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Optical coherence tomography criteria for defining functional severity of intermediate lesions: a comparative study with FFR

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Abstract

Fractional flow reserve (FFR) is the gold standard in the assessment of severity of the coronary stenosis. The aim of the study was to compare optical coherence tomography (OCT) obtained intermediate coronary lesions lumen areas measurements with FFR assessments, with the goal to develop an OCT threshold to identify significant coronary stenosis. 48 patients (mean age 65 ± 10 years) was enrolled for the study. Within this population, 71 intermediate coronary lesions were investigated using both FFR and OCT. High dose bolus of Adenosine (120 μg) was used to obtain coronary hyperemia. OCT imaging was performed using non-occlusive technique to assess minimal lumen area (MLA) and diameter. The OCT cut-off value that showed the best correlation with the FFR cut-off of 0.80 was the MLA less than 2.05 mm2 (accuracy 87 %, sensitivity 75 %, specificity 90 %, p < 0.001). The study did not disclose any relationship between FFR value and the lesion length. Vessel size influenced the OCT cut-off values, with greater values being found in presence of arteries with a reference diameter greater than 3.0 mm. OCT derived minimal lumen area might be complementary to FFR measurement in identifying ischemia related lesions. Further studies are warranted to assess threshold values in relation to vessel size and location.

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References

  1. De Bruyne B, Sarma J (2008) Fractional flow reserve: a review. Heart 94:948–959

    Article  Google Scholar 

  2. Mintz GS, Nissen SE, Anderson WD et al (2001) ACC Clinical Expert Consensus Document on Standards for the acquisition, measurement and reporting of intravascular ultrasound studies: a report of the American College of Cardiology Task Force on Clinical Expert Consensus Documents (Committee to Develop a Clinical Expert Consensus Document on Standards for Acquisition, Measurement and Reporting of Intravascular Ultrasound Studies [IVUS]). J Am Coll Cardiol 37:1478–1492

    Article  PubMed  CAS  Google Scholar 

  3. Prati F, Cera M, Ramazzotti V, Imola F, Giudice R, Albertucci M (2007) Safety and feasibility of a new non-occlusive technique for facilitated intracoronary optical coherence tomography (OCT) acquisition in various clinical and anatomical scenarios. EuroIntervention 3:365–370

    Article  PubMed  Google Scholar 

  4. Tonino PA, De Bruyne B, Pijls NH et al (2009) Fractional flow reserve versus angiography for guiding percutaneous coronary intervention. N Engl J Med 360:213–224

    Article  PubMed  CAS  Google Scholar 

  5. De Bruyne B, Pijls NHJ, Bartunek J et al (2001) Fractional flow reserve in patients with prior myocardial infarction. Circulation 14:157–162

    Article  Google Scholar 

  6. Pijls NH, De Bruyne B, Bech GJ et al (2000) Coronary pressure measurement to assess the hemodynamic significance of serial stenoses within one coronary artery: validation in humans. Circulation 102:2371–2377

    Article  PubMed  CAS  Google Scholar 

  7. Gil R, Pawlowski T, Dudek D et al (2007) Comparison of angiographically guided direct stenting technique with direct stenting and optimal balloon angioplasty guided with intravascular ultrasound. The multicenter, randomized trial results Am Heart J 154:669–675

    Article  Google Scholar 

  8. Briguori C, Anzuini A, Airoldi F et al (2001) Intravascular ultrasound criteria for the assessment of the functional significance of intermediate coronary artery stenoses and comparison with fractional flow reserve. Am J Cardiol 87:136–141

    Article  PubMed  CAS  Google Scholar 

  9. De la Torre Hernandez JM, Hernandez FH, Alfonso F et al (2011) Prospective application of predefined intravascular ultrasound criteria for assessment of intermediate left main coronary artery lesions: Results from the multicenter LITRO study. J Am Coll Cardiol 58:351–358

    Article  PubMed  Google Scholar 

  10. Takagi A, Tsurumi Y, Ishii Y, Kazuhito S, Kawara M, Kasanuki H (1999) Clinical potential of intravascular ultrasound for physiological assessment of coronary stenosis. Relationship between quantitative ultrasound tomography and pressure derived fractional flow reserve. Circulation 100:250–255

    Article  PubMed  CAS  Google Scholar 

  11. Kang S, Lee J, Ahn J et al (2011) Validation of intravascular ultrasound–derived parameters with fractional flow reserve for assessment of coronary stenosis severity. Circ Cardiovasc Interv 4:65–71

    Article  PubMed  Google Scholar 

  12. Dor I, Turguson R, Gaglia M et al (2011) Correlation between fractional flow reserve and intravascular ultrasound area in intermediate coronary artery stenosis. EuroIntervention 7:225–233

    Article  Google Scholar 

  13. Koo B, Yang H, Doh J et al (2011) Optimal intravascular ultrasound criteria and their accuracy for defining the functional significance of intermediate coronary stenoses of different locations. J Am Coll Cardiol Interv 4:803–811

    Article  Google Scholar 

  14. Prati F, Regar E, Mintz G et al (2010) Expert review document on methodology, terminology, and clinical applications of optical coherence tomography: physical principles, methodology of image acquisition, and clinical application for assessment of coronary arteries and atherosclerosis. Euro Heart J 31:401–415

    Article  Google Scholar 

  15. Gonzalo N, Escaned J, Alfonso F et al (2012) Morphometric assessment of coronary stenosis relevance with optical coherence tomography. A comparison with fractional flow reserve and intravascular ultrasound. J Am Coll Cardiol 59:1080–1089

    Article  PubMed  Google Scholar 

  16. Shiono Y, Kitabata H, Kubo T et al (2012) Optical coherence tomography-derived anatomical criteria for functionally significant coronary stenosis assessed by fractional flow reserve. Circ J. (advance publication; released: June 21)

  17. Costa M, Sabate M, Staico R et al (2007) Anatomical and physiologic assessments in patients with small coronary artery disease: final results of the physiologic and anatomical evaluation prior to and after stent implantation in small coronary vessels (PHANTOM) trial. Am Heart J 153:296e1–296e7

    Google Scholar 

  18. Lee CH, Tai BC, Soon CY et al (2010) New set of intravascular ultrasound-derived anatomic criteria for defining functionally significant stenoses in small coronary arteries (results from Intravascular Ultrasound Diagnostic Evaluation of Atherosclerosis in Singapore [IDEAS] study). Am J Cardiol 105:1378–1384

    Article  PubMed  Google Scholar 

  19. Reith S, Battermann S, Jaskolka A, Lehmacher W, Hoffmann R, Marx N, Burgmaier M (2013) Relationship between optical coherence tomography derived intraluminal and intramural criteria and haemodynamic relevance as determined by fractional flow reserve in intermediate coronary stenoses of patients with type 2 diabetes. Heart 99(10):700–707. doi:10.1136/heartjnl-2013-303616

    Article  PubMed  Google Scholar 

  20. Moussa I, Kobayashi Y, Adamian M et al (2001) Characteristics of patients with a large discrepancy in coronary artery diameter between quantitative angiography and intravascular ultrasound. Am J Cardiol 88:294–296

    Article  PubMed  CAS  Google Scholar 

  21. Gonzalo N, Serruys P, García-García H et al (2009) Quantitative ex vivo and in vivo comparison of lumen dimensions measured by optical coherence tomography and intravascular ultrasound in human coronary arteries. Rev Esp Cardiol 62(6):615–624

    Article  PubMed  Google Scholar 

  22. Kolozsvári R, Tar B, Lugosi P, Sánta J, Béres Z, Ungvári T, Polgár P, Kőszegi Z (2012) Plaque volume derived from three-dimensional reconstruction of coronary angiography predicts the fractional flow reserve. Int J Cardiol 160(2):140–144

    Article  PubMed  Google Scholar 

  23. Guagliumi G, Sirbu V, Petroff C, Capodanno D, Musumeci G, Yamamoto H, Elbasiony A, Brushett C, Matiashvili A, Lortkipanidze N, Valsecchi O, Bezerra HG, Schmitt JM (2013) Volumetric assessment of lesion severity with optical coherence tomography: relationship with fractional flow. EuroIntervention 8(10):1172–1181

    Article  PubMed  Google Scholar 

  24. Stefano G, Bezerra H, Attizzani G et al (2011) Utilization of frequency domain optical coherence tomography and fractional flow reserve to assess intermediate coronary artery stenoses: conciliating anatomic and physiologic information. Int J Cardiovasc Imaging 2:299–308

    Article  Google Scholar 

  25. Prati F, Di Vito L, Biondi-Zoccai G et al (2012) Angiography alone versus angiography plus optical coherence tomography to guide decision-making during percutaneous coronary intervention: the Centro per la Lotta contro l’Infarto-Optimisation of Percutaneous Coronary Intervention (CLI-OPCI) study. EuroIntervention 8:823–829

    Article  PubMed  Google Scholar 

  26. Wijns W, Kolh P, Danchin N et al (2010) Guidelines on myocardial revascularization: the task force on myocardial revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) European Association for Percutaneous Cardiovascular Interventions. Eur Heart J 31:2501–2555

    Article  PubMed  Google Scholar 

  27. Jeremias A, Whitbourn RJ, Filardo SD et al (2000) Adequacy of intracoronary versus intravenous adenosine-induced maximal coronary hyperemia for fractional flow reserve measurements. Am Heart J 140:651–657

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Invasive Cardiology, Central Clinical Hospital of the Ministry of Interior, Warsaw, Poland

    Tomasz Pawlowski, Tomasz Kulawik, Jacek Bil & Robert Gil

  2. San Giovanni Hospital, CLI Foundation, Rome, Italy

    Francesco Prati & Eleonora Ficarra

  3. Medical Research Center, Polish Academy of Sciences, Warsaw, Poland

    Robert Gil

Authors
  1. Tomasz Pawlowski
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  2. Francesco Prati
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  3. Tomasz Kulawik
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  4. Eleonora Ficarra
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  5. Jacek Bil
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  6. Robert Gil
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Correspondence to Tomasz Pawlowski.

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Pawlowski, T., Prati, F., Kulawik, T. et al. Optical coherence tomography criteria for defining functional severity of intermediate lesions: a comparative study with FFR. Int J Cardiovasc Imaging 29, 1685–1691 (2013). https://doi.org/10.1007/s10554-013-0283-x

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  • DOI: https://doi.org/10.1007/s10554-013-0283-x

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