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Three-Dimensional Angiographic Characteristics versus Functional Stenosis Severity in Fractional and Coronary Flow
Valerie Stegehuis1, Jelmer Westra2, Coen Boerhout1
1Amsterdam UMC-Location AMC, Department of Cardiology, University of Amsterdam, Heart Center, Amsterdam Cardiovascular Sciences, 1105 AZ Amsterdam, The Netherlands.
Insights
Coronary angiography alone is insufficient for identifying ischemia-causing lesions. Combining 2D/3D QCA with invasive measures like FFR, CFR, and CFC reveals discrepancies, highlighting potential mismatches in assessing lesion severity and ischemia.
Area of Science:
- Cardiovascular Imaging
- Interventional Cardiology
- Diagnostic Accuracy
Background:
- Coronary angiography alone cannot reliably identify lesions causing myocardial ischemia.
- Invasive coronary physiology measurements (FFR, CFR, CFC) may enhance decision-making alongside angiography.
- The relationship between 2D/3D quantitative coronary angiography (QCA) and invasive flow/pressure data requires further investigation.
Purpose of the Study:
- To investigate the association between 2D and 3D QCA and invasive coronary physiology measurements (FFR, CFR, CFC).
- To evaluate the diagnostic performance of QCA in identifying functionally significant coronary artery lesions.
Main Methods:
- Invasive FFR, CFR, and CFC were measured and correlated with 2D and 3D QCA.
- Analysis included 430 intermediate lesions in 366 patients.
- Comparison of QCA characteristics across different functional lesion categories (e.g., FFR+/CFR-, FFR-/CFR+).
Main Results:
- 3D QCA provided a more accurate assessment of stenosis severity than 2D QCA.
- Lesions with FFR+/CFR- discordance showed similar 3D QCA features to FFR+/CFR+ lesions.
- FFR-/CFR+ lesions exhibited 3D QCA characteristics akin to FFR-/CFR- lesions, but often with reduced CFC.
Conclusions:
- Non-flow-limiting lesions (FFR+/CFR-) may share angiographic features with flow-limiting lesions but often lack inducible ischemia.
- Discordant lesions (FFR-/CFR+) show angiographic similarities to non-ischemic lesions but frequently have reduced coronary flow capacity, indicating an angiographic-functional mismatch.
Background:
Coronary angiography alone is insufficient to identify lesions associated with myocardial ischemia that may benefit from revascularization. Coronary physiology parameters may improve clinical decision making in addition to coronary angiography, but the association between 2D and 3D qualitative coronary angiography (QCA) and invasive pressure and flow measurements is yet to be elucidated.
Methods:
We associated invasive fractional flow reserve (FFR), coronary flow reserve (CFR) and coronary flow capacity (CFC) with 2D- and 3D-QCA in 430 intermediate lesions of 366 patients.
Results:
Overall, 2D-QCA analysis resulted in less severe stenosis severity compared with 3D-QCA analysis. FFR+/CFR- lesions had similar 3D-QCA characteristics as FFR+/CFR+ lesions. In contrast, vessels with FFR-/CFR+ discordance had 3D-QCA characteristics similar to those of vessels with concordant FFR-/CFR-. Contrarily, FFR+/CFR- lesions had CFC similar to that of as FFR-/CFR- lesions.
Conclusions:
Non-flow-limiting lesions (FFR+/CFR-) have 3D-QCA characteristics similar to those of FFR+/CFR+, but the majority are not associated with inducible myocardial ischemia as determined by invasive CFC. FFR-/CFR+ lesions have 3D-QCA characteristics similar to those of FFR-/CFR- lesions but are more frequently associated with a moderately to severely reduced CFC, illustrating the angiographic-functional mismatch in discordant lesions.
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