Myocardial Mass Contributes to the Discrepancy Between Anatomic Stenosis Severity Assessed by Intravascular Ultrasound and Fractional Flow Reserve in Intermediate Lesions of the Coronary Artery
Objectives The present study investigated the major contributors to the discrepancy between the minimal lumen area (MLA) and fractional flow reserve (FFR). Background There was considerable discrepancy between MLA or diameter stenosis (DS) and FFR. Methods We enrolled 744 patients with intermediate...
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Veröffentlicht in: | Catheterization and cardiovascular interventions 2018-02, Vol.91 (2), p.182-191 |
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creator | Yoon, Myeong‐Ho Tahk, Seung‐Jea Lim, Hong‐Seok Yang, Hyoung‐Mo Seo, Kyoung‐Woo Choi, Byoung‐Joo Choi, So‐Yeon Hwang, Gyo‐Seung Park, Jin‐Sun Shin, Joon‐Han |
description | Objectives
The present study investigated the major contributors to the discrepancy between the minimal lumen area (MLA) and fractional flow reserve (FFR).
Background
There was considerable discrepancy between MLA or diameter stenosis (DS) and FFR.
Methods
We enrolled 744 patients with intermediate stenoses of the left anterior descending artery (LAD). Summed epicardial coronary artery length distal to the target stenosis was obtained from each longest view of the vessels on the coronary angiograms. Mismatching was defined as a lesion with FFR of >0.80 and MLA smaller than the best cut‐off value (BCV) for predicting FFR of ≤0.80. Reverse mismatching was defined as a lesion with FFR of ≤0.80 and MLA larger than the BCV.
Results
Summed epicardial coronary artery length was longer at the lesions of proximal LAD than that of middle LAD (380 mm ± 82 mm vs. 341 mm ± 80 mm, P < 0.001). Reverse mismatching was found more frequently in the proximal than middle LAD (28.3% vs. 5.5%, P < 0.001). Independent predictors of FFR ≤ 0.80 were age, male, multi‐vessel disease, proximal LAD lesion, MLA, DS, plaque burden at distal reference, lesion length and summed epicardial coronary artery length. Proximal LAD lesion was an independent predictor of reverse mismatching (hazard ratio 3.162, 1.858–5.382, P < 0.001).
Conclusions
Myocardial mass subtended by a lesion is an important factor predicting FFR ≤0.80 and discrepancy between FFR and MLA. Myocardial mass subtended by a lesion should be considered when determining the revascularization therapy by intravascular ultrasound parameters. © 2017 Wiley Periodicals, Inc. |
doi_str_mv | 10.1002/ccd.27072 |
format | Article |
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The present study investigated the major contributors to the discrepancy between the minimal lumen area (MLA) and fractional flow reserve (FFR).
Background
There was considerable discrepancy between MLA or diameter stenosis (DS) and FFR.
Methods
We enrolled 744 patients with intermediate stenoses of the left anterior descending artery (LAD). Summed epicardial coronary artery length distal to the target stenosis was obtained from each longest view of the vessels on the coronary angiograms. Mismatching was defined as a lesion with FFR of >0.80 and MLA smaller than the best cut‐off value (BCV) for predicting FFR of ≤0.80. Reverse mismatching was defined as a lesion with FFR of ≤0.80 and MLA larger than the BCV.
Results
Summed epicardial coronary artery length was longer at the lesions of proximal LAD than that of middle LAD (380 mm ± 82 mm vs. 341 mm ± 80 mm, P < 0.001). Reverse mismatching was found more frequently in the proximal than middle LAD (28.3% vs. 5.5%, P < 0.001). Independent predictors of FFR ≤ 0.80 were age, male, multi‐vessel disease, proximal LAD lesion, MLA, DS, plaque burden at distal reference, lesion length and summed epicardial coronary artery length. Proximal LAD lesion was an independent predictor of reverse mismatching (hazard ratio 3.162, 1.858–5.382, P < 0.001).
Conclusions
Myocardial mass subtended by a lesion is an important factor predicting FFR ≤0.80 and discrepancy between FFR and MLA. Myocardial mass subtended by a lesion should be considered when determining the revascularization therapy by intravascular ultrasound parameters. © 2017 Wiley Periodicals, Inc.</description><identifier>ISSN: 1522-1946</identifier><identifier>EISSN: 1522-726X</identifier><identifier>DOI: 10.1002/ccd.27072</identifier><identifier>PMID: 28568890</identifier><language>eng</language><publisher>United States: Wiley Subscription Services, Inc</publisher><subject>Aged ; Cardiac Catheterization ; Coronary Angiography ; Coronary artery ; Coronary Artery Disease - diagnostic imaging ; Coronary Artery Disease - pathology ; Coronary Artery Disease - physiopathology ; Coronary Stenosis - diagnostic imaging ; Coronary Stenosis - pathology ; Coronary Stenosis - physiopathology ; Coronary vessels ; Coronary Vessels - diagnostic imaging ; Coronary Vessels - physiopathology ; Female ; FFR ; Fractional Flow Reserve, Myocardial ; Humans ; Lesions ; Male ; Middle Aged ; mismatching ; myocardial mass ; Myocardium - pathology ; Predictive Value of Tests ; Prospective Studies ; Reproducibility of Results ; Stenosis ; Stents ; Ultrasonic imaging ; Ultrasonography, Interventional ; Ultrasound ; Veins & arteries</subject><ispartof>Catheterization and cardiovascular interventions, 2018-02, Vol.91 (2), p.182-191</ispartof><rights>2017 Wiley Periodicals, Inc.</rights><rights>2018 Wiley Periodicals, Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3532-35ac2ce3a251eb0010d2e9641592e13eba3a75bd94da63946211cb80634dea383</citedby><cites>FETCH-LOGICAL-c3532-35ac2ce3a251eb0010d2e9641592e13eba3a75bd94da63946211cb80634dea383</cites><orcidid>0000-0002-6412-8594</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fccd.27072$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fccd.27072$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1417,27924,27925,45574,45575</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28568890$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Yoon, Myeong‐Ho</creatorcontrib><creatorcontrib>Tahk, Seung‐Jea</creatorcontrib><creatorcontrib>Lim, Hong‐Seok</creatorcontrib><creatorcontrib>Yang, Hyoung‐Mo</creatorcontrib><creatorcontrib>Seo, Kyoung‐Woo</creatorcontrib><creatorcontrib>Choi, Byoung‐Joo</creatorcontrib><creatorcontrib>Choi, So‐Yeon</creatorcontrib><creatorcontrib>Hwang, Gyo‐Seung</creatorcontrib><creatorcontrib>Park, Jin‐Sun</creatorcontrib><creatorcontrib>Shin, Joon‐Han</creatorcontrib><title>Myocardial Mass Contributes to the Discrepancy Between Anatomic Stenosis Severity Assessed by Intravascular Ultrasound and Fractional Flow Reserve in Intermediate Lesions of the Coronary Artery</title><title>Catheterization and cardiovascular interventions</title><addtitle>Catheter Cardiovasc Interv</addtitle><description>Objectives
The present study investigated the major contributors to the discrepancy between the minimal lumen area (MLA) and fractional flow reserve (FFR).
Background
There was considerable discrepancy between MLA or diameter stenosis (DS) and FFR.
Methods
We enrolled 744 patients with intermediate stenoses of the left anterior descending artery (LAD). Summed epicardial coronary artery length distal to the target stenosis was obtained from each longest view of the vessels on the coronary angiograms. Mismatching was defined as a lesion with FFR of >0.80 and MLA smaller than the best cut‐off value (BCV) for predicting FFR of ≤0.80. Reverse mismatching was defined as a lesion with FFR of ≤0.80 and MLA larger than the BCV.
Results
Summed epicardial coronary artery length was longer at the lesions of proximal LAD than that of middle LAD (380 mm ± 82 mm vs. 341 mm ± 80 mm, P < 0.001). Reverse mismatching was found more frequently in the proximal than middle LAD (28.3% vs. 5.5%, P < 0.001). Independent predictors of FFR ≤ 0.80 were age, male, multi‐vessel disease, proximal LAD lesion, MLA, DS, plaque burden at distal reference, lesion length and summed epicardial coronary artery length. Proximal LAD lesion was an independent predictor of reverse mismatching (hazard ratio 3.162, 1.858–5.382, P < 0.001).
Conclusions
Myocardial mass subtended by a lesion is an important factor predicting FFR ≤0.80 and discrepancy between FFR and MLA. Myocardial mass subtended by a lesion should be considered when determining the revascularization therapy by intravascular ultrasound parameters. © 2017 Wiley Periodicals, Inc.</description><subject>Aged</subject><subject>Cardiac Catheterization</subject><subject>Coronary Angiography</subject><subject>Coronary artery</subject><subject>Coronary Artery Disease - diagnostic imaging</subject><subject>Coronary Artery Disease - pathology</subject><subject>Coronary Artery Disease - physiopathology</subject><subject>Coronary Stenosis - diagnostic imaging</subject><subject>Coronary Stenosis - pathology</subject><subject>Coronary Stenosis - physiopathology</subject><subject>Coronary vessels</subject><subject>Coronary Vessels - diagnostic imaging</subject><subject>Coronary Vessels - physiopathology</subject><subject>Female</subject><subject>FFR</subject><subject>Fractional Flow Reserve, Myocardial</subject><subject>Humans</subject><subject>Lesions</subject><subject>Male</subject><subject>Middle Aged</subject><subject>mismatching</subject><subject>myocardial mass</subject><subject>Myocardium - pathology</subject><subject>Predictive Value of Tests</subject><subject>Prospective Studies</subject><subject>Reproducibility of Results</subject><subject>Stenosis</subject><subject>Stents</subject><subject>Ultrasonic imaging</subject><subject>Ultrasonography, Interventional</subject><subject>Ultrasound</subject><subject>Veins & arteries</subject><issn>1522-1946</issn><issn>1522-726X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kdtuEzEQhi0EoqVwwQsgS9zARVof9uTLsG2gUiokSiXuVl7vRLjarIPHm2gfr2_GpAlcVKpky2Ppm38OP2PvpTiXQqgL57pzVYpSvWCnMldqVqri18tjLE1WnLA3iPdCCFMo85qdqCovqsqIU_ZwMwVnY-dtz28sIq_DkKJvxwTIU-DpN_BLjy7Cxg5u4l8g7QAGPh9sCmvv-G2CIaBHfgtbiD5NfI4IdDreTvyaxOzWoht7G_ldTz8M49BxS3cRrUs-DFR60Ycd_wEIcQvcD_s8iGugthLwJSBRyMPqsZ06RMqJVCgSNL1lr1a2R3h3fM_Y3eLqZ_1ttvz-9bqeL2dO51rNdG6dcqCtyiW0QkjRKTBFJnOjQGporbZl3nYm62yhaWdKStdWotBZB1ZX-ox9OuhuYvgzAqZmTXuBvrcDhBEbaURmhMhUTujHJ-h9GCPNuadMprUuTUnU5wPlYkCMsGo20a9psEaKZu9rQ742j74S--GoOLa0lv_kPyMJuDgAO9_D9LxSU9eXB8m_0uSvvg</recordid><startdate>20180201</startdate><enddate>20180201</enddate><creator>Yoon, Myeong‐Ho</creator><creator>Tahk, Seung‐Jea</creator><creator>Lim, Hong‐Seok</creator><creator>Yang, Hyoung‐Mo</creator><creator>Seo, Kyoung‐Woo</creator><creator>Choi, Byoung‐Joo</creator><creator>Choi, So‐Yeon</creator><creator>Hwang, Gyo‐Seung</creator><creator>Park, Jin‐Sun</creator><creator>Shin, Joon‐Han</creator><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>7U9</scope><scope>H94</scope><scope>K9.</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-6412-8594</orcidid></search><sort><creationdate>20180201</creationdate><title>Myocardial Mass Contributes to the Discrepancy Between Anatomic Stenosis Severity Assessed by Intravascular Ultrasound and Fractional Flow Reserve in Intermediate Lesions of the Coronary Artery</title><author>Yoon, Myeong‐Ho ; Tahk, Seung‐Jea ; Lim, Hong‐Seok ; Yang, Hyoung‐Mo ; Seo, Kyoung‐Woo ; Choi, Byoung‐Joo ; Choi, So‐Yeon ; Hwang, Gyo‐Seung ; Park, Jin‐Sun ; Shin, Joon‐Han</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3532-35ac2ce3a251eb0010d2e9641592e13eba3a75bd94da63946211cb80634dea383</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Aged</topic><topic>Cardiac Catheterization</topic><topic>Coronary Angiography</topic><topic>Coronary artery</topic><topic>Coronary Artery Disease - diagnostic imaging</topic><topic>Coronary Artery Disease - pathology</topic><topic>Coronary Artery Disease - physiopathology</topic><topic>Coronary Stenosis - diagnostic imaging</topic><topic>Coronary Stenosis - pathology</topic><topic>Coronary Stenosis - physiopathology</topic><topic>Coronary vessels</topic><topic>Coronary Vessels - diagnostic imaging</topic><topic>Coronary Vessels - physiopathology</topic><topic>Female</topic><topic>FFR</topic><topic>Fractional Flow Reserve, Myocardial</topic><topic>Humans</topic><topic>Lesions</topic><topic>Male</topic><topic>Middle Aged</topic><topic>mismatching</topic><topic>myocardial mass</topic><topic>Myocardium - pathology</topic><topic>Predictive Value of Tests</topic><topic>Prospective Studies</topic><topic>Reproducibility of Results</topic><topic>Stenosis</topic><topic>Stents</topic><topic>Ultrasonic imaging</topic><topic>Ultrasonography, Interventional</topic><topic>Ultrasound</topic><topic>Veins & arteries</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Yoon, Myeong‐Ho</creatorcontrib><creatorcontrib>Tahk, Seung‐Jea</creatorcontrib><creatorcontrib>Lim, Hong‐Seok</creatorcontrib><creatorcontrib>Yang, Hyoung‐Mo</creatorcontrib><creatorcontrib>Seo, Kyoung‐Woo</creatorcontrib><creatorcontrib>Choi, Byoung‐Joo</creatorcontrib><creatorcontrib>Choi, So‐Yeon</creatorcontrib><creatorcontrib>Hwang, Gyo‐Seung</creatorcontrib><creatorcontrib>Park, Jin‐Sun</creatorcontrib><creatorcontrib>Shin, Joon‐Han</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Catheterization and cardiovascular interventions</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Yoon, Myeong‐Ho</au><au>Tahk, Seung‐Jea</au><au>Lim, Hong‐Seok</au><au>Yang, Hyoung‐Mo</au><au>Seo, Kyoung‐Woo</au><au>Choi, Byoung‐Joo</au><au>Choi, So‐Yeon</au><au>Hwang, Gyo‐Seung</au><au>Park, Jin‐Sun</au><au>Shin, Joon‐Han</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Myocardial Mass Contributes to the Discrepancy Between Anatomic Stenosis Severity Assessed by Intravascular Ultrasound and Fractional Flow Reserve in Intermediate Lesions of the Coronary Artery</atitle><jtitle>Catheterization and cardiovascular interventions</jtitle><addtitle>Catheter Cardiovasc Interv</addtitle><date>2018-02-01</date><risdate>2018</risdate><volume>91</volume><issue>2</issue><spage>182</spage><epage>191</epage><pages>182-191</pages><issn>1522-1946</issn><eissn>1522-726X</eissn><abstract>Objectives
The present study investigated the major contributors to the discrepancy between the minimal lumen area (MLA) and fractional flow reserve (FFR).
Background
There was considerable discrepancy between MLA or diameter stenosis (DS) and FFR.
Methods
We enrolled 744 patients with intermediate stenoses of the left anterior descending artery (LAD). Summed epicardial coronary artery length distal to the target stenosis was obtained from each longest view of the vessels on the coronary angiograms. Mismatching was defined as a lesion with FFR of >0.80 and MLA smaller than the best cut‐off value (BCV) for predicting FFR of ≤0.80. Reverse mismatching was defined as a lesion with FFR of ≤0.80 and MLA larger than the BCV.
Results
Summed epicardial coronary artery length was longer at the lesions of proximal LAD than that of middle LAD (380 mm ± 82 mm vs. 341 mm ± 80 mm, P < 0.001). Reverse mismatching was found more frequently in the proximal than middle LAD (28.3% vs. 5.5%, P < 0.001). Independent predictors of FFR ≤ 0.80 were age, male, multi‐vessel disease, proximal LAD lesion, MLA, DS, plaque burden at distal reference, lesion length and summed epicardial coronary artery length. Proximal LAD lesion was an independent predictor of reverse mismatching (hazard ratio 3.162, 1.858–5.382, P < 0.001).
Conclusions
Myocardial mass subtended by a lesion is an important factor predicting FFR ≤0.80 and discrepancy between FFR and MLA. Myocardial mass subtended by a lesion should be considered when determining the revascularization therapy by intravascular ultrasound parameters. © 2017 Wiley Periodicals, Inc.</abstract><cop>United States</cop><pub>Wiley Subscription Services, Inc</pub><pmid>28568890</pmid><doi>10.1002/ccd.27072</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0002-6412-8594</orcidid></addata></record> |
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subjects | Aged Cardiac Catheterization Coronary Angiography Coronary artery Coronary Artery Disease - diagnostic imaging Coronary Artery Disease - pathology Coronary Artery Disease - physiopathology Coronary Stenosis - diagnostic imaging Coronary Stenosis - pathology Coronary Stenosis - physiopathology Coronary vessels Coronary Vessels - diagnostic imaging Coronary Vessels - physiopathology Female FFR Fractional Flow Reserve, Myocardial Humans Lesions Male Middle Aged mismatching myocardial mass Myocardium - pathology Predictive Value of Tests Prospective Studies Reproducibility of Results Stenosis Stents Ultrasonic imaging Ultrasonography, Interventional Ultrasound Veins & arteries |
title | Myocardial Mass Contributes to the Discrepancy Between Anatomic Stenosis Severity Assessed by Intravascular Ultrasound and Fractional Flow Reserve in Intermediate Lesions of the Coronary Artery |
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