title: Validation of minimal luminal area measured by intravascular ultrasound for assessment of functionally significant coronary stenosis comparison with myocardial perfusion imaging.
abstract: OBJECTIVE
  This study sought to evaluate the ability of minimal luminal area (MLA) measured by intravascular ultrasound (IVUS) to assess the functional significance of coronary artery disease.
  
  
  BACKGROUND
  The use of IVUS to determine the functional significance of coronary artery lesions remains a matter for debate.
  
  
  METHODS
  From our prospective IVUS imaging database, between July 2009 and April 2010, 170 coronary lesions in 150 patients who underwent stress myocardial single-photon emission computed tomography (SPECT) performed within 1 month of IVUS evaluation were identified and analyzed. MLA and other parameters were measured by IVUS and compared with the results of myocardial SPECT.
  
  
  RESULTS
  Overall, 45 lesions had positive SPECT, and 125 lesions had negative SPECT. The MLA of lesions with positive SPECT was smaller than the MLA of those with negative SPECT (1.7 ± 0.5 mm² vs. 2.3 ± 1.1 mm², p < 0.001). By logistic regression analysis, MLA (odds ratio: 3.1 by decrease of 1 mm², 95% confidence interval [CI]: 1.75 to 5.5, p < 0.01) was an independent predictor of the positive SPECT. Using receiver-operator characteristic curve analysis, the best cutoff value of MLA was ≤ 2.1 mm² with an 86.7% sensitivity, a 50.4% specificity, a 38.6% positive predictive value, and a 91.3% negative predictive value versus lesions with a positive SPECT (area under the curve: 0.690, 95% CI: 0.615 to 0.759, p < 0.01).
  
  
  CONCLUSIONS
  The best cutoff value of MLA measured by IVUS to predict myocardial ischemia was 2.1 mm². The IVUS-measured MLA appeared to play a limited role in detecting functionally significant lesions assessed by myocardial SPECT.
authors.affiliation: Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
authors.forename: Jung-Min
authors.initials: JM
authors.lastname: Ahn
authors.forename: Soo-Jin
authors.initials: SJ
authors.lastname: Kang
authors.forename: Gary S
authors.initials: GS
authors.lastname: Mintz
authors.forename: Jun-Hyok
authors.initials: JH
authors.lastname: Oh
authors.forename: Won-Jang
authors.initials: WJ
authors.lastname: Kim
authors.forename: Jong-Young
authors.initials: JY
authors.lastname: Lee
authors.forename: Duk-Woo
authors.initials: DW
authors.lastname: Park
authors.forename: Seung-Whan
authors.initials: SW
authors.lastname: Lee
authors.forename: Young-Hak
authors.initials: YH
authors.lastname: Kim
authors.forename: Cheol Whan
authors.initials: CW
authors.lastname: Lee
authors.forename: Seong-Wook
authors.initials: SW
authors.lastname: Park
authors.forename: Dae Hyuk
authors.initials: DH
authors.lastname: Moon
authors.forename: Seung-Jung
authors.initials: SJ
authors.lastname: Park
mesh_terms: D019540:Area Under Curve; D016001:Confidence Intervals; D023921:Coronary Stenosis / Q000000981:diagnostic imaging* / Q000473:pathology; D003331:Coronary Vessels / Q000000981:diagnostic imaging* / Q000473:pathology; D016208:Databases, Factual; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging* / Q000473:pathology; D015425:Myocardial Reperfusion / Q000295:instrumentation* / Q000379:methods; D016017:Odds Ratio; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D013793:Thallium; D015899:Tomography, Emission-Computed, Single-Photon / Q000295:instrumentation / Q000379:methods; D018084:Ultrasonography, Interventional / Q000295:instrumentation* / Q000379:methods / Q000592:standards
chemical_list: C027549:thallium chloride; D013793:Thallium