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).
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 mm(2), 0.86, 81%, and 81% and 2.68 mm(2), 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.
Global Genomics Group, Richmond, Virginia. Electronic address: szilardvorosmd@gmail.com.
Szilard
S
Voros
Department of Cardiovascular CT and MRI, Piedmont Heart Institute, Atlanta, Georgia.
Sarah
S
Rinehart
Department of Cardiovascular CT and MRI, Piedmont Heart Institute, Atlanta, Georgia.
Jesus G
JG
Vazquez-Figueroa
Department of Cardiovascular CT and MRI, Piedmont Heart Institute, Atlanta, Georgia.
Anna
A
Kalynych
Department of Cardiovascular CT and MRI, Piedmont Heart Institute, Atlanta, Georgia.
Dimitri
D
Karmpaliotis
Department of Cardiovascular CT and MRI, Piedmont Heart Institute, Atlanta, Georgia.
Zhen
Z
Qian
Department of Cardiovascular CT and MRI, Piedmont Heart Institute, Atlanta, Georgia.
Parag H
PH
Joshi
Department of Cardiovascular CT and MRI, Piedmont Heart Institute, Atlanta, Georgia.
Hunt
H
Anderson
Department of Cardiovascular CT and MRI, Piedmont Heart Institute, Atlanta, Georgia.
Laura
L
Murrieta
Department of Cardiovascular CT and MRI, Piedmont Heart Institute, Atlanta, Georgia.
Charles
C
Wilmer
Department of Cardiovascular CT and MRI, Piedmont Heart Institute, Atlanta, Georgia.
Harold
H
Carlson
Department of Cardiovascular CT and MRI, Piedmont Heart Institute, Atlanta, Georgia.
William
W
Ballard
Department of Cardiovascular CT and MRI, Piedmont Heart Institute, Atlanta, Georgia.
Charles
C
Brown
D006328:Cardiac Catheterization; D017023:Coronary Angiography / Q000379:methods*; D023921:Coronary Stenosis / Q000175:diagnosis* / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D053805:Fractional Flow Reserve, Myocardial / Q000502:physiology*; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed / Q000379:methods*; D018084:Ultrasonography, Interventional / Q000379:methods*