Correlation of Intravascular Ultrasound and Instantaneous Wave-Free Ratio in Patients With Intermediate Left Main Coronary Artery Disease.
Correlation of Intravascular Ultrasound and Instantaneous Wave-Free Ratio in Patients With Intermediate Left Main Coronary Artery Disease.
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DOI：
10.1161/circinterventions.120.009830
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发表时间：
2021-06
期刊：
影响因子：
--
通讯作者：
Lerman A
中科院分区：
文献类型：
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作者：
El Hajj SC;Toya T;Warisawa T;Nan J;Lewis BR;Cook CM;Rajkumar C;Howard JP;Seligman H;Ahmad Y;Doi S;Nakajima A;Nakayama M;Goto S;Vera-Urquiza R;Sato T;Kikuta Y;Kawase Y;Nishina H;Nakamura S;Matsuo H;Escaned J;Akashi YJ;Davies JE;Lerman A
在左主干冠状动脉疾病（LMCD）的血管造影视觉评估中，不同观察者之间存在较大的差异。在此情况下，血流储备分数和血管内超声（IVUS）常被应用。而采用瞬时无波比值（iFR）评估LMCD的研究尚不充分。本研究旨在评估瞬时无波比值（iFR）在血管造影显示为中度左主干病变（LMCD）评估中的应用。
这是一项国际多中心回顾性观察研究，研究对象为针对血管造影显示为中度LMCD同时接受iFR和IVUS评估的患者。一个独立的核心实验室对所有IVUS数据进行了盲法离线分析。将最小管腔面积（MLA）6平方毫米作为判定显著病变的临界值。
本分析纳入了125例患者（平均年龄68.4 ± 9.5岁，男性占84.8%）。受试者工作特征曲线（ROC）分析显示，iFR ≤ 0.89可识别MLA < 6平方毫米的病变，曲线下面积为0.77（敏感性77%，特异性66%；P < 0.0001）。在69例无前降支或左旋支开口病变的患者中，ROC分析显示，iFR ≤ 0.89可识别MLA < 6平方毫米的病变，曲线下面积为0.84（敏感性70%，特异性84%；P < 0.0001）。考虑体表面积（BSA）时，相关性无显著差异。
在本研究中，对于中度LMCD患者，无论BSA如何，iFR ≤ 0.89与IVUS检测的MLA < 6平方毫米相关。本研究支持使用iFR评估中度LMCD。
There is great degree of inter-observer variability in the visual angiographic assessment of LMCD. Fractional flow reserve and intravascular ultrasound (IVUS) are often used in this setting. The use of iFR for evaluation of LMCD has not been well studied. The aim of this study is to evaluate the use of instantaneous wave-free ratio (iFR) in the assessment of angiographically intermediate left main (LMCD). This is an international multicenter retrospective observational study of patients who underwent both iFR and IVUS evaluation for angiographically intermediate LMCD. An independent core laboratory performed blinded off-line analysis of all IVUS data. A minimum lumen area (MLA) of 6 mm2 was used as the cutoff for significant disease. 125 patients (mean age 68.4 ± 9.5 years, 84.8% male) were included in this analysis. Receiver operating curve (ROC) analysis showed that an iFR of ≤0.89 identified MLA <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, ROC analysis showed that an iFR of ≤0.89 identified MLA <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 (BSA) was considered. In this study, in patients with intermediate LMCD, iFR of ≤0.89 correlates with IVUS MLA <6 mm2 regardless of BSA. The current study supports the use of iFR for the evaluation of intermediate LMCD.