Diagnostic Performance of Frequency-Domain Optical Coherence Tomography to Predict Functionally Significant Left Main Coronary Artery Stenosis.

Konstantina P Bouki,Nikolaos Goulas,George D Dimitriadis,Vaia A Lambadiari,Kyriaki Barοutsi,Athanasios A Kotsakis,Delia I Vlad,Konstantinos P Toutouzas,Joseph Dens

doi:10.1155/2021/7108284

Abstract

Aims The aim of this study was to assess the safety and diagnostic efficacy of frequency-domain optical coherence tomography (FD-OCT) in identifying functional severity of the left main coronary artery (LM) stenosis determined by fractional flow reserve (FFR). Methods and Results 101 patients with LM lesion (20–70% diameter stenosis angiographically) underwent FFR measurement and FD-OCT imaging of the LM. The following parameters were measured by FD-OCT in the LM: reference lumen area (RLA), reference lumen diameter (RLD), minimum lumen area (MLA), minimum lumen diameter (MLD), % lumen area stenosis, and % diameter stenosis. The LM lesions were analyzable by FD-OCT in 88/101 (87.1%) patients. FFR at maximum hyperemia was ≤0.80 in 39/88 (44.3%) patients. FFR values were correlated significantly with FD-OCT-derived LM lumen parameters. An MLA cutoff value of 5.38 mm2 had the highest sensitivity and specificity of 82% and 81%, respectively, followed by an MLD of 2.43 mm (sensitivity 77%, specificity 72%) and AS of 60% (sensitivity 72%, specificity 72%) for predicting FFR <0.80. Conclusions FD-OCT is a safe and feasible imaging technique for the assessment of LM stenosis. An FD-OCT-derived MLA of ≤5.38 mm2 strongly predicts the functional severity of an LM lesion.

Highlights

Significant left main (LM) coronary artery disease (CAD) has been considered a determinant of increased cardiac mortality approaching 50% at 3-year follow-up [1]
E LM lesions were analyzable by frequency-domain optical coherence tomography (FD-OCT) in all patients (71/71 patients, (100%)) with mid or distal location of the lesion
Roule et al [13] found that overall more than 90% of the quadrants of the LM were adequately assessable by FD-OCT, while most artifacts (18.6%) were located at the proximal part of the LM. e present study confirmed the difficulty of FD-OCT to evaluate the proximal part of the LM as we found that only half (56%) of the proximal LM lesions were analyzable by FD-OCT

Summary

Introduction

Significant left main (LM) coronary artery disease (CAD) has been considered a determinant of increased cardiac mortality approaching 50% at 3-year follow-up [1]. Because of its clinical significance, the accurate assessment of the severity of an LM lesion is very important. Coronary angiography has been accepted as the gold standard for the evaluation of CAD, the severity of an LM stenosis is often underestimated or overestimated [2, 3]. Proximal location of the lesion, vessel tortuosity, overlap, or foreshortening are common limitations of the coronary angiography for the quantitative analysis of the LM stenosis [2, 3]. Fractional flow reserve (FFR) is the current standard method for the functional assessment of a coronary lesion severity. An important limitation of the LM FFR is the confounding effect of downstream stenosis which are often present in patients with LM disease

Methods

Results

Discussion

Conclusion