1145, either, cat: 12
2-VIEW QUANTITATIVE CORONARY ANGIOGRAPHY (QCA) IN
MODERATE LESIONS PREDICTS SEVERE OBSTRUCTION BY
CORONARY ULTRASOUND
C.L. Laham1, M.S. Chandra1, M.J. McMahon1, R. Venzon1, M. Jerin2,
N.W. Shammas2
1
St. Lukes Hospital, Cedar Rapids, IA, 2Midwest Cardiovascular Research
Foundation, Davenport, IA, USA
Background: non left main coronary lesions are considered severe if they have a
minimum luminal area (MLA) of ≤4 mm2 by intracoronary ultrasound (IVUS).
Based on Area stenosis= ∏ x (radius)2, MLA≤ 4 mm2 corresponds to a lesion
minimum luminal diameter (MLD) of ≤2.25 mm. Given eccentricity of lesions, a
single view angiographic assessment of disease severity is unreliable.
Objective: We hypothesized, that applying 2-view QCA to symptomatic patients
with moderate lesions using a conservative average of MLD ≤2 mm as cutoff
marker of severe disease, would predict MLA<4 mm2 by IVUS.
Methods/Results: We evaluated 120 lesions in 72 patients undergoing IVUS of
symptomatic moderate angiographic disease (48.7 +/-12.2 %). Respective mean and
standard deviation for MLD using average of 2 views by QCA were 1.78 + 0.48mm
and those for MLA by IVUS were 3.46 +1.58mm2. There was a very strong
correlation of mean angiographic 2-view lesion MLD and IVUS determined MLA
using Pearson’s correlation, r = 0.822, p < 0.001. Positive predictive value of 2-view
QCA was 97% with negative predictive value of 93%.
Figure. Comparison of Lesion MLA by IVUS
vs MLD by QCA
12
Lesion MLA (mm2)
10
8
6
4
2
0
0.0
.5
1.0
1.5
2.0
2.5
3.0
3.5
Average MLD by QCA (mm)
Conclusion: Average lesion MLD ≤2 mm by QCA in 2 orthogonal angiographic
views is a strong predictor of MLA<4 mm2 by IVUS, suggesting that this method
can reliably identify severe lesions in symptomatic patients with angiographically
moderate disease.