title: Intravascular ultrasound-derived morphological predictors of myocardial ischemia assessed by stress myocardial perfusion computed tomography.
abstract: BACKGROUND
  Although ischemia-guided revascularization improves clinical outcomes, morphological determinants of clinically relevant myocardial ischemia have not been studied. To identify intravascular ultrasound (IVUS)-derived anatomical parameters for predicting myocardial perfusion defect and its extent.
  
  
  METHODS
  A total of 103 patients (88 stable and 15 unstable angina) with 153 lesions (angiographic diameter stenosis of 30-80%) underwent stress myocardial perfusion computed tomography (CT) and IVUS pre-procedure. The volume of CT perfusion defect and %CT perfusion defect in the target vessel territories were measured.
  
  
  RESULTS
  The CT perfusion defect was seen in 76 (50%) lesions. The independent determinants for the presence of CT perfusion defect were IVUS-minimal lumen area (MLA) (adjusted OR = 0.56, 95% CI = 0.38-0.82), plaque burden (adjusted OR = 1.07, 95% CI = 1.02-1.11) and involvement of left main or left anterior descending artery (adjusted OR = 4.13, 95% CI = 1.75-9.78, all P < 0.05). The CT perfusion defect was predicted by IVUS-MLA <2.28mm2(sensitivity 74%, specificity 82%) and plaque burden >77% (sensitivity 79%, specificity 78%) as thresholds. The independent determinants for the volume of CT perfusion defect were the involvement of left main or left anterior descending artery (β = 16.43, standard errors = 4.387, P = 0.020) and a greater plaque burden (β = 0.56, standard errors = 0.163, P = 0.026).
  
  
  CONCLUSIONS
  IVUS-derived morphological parameters were useful to predict the presence of CT perfusion defect and the size of myocardial ischemia that were primarily determined by lesion severity and subtended myocardial territory. © 2016 Wiley Periodicals, Inc.
authors: Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
authors: Soo-Jin
authors: SJ
authors: Kang
authors: Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
authors: Dong Hyun
authors: DH
authors: Yang
authors: Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
authors: Hyun Jung
authors: HJ
authors: Koo
authors: Department of Biostatistics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
authors: Sung-Cheol
authors: SC
authors: Yun
authors: Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
authors: June-Goo
authors: JG
authors: Lee
authors: Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
authors: Joon-Won
authors: JW
authors: Kang
authors: Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
authors: Tae-Hwan
authors: TH
authors: Lim
authors: Cardiovascular Research Foundation, New York, New York.
authors: Gary S
authors: GS
authors: Mintz
authors: Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
authors: Seong-Wook
authors: SW
authors: Park
authors: Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
authors: Young-Hak
authors: YH
authors: Kim
mesh_terms: D000241:Adenosine / Q000008:administration & dosage; D000368:Aged; D060050:Angina, Stable / Q000000981:diagnostic imaging* / Q000503:physiopathology; D000789:Angina, Unstable / Q000000981:diagnostic imaging* / Q000503:physiopathology; D000072226:Computed Tomography Angiography; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000503:physiopathology; D003326:Coronary Circulation; D023921:Coronary Stenosis / Q000000981:diagnostic imaging* / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012042:Registries; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D018084:Ultrasonography, Interventional; D014665:Vasodilator Agents / Q000008:administration & dosage
chemical_list: D014665:Vasodilator Agents; D000241:Adenosine
keywords: intravascular ultrasound; myocardial ischemia; myocardial perfusion CT