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We investigated whether or not the addition of myocardial mass at risk (MMAR) to quantitative coronary angiography was useful for diagnosing functionally significant coronary stenosis in the daily practice.
We prospectively enrolled 46 consecutive patients with 66 lesions who underwent clinically indicated coronary computed tomography angiography (CCTA) with subsequent elective coronary angiography with fractional flow reserve (FFR) measurement. MMAR was calculated using a workstation-based software program with the Voronoi algorithm.
The minimal lumen diameter (MLD) and MMAR were significantly correlated with the FFR, and the MMAR-to-MLD ratio (MMAR/MLD) showed an even better correlation. The area under the receiver operating characteristic curve of MMAR/MLD for FFR<0.8 was 0.766, and the sensitivity, specificity, positive predictive value and negative predictive value were 65%, 78%, 57% and 84%, respectively, at a cut-off value of 25.1 ml/mm. For the left coronary artery lesions in particular, MMAR/MLD showed a strong correlation with the FFR, and the area under the receiver operating characteristic curve was 0.854.
The index of MMAR/MLD correlated well with the physiological severity of coronary stenosis and showed high accuracy for detecting functional significance. MMAR might be an important parameter to consider when deciding the indication for revascularization.
IMAGING: FFR and Physiologic Lesion Assessment