; Rinehart, Sarah; Vazquez-Figueroa, Jesus G.; Kalynych, Anna; Karmpaliotis, Dimitri; Qian, Zhen; Joshi, Parag H.; Anderson, Hunt; Murrieta, Laura; Wilmer, Charles; Carlson, Harold; Ballard, William; Brown, Charles.

In: American Journal of Cardiology, Vol. 113, No. 1, 01.01.2014, p. 23-29.

Research output: Contribution to journalArticle

Voros, Szilard ; Rinehart, Sarah ; Vazquez-Figueroa, Jesus G. ; Kalynych, Anna ; Karmpaliotis, Dimitri ; Qian, Zhen ; Joshi, Parag H. ; Anderson, Hunt ; Murrieta, Laura ; Wilmer, Charles ; Carlson, Harold ; Ballard, William ; Brown, Charles. / 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). In: American Journal of Cardiology. 2014 ; Vol. 113, No. 1. pp. 23-29.
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abstract = "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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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

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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.

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