title: Angiographic severity does not correlate with fractional flow reserve in heavily calcified coronary arteries.
abstract: OBJECTIVE
  To determine the relationship between severity of stenosis and hemodynamic significance in calcified coronary arteries.
  
  
  BACKGROUND
  Severity of stenosis is widely used to determine the need for revascularization but the effect of lesion calcification on hemodynamic significance is not well understood.
  
  
  METHODS
  Two hundred consecutive patients undergoing fractional flow reserve (FFR) testing of an intermediate coronary lesion with a pressure wire and intravenous infusion of adenosine were studied. Coronary calcium was quantified based upon radiopacities at the site of the stenosis on cineangiography using the method of Mintz et al. (0 = none or mild calcium, 1 = moderate calcium, 2 = severe calcium).
  
  
  RESULTS
  Mean age was 61 ± 11 years, 66% were males, 87.5% had hypertension, 44.5% had diabetes, and 20.5% were current smokers. The mean coronary stenosis by quantitative coronary angiography was 60 ± 12% and the mean FFR was 0.83 ± 0.08. There were 109, 45, and 46 patients classified as Calcium Score of 0, 1, or 2, respectively. Compared to those with no/mild or moderate calcification, patients with severe coronary calcium were older and more likely to have chronic kidney disease and pulmonary disease. The correlation between angiographic severity and FFR decreased as lesion calcification increased [calcium score = 0 (R2= 0.25, P < 0.005); calcium score = 1 (R2= 0.11, P < 0.005); calcium score = 2 (R2= 0.02, P = 0.35)].
  
  
  CONCLUSIONS
  In patients with heavily calcified coronary lesions, there was no association between angiographic stenosis and hemodynamic significance and FFR is needed to determine hemodynamic significance of intermediate lesions. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Department of Medicine, Division of Cardiology, University of North Carolina, Chapel Hill, North Carolina.
authors.forename: Paul M
authors.initials: PM
authors.lastname: Johnson
authors.affiliation: Department of Medicine, Division of Cardiology, University of North Carolina, Chapel Hill, North Carolina.
authors.forename: Chaitanya
authors.initials: C
authors.lastname: Madamanchi
authors.affiliation: Department of Medicine, Division of Cardiology, University of North Carolina, Chapel Hill, North Carolina.
authors.forename: Zarina M
authors.initials: ZM
authors.lastname: Sharalaya
authors.affiliation: Department of Medicine, Eastern Carolina University, Greenville, North Carolina.
authors.forename: Zahra
authors.initials: Z
authors.lastname: Iqbal
authors.affiliation: Department of Medicine, Division of Cardiology, University of North Carolina, Chapel Hill, North Carolina.
authors.forename: Anil K
authors.initials: AK
authors.lastname: Gehi
authors.affiliation: Department of Medicine, Division of Cardiology, University of North Carolina, Chapel Hill, North Carolina.
authors.forename: Prashant
authors.initials: P
authors.lastname: Kaul
authors.affiliation: Department of Medicine, Division of Cardiology, University of North Carolina, Chapel Hill, North Carolina.|Department of Medicine, McAlister Heart Institute, University of North Carolina, Chapel Hill, North Carolina.
authors.forename: George A
authors.initials: GA
authors.lastname: Stouffer
mesh_terms: D000241:Adenosine / Q000008:administration & dosage; D000368:Aged; D006328:Cardiac Catheterization; D016009:Chi-Square Distribution; D002932:Cineangiography; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000503:physiopathology; D003331:Coronary Vessels / Q000000981:diagnostic imaging* / Q000503:physiopathology; D005260:Female; D053805:Fractional Flow Reserve, Myocardial; D006439:Hemodynamics; D006801:Humans; D007262:Infusions, Intravenous; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009657:North Carolina; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012720:Severity of Illness Index; D061205:Vascular Calcification / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000503:physiopathology; D014665:Vasodilator Agents / Q000008:administration & dosage
chemical_list: D014665:Vasodilator Agents; D000241:Adenosine
keywords: angiography; atherosclerosis; coronary; coronary artery disease; fractional flow reserve; quantitative coronary angiography