Author + information
- Received May 2, 2011
- Revision received September 22, 2011
- Accepted September 27, 2011
- Published online March 20, 2012.
- Nieve Gonzalo, MD, PhD⁎ (, )
- Javier Escaned, MD, PhD,
- Fernando Alfonso, MD, PhD,
- Christian Nolte, MD,
- Vera Rodriguez, BSc,
- Pilar Jimenez-Quevedo, MD, PhD,
- Camino Bañuelos, MD,
- Antonia Fernández-Ortiz, MD, PhD,
- Eulogio Garcia, MD,
- Rosana Hernandez-Antolin, MD, PhD and
- Carlos Macaya, MD, PhD
- ↵⁎Reprint requests and correspondence:
Dr. Nieves Gonzalo, Department of Interventional Cardiology, Hospital Clínico San Carlos, C/ Martín Lagos s/n, 28040 Madrid, Spain
Objectives The study sought to assess the diagnostic efficiency of optical coherence tomography (OCT) in identifying hemodynamically severe coronary stenoses as determined by fractional flow reserve (FFR). Concomitant OCT and intravascular ultrasound (IVUS) area measurements were performed in a subgroup of patients to compare the diagnostic efficiency of both techniques.
Background The value of OCT to determine stenosis severity remains unsettled.
Methods Sixty-one stenoses with intermediate angiographic severity were studied in 56 patients. Stenoses were labeled as severe if FFR ≤0.80. OCT interrogation was performed in all cases, with concomitant IVUS imaging in 47 cases.
Results Angiographic stenosis severity was 50.9 ± 8% diameter stenosis with 1.28 ± 0.3 mm minimal lumen diameter. FFR was ≤0.80 in 28 (45.9%) stenoses. An overall moderate diagnostic efficiency of OCT was found (area under the curve [AUC]: 0.74; 95% confidence interval [CI]: 0.61 to 0.84), with sensitivity/specificity of 82%/63% associated with an optimal cutoff value of 1.95 mm2. Comparison of the results in patients with simultaneous IVUS and OCT imaging revealed no significant differences in the diagnostic efficiency of OCT (AUC: 0.70; 95% CI: 0.55 to 0.83) and IVUS (AUC. 0.63; 95% CI: 0.47 to 0.77; p = 0.19). Sensitivity/specificity for IVUS was 67%/65% for an optimal cutoff value of 2.36 mm2. In the subgroup of small vessels (reference diameter <3 mm) OCT showed a significantly better diagnostic efficiency (AUC: 0.77; 95% CI: 0.60 to 0.89) than IVUS (AUC: 0.63; 95% CI: 0.46 to 0.78) to identify functionally significant stenoses (p = 0.04).
Conclusions OCT has a moderate diagnostic efficiency in identifying hemodynamically severe coronary stenoses. Although OCT seems slightly superior to IVUS for this purpose (particularly in vessels <3 mm), its low specificity precludes its use as a substitute of FFR for functional stenosis assessment.
- fractional flow reserve
- functional assessment
- intermediate coronary stenosis
- intravascular ultrasound
- optical coherence tomography
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received May 2, 2011.
- Revision received September 22, 2011.
- Accepted September 27, 2011.
- American College of Cardiology Foundation