title: Mathematically Derived Criteria for Detecting Functionally Significant Stenoses Using Coronary Computed Tomographic Angiography-Based Myocardial Segmentation and Intravascular Ultrasound-Measured Minimal Lumen Area.
abstract: The lack of practical method for quantifying myocardial territories has made it difficult to link anatomic lesion morphology to the hemodynamic significance of coronary artery stenosis. The aim of this study was to develop and validate mathematically derived morphologic criteria for predicting fractional flow reserve (FFR) <0.80 using intravascular ultrasound (IVUS) parameters and a coronary artery-based myocardial segmentation (CAMS) of the affected myocardial territory. Coronary computed tomography angiography, IVUS, and FFR data were analyzed in 103 non-left main intermediate coronary artery lesions (30% to 80% of angiographic stenosis). Using CAMS method, the total left ventricular myocardial volume and the myocardial volume subtended by a stenotic coronary segment (Vsub) were assessed. The morphologic criteria for detecting an FFR <0.80 using the IVUS and CAMS parameters were mathematically derived. Overall, an IVUS-measured minimal lumen area (MLA) <2.79 mm(2) predicted an FFR <0.80 with sensitivity of 76%, specificity of 78%, positive predictive value of 71%, and negative predictive value of 82%. A Vsub/MLA(2) >4.04 best predicted an FFR <0.80 (sensitivity 88%, specificity 90%, positive predictive value 86%, and negative predictive value 92%, area under curve = 0.944). There was a significant difference in the areas under the curves between IVUS-MLA versus Vsub/MLA(2) (difference = 0.068, p = 0.005). Conversely, adjusting for body or vessel size did not improve the diagnostic accuracy.
authors.affiliation: Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, 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, Korea.
authors.forename: Jihoon
authors.initials: J
authors.lastname: Kweon
authors.affiliation: Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
authors.forename: Dong Hyun
authors.initials: DH
authors.lastname: Yang
authors.affiliation: Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
authors.forename: June-Goo
authors.initials: JG
authors.lastname: Lee
authors.affiliation: Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
authors.forename: Joonho
authors.initials: J
authors.lastname: Jung
authors.affiliation: Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
authors.forename: Namkug
authors.initials: N
authors.lastname: Kim
authors.affiliation: Cardiovascular Research Foundation, New York, New York.
authors.forename: Gary S
authors.initials: GS
authors.lastname: Mintz
authors.affiliation: Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
authors.forename: Joon-Won
authors.initials: JW
authors.lastname: Kang
authors.affiliation: Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
authors.forename: Tae-Hwan
authors.initials: TH
authors.lastname: Lim
authors.affiliation: Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
authors.forename: Seong-Wook
authors.initials: SW
authors.lastname: Park
authors.affiliation: Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea. Electronic address: mdyhkim@amc.seoul.kr.
authors.forename: Young-Hak
authors.initials: YH
authors.lastname: Kim
mesh_terms: D000368:Aged; D000072226:Computed Tomography Angiography; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000000981:diagnostic imaging* / Q000503:physiopathology; D005260:Female; D053805:Fractional Flow Reserve, Myocardial; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging; D012720:Severity of Illness Index; D018084:Ultrasonography, Interventional