Lunardi Mattia, Kotoku Nozomi, Briguori Carlo, Maillard Luc, Kern Adam, Digne Franck, Legutko Jacek, Lesiak Maciej, Witkowski Adam, Lefèvre Thierry, Ochala Anderzej, Jachec Wojciecj, Tamburino Corrado, Contarini Marco, Rioufol Gilles, Colombo Antonio, Escaned Javier, Wijns William, Onuma Yoshinobu, Serruys Patrick W, Gil Robert
Department of Cardiology, University of Galway, Galway, Ireland.
The Lambe Institute for Translational Medicine and CURAM, University of Galway, Galway, Ireland.
Cardiol Res Pract. 2025 Jun 1;2025:7176161. doi: 10.1155/crp/7176161. eCollection 2025.
Visual angiographic assessment of left main (LM) bifurcation lesions is fraught with major limitations. Bifurcation-dedicated quantitative coronary angiography (Bif-QCA) assessment provides higher accuracy than standard QCA in bifurcation lesions. Fractal laws (e.g., Finet's and Murray's laws) can enhance the accuracy of reference diameter calculation when applied to angiography-derived algorithms and may serve as a surrogate for pressure-based assessment. To investigate the correlation between Bif-QCA, Finet's law derived Bif-QCA (Finet-QCA) and pressure-wire functional assessment for LM bifurcation stenosis. Using instantaneous wave-free ratio (iFR) as a reference standard (≤ 0.89), we compared the value of Bif-QCA and Finet-QCA (diameter stenosis ≥ 50%). Moreover, the differences in MEDINA classification according to site-reported visual assessment Bif-QCA or Finet-QCA were investigated. Eighty-four patients were included in the analysis, of which 72 (85.7%) presented an abnormal iFR. Bif-QCA derived %DS was moderately correlated with iFR values; however, implementing Finet's law in the correlation resulted weak. Site-reported MEDINA (visual assessment) resulted in significant higher rate of 1,1,1 and lower rate of 1,0,0 patterns compared to Bif-QCA MEDINA (9.5% vs. 1.2%, < 0.001 and 33.3% vs. 46.4%, < 0.001, respectively) and to Finet-QCA MEDINA (9.5% vs. 2.4%, < 0.001 and 33.3% vs. 40%, < 0.001, respectively). The present study suggested that LM MEDINA bifurcation pattern should be based on QCA analysis rather than visual assessment, both in the context of clinical practice and clinical studies. Compared to conventional Bif-QCA, the implementation of fractal laws (Finet-QCA) did not appear to improve the determination of the reference diameters of the LM shaft.
左主干（LM）分叉病变的血管造影视觉评估存在重大局限性。分叉专用定量冠状动脉造影（Bif-QCA）评估在分叉病变中比标准QCA具有更高的准确性。分形定律（如Finet定律和Murray定律）应用于血管造影衍生算法时可提高参考直径计算的准确性，并可作为基于压力评估的替代方法。为了研究Bif-QCA、Finet定律衍生的Bif-QCA（Finet-QCA）与LM分叉狭窄的压力导丝功能评估之间的相关性。以瞬时无波比值（iFR）作为参考标准（≤0.89），我们比较了Bif-QCA和Finet-QCA的值（直径狭窄≥50%）。此外，还研究了根据现场报告的视觉评估、Bif-QCA或Finet-QCA进行的MEDINA分类差异。84例患者纳入分析，其中72例（85.7%）iFR异常。Bif-QCA得出的%DS与iFR值中度相关；然而，在相关性分析中应用Finet定律结果较弱。与Bif-QCA MEDINA相比（分别为9.5%对1.2%，<0.001和33.3%对46.4%，<0.001）以及与Finet-QCA MEDINA相比（分别为9.5%对2.4%，<0.001和33.3%对40%，<0.001），现场报告的MEDINA（视觉评估）导致1,1,1模式的发生率显著更高，1,0,0模式的发生率更低。本研究表明，在临床实践和临床研究中，LM MEDINA分叉模式应基于QCA分析而非视觉评估。与传统的Bif-QCA相比，分形定律（Finet-QCA）的应用似乎并未改善LM主干参考直径的测定。
