Author + information
- Eisuke Usui,
- Taishi Yonetsu,
- Tetsumin Lee,
- Tadashi Murai,
- Yoshihisa Kanaji,
- Masahiro Hoshino,
- Takayuki Niida,
- Masahiro Hada,
- Rikuta Hamaya,
- Mitsuaki Isobe and
- Tsunekazu Kakuta
Background: Although lesion severity determined by coronary angiography is only moderately correlated with physiological stenosis significance, the mechanism of the discordance has not been fully elucidated, particularly with respect to the significance of microvascular function. The goal of this study was to clarify if microvascular function affects visual-functional mismatch between quantitative coronary angiography (QCA) and fractional flow reserve (FFR).
Methods: We assessed QCA, FFR, and the index of microcirculatory resistance (IMR) in a cohort of 737 patients with 1359 coronary lesions showing visually estimated intermediate stenosis between 30% and 80%. IMR was measured by using a thermodilution system of pressure-temperature sensor-tipped guidewire. Clinical and lesion-specific characteristics and physiological parameters associated with mismatches and reverse-mismatches were studied.
Results: QCA diameter stenosis showed a significant relationship with FFR (R2=0.191, P<0.001). Of all, 652 (48.0%) lesions showed diameter stenosis (DS) >50% and 743 (52.0%) lesions showed DS ≤50%. Among the lesions with DS >50%, FFR >0.80 (mismatch) were seen in 290 lesions (44.5%). Independent predictors of mismatch were non-left anterior descending artery (non-LAD), female, and larger minimum lumen diameter (MLD). Of lesions with DS ≤50%, FFR≤0.80 (reverse-mismatches) were observed in 201 lesions (27.1%). Independent predictors of reverse-mismatch included IMR (odd ratio: 0.959, 95% confidence interval: 0.934–0.984, p=0.001) as well as LAD, male, younger age, and high DS.
Conclusions: There were high prevalence of visual-functional mismatch between QCA and FFR. The discrepancy was related to the clinical, lesion-specific factors, and microvascular resistance that was unrecognizable by coronary angiography, thus suggesting the inaccuracy of angiography and the importance of physiological lesion assessment. Furthermore, since visual-functional mismatches are significantly associated abnormal coronary hemodynamics, care should be taken in revascularization decision making.
Poster Hall, Hall C
Friday, March 17, 2017, 10:00 a.m.-10:45 a.m.
Session Title: Interventional Cardiology: Intravascular Physiology and Endothelial Function
Abstract Category: 23. Interventional Cardiology: IVUS and Intravascular Physiology
Presentation Number: 1115-171
- 2017 American College of Cardiology Foundation