Stephanie C El Hajj1, Takumi Toya1,2, Takayuki Warisawa3,4, John Nan1, Bradley R Lewis5, Christopher M Cook3, Christopher Rajkumar3, James P Howard3, Henry Seligman3, Yousif Ahmad3, Shunichi Doi6, Akihiro Nakajima7, Masafumi Nakayama8,9, Sonoka Goto10,11, Rafael Vera-Urquiza10, Takao Sato11, Yuetsu Kikuta3,12, Yoshiaki Kawase11, Hidetaka Nishina13, Sunao Nakamura7, Hitoshi Matsuo14, Javier Escaned10, Yoshihiro J Akashi, Justin E Davies3, Amir Lerman1. 1. Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (S.C.H., T.T., J.N., A.L.). 2. Division of Cardiology, National Defense Medical College, Tokorozawa, Japan (T.T.). 3. National Heart and Lung Institute, Imperial College London (T.W., C.M.C., C.R., J.P.H., H.S., Y.A., Y. Kikuta, J.E.D.). 4. Department of Cardiovascular Medicine, St. Marianna University School of Medicine Yokohama City Seibu Hospital, Japan (T.W.). 5. Department of Biomedical Statistics and Informatics, Mao Clinic, Rochester, MN (B.R.L.). 6. Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan (S.D.). 7. Department of Cardiovascular Medicine, New Tokyo Hospital, Matsudo, Japan (A.N., S.N.). 8. Cardiovascular Centre, Toda Central General Hospital, Japan (M.N.). 9. Tokyo Women's Medical University - Waseda University Joint Institution for Advanced Biomedical Sciences, Japan (M.N.). 10. Hospital Clínico San Carlos IDISSC, Complutense University of Madrid, Spain (S.G., R.V.-U., J.E.). 11. Department of Cardiology, Tachikawa General Hospital, Nagaoka, Japan (S.G., T.S., Y. Kawase). 12. Division of Cardiology, Fukuyama Cardiovascular Hospital, Japan (Y. Kikuta). 13. Department of Cardiology, Tsukuba Medical Center Hospital, Japan (H.N.). 14. Department of Cardiovascular Medicine, Gifu Heart Center, Japan (H.M.).
Abstract
BACKGROUND: There is great degree of interobserver variability in the visual angiographic assessment of left main coronary disease (LMCD). Fractional flow reserve and intravascular ultrasound are often used in this setting. The use of instantaneous wave-free ratio (iFR) for evaluation of LMCD has not been well studied. The aim of this study is to evaluate the use of iFR in the assessment of angiographically intermediate LMCD. METHODS: This is an international multicenter retrospective observational study of patients who underwent both iFR and intravascular ultrasound evaluation for angiographically intermediate LMCD. An independent core laboratory performed blinded off-line analysis of all intravascular ultrasound data. A minimum lumen area of 6 mm2 was used as the cutoff for significant disease. RESULTS: One hundred twenty-five patients (mean age, 68.4±9.5 years, 84.8% male) were included in this analysis. Receiver operating curve analysis showed that an iFR of ≤0.89 identified minimum lumen area <6 mm2 with an area under the curve of 0.77 (77% sensitivity, 66% specificity; P<0.0001). Among the 69 patients without ostial left anterior descending artery or left circumflex artery disease, receiver operating curve analysis showed that an iFR of ≤0.89 identified minimum lumen area <6 mm2 with an area under the curve of 0.84 (70% sensitivity, 84% specificity; P<0.0001). The correlation was not significantly different when the body surface area was considered. CONCLUSIONS: In this study, in patients with intermediate LMCD, iFR of ≤0.89 correlates with intravascular ultrasound minimum lumen area <6 mm2 regardless of body surface area. The current study supports the use of iFR for the evaluation of intermediate LMCD.
BACKGROUND: There is great degree of interobserver variability in the visual angiographic assessment of left main coronary disease (LMCD). Fractional flow reserve and intravascular ultrasound are often used in this setting. The use of instantaneous wave-free ratio (iFR) for evaluation of LMCD has not been well studied. The aim of this study is to evaluate the use of iFR in the assessment of angiographically intermediate LMCD. METHODS: This is an international multicenter retrospective observational study of patients who underwent both iFR and intravascular ultrasound evaluation for angiographically intermediate LMCD. An independent core laboratory performed blinded off-line analysis of all intravascular ultrasound data. A minimum lumen area of 6 mm2 was used as the cutoff for significant disease. RESULTS: One hundred twenty-five patients (mean age, 68.4±9.5 years, 84.8% male) were included in this analysis. Receiver operating curve analysis showed that an iFR of ≤0.89 identified minimum lumen area <6 mm2 with an area under the curve of 0.77 (77% sensitivity, 66% specificity; P<0.0001). Among the 69 patients without ostial left anterior descending artery or left circumflex artery disease, receiver operating curve analysis showed that an iFR of ≤0.89 identified minimum lumen area <6 mm2 with an area under the curve of 0.84 (70% sensitivity, 84% specificity; P<0.0001). The correlation was not significantly different when the body surface area was considered. CONCLUSIONS: In this study, in patients with intermediate LMCD, iFR of ≤0.89 correlates with intravascular ultrasound minimum lumen area <6 mm2 regardless of body surface area. The current study supports the use of iFR for the evaluation of intermediate LMCD.
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