title: Intravascular ultrasound-derived predictors for fractional flow reserve in intermediate left main disease.
abstract: OBJECTIVE
  The aim of this study was to determine the best intravascular ultrasound (IVUS) criteria for predicting physiological significance of left main (LM) stenosis with fractional flow reserve (FFR) as the standard.
  
  
  BACKGROUND
  For identifying significant LM disease, optimal cutoff of minimal lumen area (MLA) and its accuracy remain debatable.
  
  
  METHODS
  We identified 55 patients (31 stable and 24 unstable angina) with an isolated LM lesion of 30% to 80% angiographic diameter stenosis who underwent IVUS and invasive physiological assessment before intervention.
  
  
  RESULTS
  The FFR at maximum hyperemia significantly correlated with IVUS-measured MLA within the LM (r = 0.623, p < 0.001), plaque burden (r = -0.548, p < 0.001), angiographic diameter stenosis (r = -0.449, p = 0.002), and angiographic length of the lesion (r = -0.292, p = 0.046). The FFR was significantly lower in 18 lesions with plaque rupture than 37 lesions without plaque rupture (0.76 ± 0.09 vs. 0.82 ± 0.09, p = 0.018). The independent determinants of FFR as a continuous variable were MLA (beta = 0.598, p < 0.001) and plaque rupture (beta = -0.255, p = 0.038). Furthermore, the MLA within the LM was the only independent determinant for FFR <0.80 (adjusted odds ratio: 0.312, p < 0.001) and for FFR <0.75 (adjusted odds ratio: 0.196, p = 0.001). The IVUS MLA value within the LM that best predicted FFR <0.80 was <4.8 mm(2) (89% sensitivity, 83% specificity). In addition, the cutoff value of plaque burden to predict FFR <0.80 was ≥72% (73% sensitivity, 79% specificity). The best cutoff values of the MLA and plaque burden for predicting FFR <0.75 were <4.1 mm(2) (95% sensitivity, 83% specificity) and ≥76% (79% sensitivity, 80% specificity), respectively.
  
  
  CONCLUSIONS
  In isolated LM disease, an IVUS-derived MLA <4.8 mm(2) is a useful criterion for predicting FFR <0.80.
authors: Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
authors: Soo-Jin
authors: SJ
authors: Kang
authors: Jong-Young
authors: JY
authors: Lee
authors: Jung-Min
authors: JM
authors: Ahn
authors: Hae Geun
authors: HG
authors: Song
authors: Won-Jang
authors: WJ
authors: Kim
authors: Duk-Woo
authors: DW
authors: Park
authors: Sung-Cheol
authors: SC
authors: Yun
authors: Seung-Whan
authors: SW
authors: Lee
authors: Young-Hak
authors: YH
authors: Kim
authors: Gary S
authors: GS
authors: Mintz
authors: Cheol Whan
authors: CW
authors: Lee
authors: Seong-Wook
authors: SW
authors: Park
authors: Seung-Jung
authors: SJ
authors: Park
mesh_terms: D000241:Adenosine; D000368:Aged; D000787:Angina Pectoris / Q000000981:diagnostic imaging / Q000503:physiopathology; D000789:Angina, Unstable / Q000000981:diagnostic imaging / Q000503:physiopathology; D016009:Chi-Square Distribution; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000000981:diagnostic imaging* / Q000503:physiopathology; D005260:Female; D053805:Fractional Flow Reserve, Myocardial; D006801:Humans; D006940:Hyperemia / Q000000981:diagnostic imaging / Q000503:physiopathology; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011379:Prognosis; D056910:Republic of Korea; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D018084:Ultrasonography, Interventional; D014665:Vasodilator Agents
chemical_list: D014665:Vasodilator Agents; D000241:Adenosine