title: Intravascular ultrasound-derived minimal lumen area criteria for functionally significant left main coronary artery stenosis.
abstract: OBJECTIVE
  This study sought to evaluate the intravascular ultrasound (IVUS) minimal lumen area (MLA) for functionally significant left main coronary artery (LMCA) stenosis using fractional flow reserve (FFR) as the standard.
  
  
  BACKGROUND
  The evaluation of significant LMCA stenosis remains challenging.
  
  
  METHODS
  We identified 112 patients with isolated ostial and shaft intermediate LMCA stenosis (angiographic diameter stenosis of 30% to 80%) who underwent IVUS and FFR measurement.
  
  
  RESULTS
  The FFR was ≤0.80 in 66 LMCA lesions (59%); these exhibited smaller reference vessels, smaller minimal lumen diameter, greater diameter of stenosis, longer lesion length, smaller MLA, larger plaque burden, and more frequent plaque rupture. The independent factors of an FFR of ≤0.80 were plaque rupture (odds ratio [OR]: 4.47; 95% Confidence Interval (CI): 1.35 to 14.8; p = 0.014); body mass index (OR: 1.19; 95% CI: 1.00 to 1.41; p = 0.05), age (OR: 0.95; 95% CI: 0.90 to 1.00; p = 0.031), and IVUS MLA (OR: 0.37; 95% CI: 0.25 to 0.56; p < 0.001). The optimal IVUS MLA cutoff value for an FFR of ≤0.80 was 4.5 mm(2) (77% sensitivity, 82% specificity, 84% positive predictive value, 75% negative predictive value, area under the curve: 0.83, 95% CI: 0.76 to 0.96; p < 0.001) overall and 4.1 to 4.5 mm(2) in various subgroups. Adjustment for the body surface area, body mass index, and left ventricular mass did not improve the diagnostic accuracy of the IVUS MLA.
  
  
  CONCLUSIONS
  In patients with isolated ostial and shaft intermediate LMCA stenosis, an IVUS-derived MLA of ≤4.5 mm(2) is a useful index of an FFR of ≤0.80.
authors.affiliation: Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea. Electronic address: sjpark@amc.seoul.kr.
authors.forename: Seung-Jung
authors.initials: SJ
authors.lastname: Park
authors.affiliation: Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
authors.forename: Jung-Min
authors.initials: JM
authors.lastname: Ahn
authors.affiliation: Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
authors.forename: Soo-Jin
authors.initials: SJ
authors.lastname: Kang
authors.affiliation: Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
authors.forename: Sung-Han
authors.initials: SH
authors.lastname: Yoon
authors.affiliation: Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea.
authors.forename: Bon-Kwon
authors.initials: BK
authors.lastname: Koo
authors.affiliation: Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
authors.forename: Jong-Young
authors.initials: JY
authors.lastname: Lee
authors.affiliation: Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
authors.forename: Won-Jang
authors.initials: WJ
authors.lastname: Kim
authors.affiliation: Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
authors.forename: Duk-Woo
authors.initials: DW
authors.lastname: Park
authors.affiliation: Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
authors.forename: Seung-Whan
authors.initials: SW
authors.lastname: Lee
authors.affiliation: Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
authors.forename: Young-Hak
authors.initials: YH
authors.lastname: Kim
authors.affiliation: Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
authors.forename: Cheol Whan
authors.initials: CW
authors.lastname: Lee
authors.affiliation: Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
authors.forename: Seong-Wook
authors.initials: SW
authors.lastname: Park
mesh_terms: D000367:Age Factors; D000368:Aged; D015992:Body Mass Index; D006328:Cardiac Catheterization; D016009:Chi-Square Distribution; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000000981:diagnostic imaging* / Q000503:physiopathology; D003331:Coronary Vessels / Q000000981:diagnostic imaging* / Q000503:physiopathology; D005260:Female; D053805:Fractional Flow Reserve, Myocardial; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011237:Predictive Value of Tests; D012307:Risk Factors; D012422:Rupture, Spontaneous; D012720:Severity of Illness Index; D018084:Ultrasonography, Interventional
keywords: coronary disease; fractional flow reserve; intravascular ultrasound; left main coronary artery