Differences in severity of diffuse and focal coronary stenosis between visual and quantitative assessment.

IF 2.8 3区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS
Frontiers in Cardiovascular Medicine Pub Date : 2024-12-16 eCollection Date: 2024-01-01 DOI:10.3389/fcvm.2024.1501576
Xinmao Wang, Chao Song, Heng Liu, Lin Zhou, Letian Zhang
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引用次数: 0

Abstract

Background: Coronary Artery Disease (CAD) is a leading cause of mortality, with an increasing number of patients affected by coronary artery stenosis each year. Coronary angiography (CAG) is commonly employed as the definitive diagnostic tool for identifying coronary artery stenosis. Physician Visual Assessment (PVA) is often used as the primary method to determine the need for further intervention, but its subjective nature poses challenges. This study sought to evaluate the differences of severity of diffuse and focal coronary stenosis between PVA and Quantitative Coronary Angiography (QCA).

Methods: 293 patients with coronary artery disease (334 coronary lesions) underwent CAG and fractional flow reserve (FFR). PVA and QCA was used to quantify diameter stenosis (DS). DS ≥50% was defined as obstructive. FFR ≤0.8 was defined as myocardial ischemia.

Results: The mean ± SD age of all patients was 66 ± 9 years. ΔDS between PVA and QCA was higher in diffuse lesions (16.45 ± 7.37%) than in focal lesions (14.39 ± 7.83%) (P = 0.04). DSPVA and DSQCA had linear negative correlation (rPVA = -0.3182, rQCA = -0.4054) with FFR in diffuse, while in focal, DSPVA and DSQCA had an even stronger linear negative correlation (rPVA = -0.4090, rQCA = -0.4861) with FFR. ROC analysis demonstrated that DSQCA had better discrimination capability for myocardial ischemia (FFR ≤ 0.80) than DSPVA in different of length stenosis.

Conclusions: PVA was more likely to overestimate diameter stenosis in coronary arteries than QCA, and the severity of diffuse stenosis was more likely to be overestimated than that of focal stenosis.

冠状动脉弥漫性和局灶性狭窄严重程度的目测和定量评估差异。
背景:冠状动脉疾病(CAD)是导致死亡的主要原因,每年有越来越多的患者受冠状动脉狭窄的影响。冠状动脉造影(CAG)通常被用作确定冠状动脉狭窄的最终诊断工具。医师视觉评估(PVA)通常被用作确定是否需要进一步干预的主要方法,但其主观性带来了挑战。本研究旨在评估PVA和定量冠状动脉造影(QCA)对弥漫性和局灶性冠状动脉狭窄严重程度的差异。方法:293例冠心病患者(334例冠状动脉病变)行CAG和血流储备分数(FFR)测定。采用PVA和QCA量化管径狭窄(DS)。DS≥50%为梗阻性。FFR≤0.8定义为心肌缺血。结果:所有患者的平均±SD年龄为66±9岁。PVA与QCA在弥漫性病变中的比值ΔDS(16.45±7.37%)高于局灶性病变(14.39±7.83%)(P = 0.04)。弥漫性DSPVA和DSQCA与FFR呈线性负相关(rPVA = -0.3182, rQCA = -0.4054),而灶性DSPVA和DSQCA与FFR呈更强的线性负相关(rPVA = -0.4090, rQCA = -0.4861)。ROC分析表明,在不同长度的狭窄情况下,DSQCA对心肌缺血的判别能力优于DSPVA (FFR≤0.80)。结论:PVA比QCA更容易高估冠状动脉内径狭窄,弥漫性狭窄的严重程度比局灶性狭窄的严重程度更容易高估。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Frontiers in Cardiovascular Medicine
Frontiers in Cardiovascular Medicine Medicine-Cardiology and Cardiovascular Medicine
CiteScore
3.80
自引率
11.10%
发文量
3529
审稿时长
14 weeks
期刊介绍: Frontiers? Which frontiers? Where exactly are the frontiers of cardiovascular medicine? And who should be defining these frontiers? At Frontiers in Cardiovascular Medicine we believe it is worth being curious to foresee and explore beyond the current frontiers. In other words, we would like, through the articles published by our community journal Frontiers in Cardiovascular Medicine, to anticipate the future of cardiovascular medicine, and thus better prevent cardiovascular disorders and improve therapeutic options and outcomes of our patients.
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