(Circulation. 1999;100:250-255.)
© 1999 American Heart Association, Inc.
Clinical Investigation and Reports |
Clinical Potential of Intravascular Ultrasound for Physiological Assessment of Coronary Stenosis
Relationship Between Quantitative Ultrasound Tomography and Pressure-Derived Fractional Flow Reserve
From the Department of Cardiology, The Heart Institute of Japan, Tokyo Women's Medical University, Tokyo, Japan. Dr Takagi is currently at the Center for Research in Cardiovascular Interventions, Stanford University Medical Center, Stanford, Calif.
Correspondence to Yukio Tsurumi, MD, Department of Cardiology, Tokyo Women's Medical University, 8-1 Kawada-Cho, Shinjuku, Tokyo 162-8666, Japan. E-mail mturumi{at}hij.twmu.ac.jp
Background—Little is known regarding intravascular ultrasound (IVUS) criteria to determine the functional severity of coronary stenosis. Recently, fractional flow reserve (FFR) has emerged as a lesion-specific index of the functional severity of a coronary stenosis that is independent of systemic hemodynamic variability. The present study was undertaken to determine the IVUS parameters for the physiological severity of coronary stenosis.
Methods and Results—Fifty-one lesions in 42 patients were evaluated by means of quantitative coronary angiogram, IVUS, and intracoronary pressure measurements. The FFR was calculated as the ratio of the distal coronary pressure divided by the proximal coronary pressure under hyperemia. We considered a value of the FFR <0.75 as significant in determining inducible ischemia, according to the previous studies. The minimal luminal area (MLA) and the area stenosis were measured by IVUS. By regression analysis, the MLA showed a positive correlation with the FFR value (r2=0.62, P<0.0001). The area stenosis had a significant inverse correlation with the value of FFR (r2=0.60, P<0.0001). The IVUS thresholds that maximized the sensitivity and specificity were MLA <3.0 mm2 (sensitivity, 83.0%; specificity, 92.3%) and area stenosis >0.6 (sensitivity, 92.0%; specificity, 88.5%). The combination of both criteria (MLA <3.0 mm2 and area stenosis <0.6) without exception met a value of the FFR <0.75.
Conclusions—Anatomic parameters obtained by IVUS showed a significant correlation to the FFR values. The present study demonstrated that the combination of the MLA and area stenosis measured by IVUS can be an anatomic predictor for the physiological impact of coronary epicardial stenosis.
Key Words: pressure • blood flow • ultrasonics
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