J Korean Med Sci. 2015;30(6):716-24.

Three dimensional quantitative coronary angiography can detect reliably ischemic coronary lesions based on fractional flow reserve.

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제1저자 정우영 · 교신저자 Lerman A

PMID 26028923 PMC4444471 DOI 10.3346/jkms.2015.30.6.716 IF 3.2 순환기내과

소속 (5)

Devision of Cardiology, Department of Internal Medicine, Boramae Medical Center, Seoul National University, College of Medicine, Seoul, Korea.
Department of Cardiology, Ajou University School of Medicine, Suwon, Korea.
Division of Cardiology, Department of Internal Medicine, School of Medicine, Dankook University, Cheonan, Korea.
Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan.
Division of Cardiovascular Disease, Mayo Clinic, Rochester, MN, USA.

Abstract

Conventional coronary angiography (CAG) has limitations in evaluating lesions producing ischemia. Three dimensional quantitative coronary angiography (3D-QCA) shows reconstructed images of CAG using computer based algorithm, the Cardio-op B system (Paieon Medical, Rosh Ha'ayin, Israel). The aim of this study was to evaluate whether 3D-QCA can reliably predict ischemia assessed by myocardial fractional flow reserve (FFR) < 0.80. 3D-QCA images were reconstructed from CAG which also were evaluated with FFR to assess ischemia. Minimal luminal diameter (MLD), percent diameter stenosis (%DS), minimal luminal area (MLA), and percent area stenosis (%AS) were obtained. The results of 3D-QCA and FFR were compared. A total of 266 patients was enrolled for the present study. FFR for all lesions ranged from 0.57 to 1.00 (0.85 ± 0.09). Measurement of MLD, %DS, MLA, and %AS all were significantly correlated with FFR (r = 0.569, 0609, 0.569, 0.670, respectively, all P < 0.001). In lesions with MLA < 4.0 mm(2), %AS of more than 65.5% had a 80% sensitivity and a 83% specificity to predict FFR < 0.80 (area under curve, AUC was 0.878). 3D-QCA can reliably predict coronary lesions producing ischemia and may be used to guide therapeutic approach for coronary artery disease.

Keywords

Coronary AngiographyCoronary Artery DiseaseMyocardial Ischemia

Figures

**Fig. 1** Reconstruction of three dimensional images. (A) Calibration is done with catheter seen on the same image. (B, C) Clicking the narrowest point, proximal and distal reference segment make the lesion lineated automatically. It should be done on two images at least 30 degree apart from each other. (D-F), After finishing (A-C), computer based algorithm is activated and shows three dimensional images and quantitative data.

**Fig. 2** Bivariate linear correlation of 3D-QCA variables with FFR. (A) MLD, (B) %DS, (C) MLA, and (D) %AS. 3D-QCA, three-dimensional quantitative coronary angiography; FFR, fractional flow reserve; MLD, minimal luminal diameter; %DS, percent diameter stenosis; MLA, minimal luminal area; %AS, percent area stenosis; r, Pearson's correlation coefficient.

**Fig. 3** Difference in FFR according to MLA divided by 4.0 mm² on 3D-QCA. 3D-QCA, three-dimensional quantitative coronary angiography; MLA, minimal luminal area; FFR, fractional flow reserve.

**Fig. 4** Receiver operating characteristic curve of 3D-QCA variables in lesions with MLA < 4.0 mm² for FFR < 0.80. (A) Minimal luminal diameter. (B) percent area stenosis. (C) minimal luminal area. (D) percent area stenosis. 3D-QCA, three-dimensional quantitative coronary angiography; FFR, fractional flow reserve; MLD, minimal luminal diameter; %DS, percent diameter stenosis; MLA, minimal luminal area; %AS, percent area stenosis; AUC, area under curve.

**Fig. 5** Receiver operating characteristic curve of combined 3D-QCA variables in lesions with MLA < 4.0 mm² for FFR < 0.80. (A) MLA plus %AS plus %DS. (B) MLD plus %DS. (C) MLD plus %DS plus %AS. (D) MLA plus %AS. 3D-QCA, three-dimensional quantitative coronary angiography; FFR, fractional flow reserve; MLD, minimal luminal diameter; %DS, percent diameter stenosis; MLA, minimal luminal area; %AS, percent area stenosis; AUC, area under curve.

그림 출처: PubMed Central 공개 논문 (PMC4444471)

Conflict of interest statement

DISCLOSURE: The authors have no conflicts of interest to disclose.

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