Abstract 17712: Comparison of Three-Dimensional and Two-Dimensional Quantitative Coronary Angiography and Intravascular Ultrasound for the Functional Assessment of Coronary Lesions

Abstract

Introduction: Three-dimensional (3-D) quantitative coronary angiography (QCA) reportedly allows a more accurate depiction of true vessel geometry when compared with standard two-dimensional (2-D) QCA and has been validated by intravascular ultrasound (IVUS). Although IVUS is currently thought to provide the most accurate measurements of vessel geometry and lesion severity, 3-D QCA measurements can be performed on existing standard coronary angiography images without the need for additional time or equipment during the procedure. Hypothesis: We assessed the hypothesis that 3-D QCA measurements and IVUS are comparable in accuracy in predicting physiologically significant stenosis assessed by fractional flow reserve (FFR). Methods: Forty lesions in 38 patients were assessed by FFR, IVUS, and 2-D and 3-D QCA. Correlations between anatomical data and FFR were analyzed. The area under the receiver-operating characteristic (ROC) curve (AUC) was calculated to identify the accuracy of predicting FFR ≤0.80. Results: Mean FFR value was 0.75 ± 0.13. FFR ≤0.80 was observed in 26 lesions (65%). Of all measurements of lesion severity obtained by IVUS, minimum lumen diameter (MLD) (r = 0.80, p <0.001) and minimum lumen area (MLA) (r = 0.72, p <0.001) were well correlated with FFR values. Of all 3-D QCA measurements, MLA correlated best with FFR values (r = 0.75, p <0.001). Of all 2-D QCA measurements, MLD correlated best with FFR values (r = 0.58, p <0.001). The AUC were 0.95 for MLA by IVUS, 0.93 for MLD by IVUS, 0.93 for MLA by 3-D QCA, and 0.78 for MLD by 2-D QCA (Figure). Conclusions: Anatomical parameters obtained by 3-D QCA and IVUS correlate better with FFR values than those obtained by 2-D QCA. The predictive value of 3-D QCA for reduced FFR is comparable to IVUS measurements.