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Determination of haemodynamic significance of intermediate coronary lesions using three-dimensional coronary
Mohammed Saad1, Ralph Toelg, Ahmed A Khattab
1Herz-Kreislauf-Zentrum, Segeberger Kliniken GmbH (Academic Teaching Hospital of the University of Kiel), Bad Segeberg, Germany.
Insights
Three-dimensional quantitative coronary angiography (3-D QCA) accurately assesses intermediate coronary lesions. A cross-sectional stenosis over 57% by 3-D QCA effectively identifies hemodynamically significant stenosis.
Area of Science:
- Cardiovascular Imaging
- Interventional Cardiology
- Medical Imaging Analysis
Background:
- Angiographically borderline lesions require accurate assessment for intervention.
- Fractional flow reserve (FFR) is a key indicator of hemodynamic significance.
- Three-dimensional quantitative coronary angiography (3-D QCA) offers advanced visualization of coronary anatomy.
Purpose of the Study:
- To evaluate the efficacy of 3-D QCA in assessing angiographically borderline coronary lesions.
- To correlate 3-D QCA parameters with fractional flow reserve (FFR) values.
- To determine the diagnostic accuracy of 3-D QCA for identifying hemodynamically significant lesions.
Main Methods:
- 3-D QCA was performed on 41 intermediate coronary stenotic lesions in 31 patients.
- Measurements included cross-sectional stenosis (CSS), diameter stenosis (DS), and plaque volume (PV).
- Results were correlated with FFR values, with FFR <0.75 considered significant.
Main Results:
- Only 9/41 lesions were hemodynamically significant (FFR <0.75).
- Significant lesions showed higher CSS, DS, and PV by 3-D QCA compared to non-significant lesions.
- A CSS of 57% by 3-D QCA demonstrated high sensitivity (88.9%) and specificity (87.5%) for detecting significant stenosis.
Conclusions:
- 3-D QCA parameters significantly correlate with FFR values.
- 3-D QCA-derived CSS is a strong predictor of FFR.
- A CSS threshold of 57% by 3-D QCA reliably identifies hemodynamically significant intermediate coronary stenosis.
Aims:
This study evaluates three-dimensional (3-D) reconstruction of the coronary arteries in assessment of angiographically borderline lesions.
Methods And Results:
Three-dimensional (3-D) quantitative coronary angiography (QCA) was performed for 41 intermediate coronary stenotic lesions (IL) in 31 patients. Measurements of cross-sectional stenosis (CSS), diameter stenosis (DS) and plaque volume (PV) were correlated with the fractional flow reserve (FFR) values measured with a commercially-available pressure guide-wire. FFR <0.75 was considered significant. Using FFR, only 9/41 lesions appeared haemodynamically significant (FFR <0.75). When compared to lesions with an FFR >0.75, these lesions had higher CSS (65.3+/-9.4% vs. 44.7+/-10.6%, p=0.0001), higher DS (48+/-5.7% vs. 32.5+/-9.9%, p=0.0001), and higher PV (41.6+/-7.6% vs. 29.4+/-6.7%, p=0.0005), as measured by 3-D QCA. Regression analysis showed significant correlations between FFR and CSS (r=-0.481, p=0.001) and PV (r=-0.443, p=0.004), and a modest correlation between FFR and DS (r=-0,320, p=0.041). Compared with FFR, a CSS of 57% had the highest sensitivity and specificity (88.9% and 87.5%, respectively) for determining significant IL. Multivariate analysis showed 3-D-determined CSS to better predict FFR compared to the other measured variables (p=0.012).
Conclusions:
Parameters obtained by 3-D QCA showed a significant correlation with FFR values. A cross-sectional stenosis >57% obtained by 3-D QCA has a high degree of sensitivity and specificity to detect a haemodynamically significant intermediate coronary stenosis.
