J Korean Med Sci.  2015 Jun;30(6):716-724. 10.3346/jkms.2015.30.6.716.

Three Dimensional Quantitative Coronary Angiography Can Detect Reliably Ischemic Coronary Lesions Based on Fractional Flow Reserve

• Chung WY
• Choi BJ
• Lim SH
• Matsuo Y
• Lennon RJ
• Gulati R
• Sandhu GS
• Holmes DR
• Rihal CS
• Lerman A

• KMID: 2160599
• DOI: http://doi.org/10.3346/jkms.2015.30.6.716

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 mm2, %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.

Keyword

Coronary Angiography; Myocardial Ischemia; Coronary Artery Disease

MeSH Terms

Aged
Coronary Angiography/*methods
Coronary Circulation
Coronary Stenosis/etiology/*physiopathology/*radiography
Female
*Fractional Flow Reserve, Myocardial
Humans
Imaging, Three-Dimensional/*methods
Male
Myocardial Ischemia/complications/physiopathology/*radiography
Radiographic Image Enhancement/methods
Radiographic Image Interpretation, Computer-Assisted/methods
Reproducibility of Results
Sensitivity and Specificity

Figure

• 

  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.

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  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.

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