Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
JACC Cardiovasc Interv. 2011 Jun;4(6):665-71. doi: 10.1016/j.jcin.2011.02.013.
This study sought to evaluate the ability of minimal luminal area (MLA) measured by intravascular ultrasound (IVUS) to assess the functional significance of coronary artery disease.
The use of IVUS to determine the functional significance of coronary artery lesions remains a matter for debate.
From our prospective IVUS imaging database, between July 2009 and April 2010, 170 coronary lesions in 150 patients who underwent stress myocardial single-photon emission computed tomography (SPECT) performed within 1 month of IVUS evaluation were identified and analyzed. MLA and other parameters were measured by IVUS and compared with the results of myocardial SPECT.
Overall, 45 lesions had positive SPECT, and 125 lesions had negative SPECT. The MLA of lesions with positive SPECT was smaller than the MLA of those with negative SPECT (1.7 ± 0.5 mm² vs. 2.3 ± 1.1 mm², p < 0.001). By logistic regression analysis, MLA (odds ratio: 3.1 by decrease of 1 mm², 95% confidence interval [CI]: 1.75 to 5.5, p < 0.01) was an independent predictor of the positive SPECT. Using receiver-operator characteristic curve analysis, the best cutoff value of MLA was ≤ 2.1 mm² with an 86.7% sensitivity, a 50.4% specificity, a 38.6% positive predictive value, and a 91.3% negative predictive value versus lesions with a positive SPECT (area under the curve: 0.690, 95% CI: 0.615 to 0.759, p < 0.01).
The best cutoff value of MLA measured by IVUS to predict myocardial ischemia was 2.1 mm². The IVUS-measured MLA appeared to play a limited role in detecting functionally significant lesions assessed by myocardial SPECT.
本研究旨在评估血管内超声（IVUS）测量的最小管腔面积（MLA）评估冠状动脉疾病功能意义的能力。
使用 IVUS 确定冠状动脉病变的功能意义仍然存在争议。
从 2009 年 7 月至 2010 年 4 月，我们对 150 例患者的 170 个冠状动脉病变进行了前瞻性 IVUS 成像检查，这些患者在接受 IVUS 评估后 1 个月内接受了应激心肌单光子发射计算机断层扫描（SPECT）检查，并对这些病变进行了分析。通过 IVUS 测量 MLA 和其他参数，并与心肌 SPECT 结果进行比较。
总的来说，45 个病变的 SPECT 结果为阳性，125 个病变的 SPECT 结果为阴性。SPECT 阳性病变的 MLA 小于 SPECT 阴性病变的 MLA（1.7 ± 0.5mm² vs. 2.3 ± 1.1mm²，p < 0.001）。通过逻辑回归分析，MLA（每减少 1mm²的优势比为 3.1，95%置信区间[CI]为 1.75 至 5.5，p < 0.01）是 SPECT 阳性的独立预测因子。使用受试者工作特征曲线分析，MLA 的最佳截断值为≤2.1mm²，其灵敏度为 86.7%，特异性为 50.4%，阳性预测值为 38.6%，阴性预测值为 91.3%，与 SPECT 阳性病变相比（曲线下面积：0.690，95%CI：0.615 至 0.759，p < 0.01）。
IVUS 测量的 MLA 预测心肌缺血的最佳截断值为 2.1mm²。IVUS 测量的 MLA 在检测心肌 SPECT 评估的功能显著病变方面似乎作用有限。
