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(Circulation. 2004;110:2831-2836.)
© 2004 American Heart Association, Inc.

Coronary Heart Disease

Correlations Between Fractional Flow Reserve and Intravascular Ultrasound in Patients With an Ambiguous Left Main Coronary Artery Stenosis

Venu Jasti, MD; Eugen Ivan, MD; Venkata Yalamanchili, MD; Nattawut Wongpraparut, MD; Massoud A. Leesar, MD

From the Division of Cardiology, University of Louisville, Louisville, Ky.

Correspondence to Massoud A. Leesar, MD, Division of Cardiology, University of Louisville, Louisville, KY 40292. E-mail malees01{at}louisville.edu

Received March 4, 2004; revision received April 29, 2004; accepted July 9, 2004.

Background— Intravascular ultrasound (IVUS) is being used to assess the significance of a left main coronary artery stenosis (LMCS). However, the cutoff values of IVUS parameters at which to predict a fractional flow reserve (FFR) of 0.75 are unknown.

Methods and Results— In 55 patients with an angiographically ambiguous LMCS, a pressure guidewire was used to calculate FFR, and IVUS parameters were calculated after automatic pullback. FFR averaged 0.86±0.13 (range, 0.55 to 1.0). IVUS minimum lumen diameter (MLD), minimum lumen area (MLA), cross-sectional narrowing (CSN), and area stenosis (AS) were 3.8±0.61 mm, 7.65±2.9 mm², 59±13%, and 47±19%, respectively. Regression analysis demonstrated strong correlations between FFR and MLD (r=0.79, P<0.0001) as well as between FFR and MLA (r=0.74, P<0.0001). There were inverse, moderate correlations between FFR and CSN (r=0.69, P<0.0001), followed by those between FFR and AS (r=0.54, P<0.0001). Compared with FFR as the "gold standard," an MLD of 2.8 mm had the highest sensitivity and specificity (93% and 98%, respectively) for determining the significance of an LMCS, followed by an MLA of 5.9 mm² (93% and 95%, respectively). Based on an FFR <0.75 and an FFR 0.75, the 38-month survival and event-free survival estimates (EFSEs) were both 100% and 100% versus 90%, respectively (P=NS).

Conclusions— We conclude that (1) an IVUS MLD and MLA of 2.8 mm and 5.9 mm², respectively, strongly predict the physiological significance of an LMCS and (2) among patients with an LMCS, an FFR of 0.75 is a strong predictor of survival and EFSE.

Key Words: blood flow • imaging • ischemia • artery • coronary disease

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