Naganuma Toru, Latib Azeem, Costopoulos Charis, Takagi Kensuke, Naim Charbel, Sato Katsumasa, Miyazaki Tadashi, Kawaguchi Masanori, Panoulas Vasileios F, Basavarajaiah Sandeep, Figini Filippo, Chieffo Alaide, Montorfano Matteo, Carlino Mauro, Colombo Antonio
Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy; Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy; Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan.
Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy; Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy.
Cardiovasc Revasc Med. 2014 Jan;15(1):3-7. doi: 10.1016/j.carrev.2013.11.002. Epub 2013 Dec 10.
The correlation between fractional flow reserve (FFR) and intravascular ultrasound (IVUS) metrics including minimal lumen area (MLA), plaque burden and morphology remain a matter of debate.
Between June 2008 and May 2013, 132 intermediate stenoses in 109 patients were assessed by FFR, IVUS and quantitative angiography. Receiver-operating characteristic (ROC) curve analyses were used to identify MLA/lesion length/plaque burden cut-off values predictive of FFR <0.80.
FFR <0.80 was observed in 39 lesions. In the entire cohort, MLA value <2.70mm(2) had 79.5% sensitivity, 76.3% specificity, 0.822 area under curve (AUC), 58.5% positive predictive value, 89.9% negative predictive value and 77.3% accuracy in predicting a positive FFR. In lesions with reference diameter vessel (RVD) ≥3.0mm, the MLA cut-off value was 2.84mm(2) (sensitivity 72.2%, specificity 83.0%, AUC 0.842) whereas in lesions with RVD <3.0mm, 2.59mm(2) (sensitivity 90.5%, specificity 69.6%, AUC 0.823). A moderate correlation was observed between MLA and FFR (r=0.429, p<0.001). The cut-off lesion length predictive of FFR <0.80 was 11.0mm with a weak correlation between the two (r=-0.348, p<0.001). Plaque morphology did not significantly affect FFR (p=0.485). On multivariable analysis, MLA (OR: 0.15; 95% CI: 0.05-0.40; p<0.001) and plaque burden (OR: 1.11; 95% CI: 1.04-1.20; p<0.003) were independent predictors of FFR <0.80.
A modest, yet significant correlation was observed between MLA and FFR. The high negative predictive value of large MLAs (using afore-mentioned cut-off values) may provide some degree of confidence that the lesion in question is not functionally significant.
血流储备分数（FFR）与血管内超声（IVUS）指标（包括最小管腔面积（MLA）、斑块负荷和形态）之间的相关性仍存在争议。
在2008年6月至2013年5月期间，对109例患者的132处中度狭窄病变进行了FFR、IVUS和定量血管造影评估。采用受试者操作特征（ROC）曲线分析来确定预测FFR<0.80的MLA/病变长度/斑块负荷临界值。
在39处病变中观察到FFR<0.80。在整个队列中，MLA值<2.70mm²在预测FFR阳性时，灵敏度为79.5%，特异度为76.3%，曲线下面积（AUC）为0.822，阳性预测值为58.5%，阴性预测值为89.9%，准确率为77.3%。在参考血管直径（RVD）≥3.0mm的病变中，MLA临界值为2.84mm²（灵敏度72.2%，特异度83.0%，AUC 0.842）；而在RVD<3.0mm的病变中，MLA临界值为2.59mm²（灵敏度90.5%，特异度69.6%，AUC 0.823）。观察到MLA与FFR之间存在中度相关性（r=−0.429，p<0.001）。预测FFR<0.80的临界病变长度为11.0mm，两者之间相关性较弱（r=−0.348，p<0.001）。斑块形态对FFR无显著影响（p=0.485）。多变量分析显示，MLA（比值比：0.15；95%置信区间：0.05 - 0.40；p<0.001）和斑块负荷（比值比：1.ll；95%置信区间：1.04 - 1.20；p<0.003）是FFR<0.80的独立预测因素。
观察到MLA与FFR之间存在适度但显著的相关性。大MLA值（使用上述临界值）的高阴性预测值可能为所讨论的病变在功能上不显著提供一定程度的信心。
