Shuai Yang, Shuang Leng, Jiang Ming Fam, Adrian Fatt Hoe Low, Ru-San Tan, Ping Chai, Lynette Teo, Chee Yang Chin, John C Allen, Mark Yan-Yee Chan, Khung Keong Yeo, Aaron Sung Lung Wong, Qinghua Wu, Soo Teik Lim, Liang Zhong
{"title":"验证定量冠状动脉造影的预测模型，以检测有创分数血流储备评估的缺血性病变。","authors":"Shuai Yang, Shuang Leng, Jiang Ming Fam, Adrian Fatt Hoe Low, Ru-San Tan, Ping Chai, Lynette Teo, Chee Yang Chin, John C Allen, Mark Yan-Yee Chan, Khung Keong Yeo, Aaron Sung Lung Wong, Qinghua Wu, Soo Teik Lim, Liang Zhong","doi":"10.1016/j.hlc.2024.09.004","DOIUrl":null,"url":null,"abstract":"<p><strong>Aim: </strong>Physician visual assessment (PVA) in invasive coronary angiography (ICA) is clinically used to determine stenosis severity and guide coronary intervention. However, PVA provides limited information regarding the haemodynamic significance of stenosis. This prospective study aimed to develop a model combining visual diameter stenosis (DS<sub>PVA</sub>) and quantitative coronary angiography (QCA)-derived parameters to diagnose ischaemic lesions using invasive fractional flow reserve (FFR) with pharmacologically induced maximal hyperaemia as the gold standard.</p><p><strong>Methods: </strong>A total of 103 patients (148 lesions) who underwent ICA and FFR measurement were included in the study. Quantitative coronary angiography was used to evaluate various parameters, including anatomical parameters such as lesion length (LL), minimal lumen diameter (MLD), and minimal lumen area, along with haemodynamic parameters like LL/MLD<sup>4</sup> and stenotic flow reserve (SFR). Plaque area, a characteristic parameter of plaque, was also assessed. Lesion-specific ischaemia was defined as invasive FFR ≤0.8.</p><p><strong>Results: </strong>The LL/MLD<sup>4</sup> (r= -0.66, p<0.001) and SFR (r=0.66, p<0.001) exhibited inverse and positive correlations, respectively, with invasive FFR. In the multivariable logistic regression analysis, LL/MLD<sup>4</sup> (≥10.6 mm<sup>-3</sup> vs <10.6 mm<sup>-3</sup>; Odds ratio [OR] 10.59, 95% confidence interval [CI] 3.94-28.50; p<0.001) and SFR (≤2.85 vs >2.85; OR 4.38, 95% CI 1.63-11.79; p=0.004) were identified as the optimal dichotomised predictors for discriminating ischaemia. The area under the curve (AUC) was 0.77 using DS<sub>PVA</sub> ≥70% as a single predictor. Adding LL/MLD<sup>4</sup> ≥10.6 mm<sup>-3</sup> and SFR ≤2.85 into the model significantly increased the AUC to 0.87 (p<0.001).</p><p><strong>Conclusion: </strong>Incorporating QCA-derived haemodynamic parameters provided significant incremental value in the model's discriminatory capability for ischaemic lesions compared with visual diameter assessment alone.</p>","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":" ","pages":""},"PeriodicalIF":2.2000,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Validation of a Prediction Model From Quantitative Coronary Angiography to Detect Ischaemic Lesions as Evaluated by Invasive Fractional Flow Reserve.\",\"authors\":\"Shuai Yang, Shuang Leng, Jiang Ming Fam, Adrian Fatt Hoe Low, Ru-San Tan, Ping Chai, Lynette Teo, Chee Yang Chin, John C Allen, Mark Yan-Yee Chan, Khung Keong Yeo, Aaron Sung Lung Wong, Qinghua Wu, Soo Teik Lim, Liang Zhong\",\"doi\":\"10.1016/j.hlc.2024.09.004\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Aim: </strong>Physician visual assessment (PVA) in invasive coronary angiography (ICA) is clinically used to determine stenosis severity and guide coronary intervention. However, PVA provides limited information regarding the haemodynamic significance of stenosis. This prospective study aimed to develop a model combining visual diameter stenosis (DS<sub>PVA</sub>) and quantitative coronary angiography (QCA)-derived parameters to diagnose ischaemic lesions using invasive fractional flow reserve (FFR) with pharmacologically induced maximal hyperaemia as the gold standard.</p><p><strong>Methods: </strong>A total of 103 patients (148 lesions) who underwent ICA and FFR measurement were included in the study. Quantitative coronary angiography was used to evaluate various parameters, including anatomical parameters such as lesion length (LL), minimal lumen diameter (MLD), and minimal lumen area, along with haemodynamic parameters like LL/MLD<sup>4</sup> and stenotic flow reserve (SFR). Plaque area, a characteristic parameter of plaque, was also assessed. Lesion-specific ischaemia was defined as invasive FFR ≤0.8.</p><p><strong>Results: </strong>The LL/MLD<sup>4</sup> (r= -0.66, p<0.001) and SFR (r=0.66, p<0.001) exhibited inverse and positive correlations, respectively, with invasive FFR. In the multivariable logistic regression analysis, LL/MLD<sup>4</sup> (≥10.6 mm<sup>-3</sup> vs <10.6 mm<sup>-3</sup>; Odds ratio [OR] 10.59, 95% confidence interval [CI] 3.94-28.50; p<0.001) and SFR (≤2.85 vs >2.85; OR 4.38, 95% CI 1.63-11.79; p=0.004) were identified as the optimal dichotomised predictors for discriminating ischaemia. The area under the curve (AUC) was 0.77 using DS<sub>PVA</sub> ≥70% as a single predictor. 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Validation of a Prediction Model From Quantitative Coronary Angiography to Detect Ischaemic Lesions as Evaluated by Invasive Fractional Flow Reserve.
Aim: Physician visual assessment (PVA) in invasive coronary angiography (ICA) is clinically used to determine stenosis severity and guide coronary intervention. However, PVA provides limited information regarding the haemodynamic significance of stenosis. This prospective study aimed to develop a model combining visual diameter stenosis (DSPVA) and quantitative coronary angiography (QCA)-derived parameters to diagnose ischaemic lesions using invasive fractional flow reserve (FFR) with pharmacologically induced maximal hyperaemia as the gold standard.
Methods: A total of 103 patients (148 lesions) who underwent ICA and FFR measurement were included in the study. Quantitative coronary angiography was used to evaluate various parameters, including anatomical parameters such as lesion length (LL), minimal lumen diameter (MLD), and minimal lumen area, along with haemodynamic parameters like LL/MLD4 and stenotic flow reserve (SFR). Plaque area, a characteristic parameter of plaque, was also assessed. Lesion-specific ischaemia was defined as invasive FFR ≤0.8.
Results: The LL/MLD4 (r= -0.66, p<0.001) and SFR (r=0.66, p<0.001) exhibited inverse and positive correlations, respectively, with invasive FFR. In the multivariable logistic regression analysis, LL/MLD4 (≥10.6 mm-3 vs <10.6 mm-3; Odds ratio [OR] 10.59, 95% confidence interval [CI] 3.94-28.50; p<0.001) and SFR (≤2.85 vs >2.85; OR 4.38, 95% CI 1.63-11.79; p=0.004) were identified as the optimal dichotomised predictors for discriminating ischaemia. The area under the curve (AUC) was 0.77 using DSPVA ≥70% as a single predictor. Adding LL/MLD4 ≥10.6 mm-3 and SFR ≤2.85 into the model significantly increased the AUC to 0.87 (p<0.001).
Conclusion: Incorporating QCA-derived haemodynamic parameters provided significant incremental value in the model's discriminatory capability for ischaemic lesions compared with visual diameter assessment alone.
期刊介绍：
Heart, Lung and Circulation publishes articles integrating clinical and research activities in the fields of basic cardiovascular science, clinical cardiology and cardiac surgery, with a focus on emerging issues in cardiovascular disease. The journal promotes multidisciplinary dialogue between cardiologists, cardiothoracic surgeons, cardio-pulmonary physicians and cardiovascular scientists.
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