Comparison of three-dimensional quantitative coronary angiography and intravascular ultrasound for detecting functionally significant coronary lesions

Abstract

Background: Three-dimensional quantitative coronary angiography (3D-QCA) can provide more accurate measurement of true vessel size and may be comparable to intravascular ultrasound (IVUS) in identifying functionally significant coronary stenosis, as determined by fractional flow reserve (FFR). This study aimed to evaluate the diagnostic accuracy of 3D-QCA for predicting FFR <0.8. Methods: We assessed 175 lesions in 175 patients by FFR, IVUS, and 3D-QCA. Correlations between 3D-QCA values, IVUS values, and FFR values were analyzed. Receiver operating characteristic (ROC) curves were used to evaluate diagnostic accuracy of 3D-QCA for predicting FFR <0.8 and to determine the appropriate cut-off value. Results: Upon evaluating 3D-QCA values, minimum lumen area (MLA) correlated with FFR value (r=0.48, P<0.001). Considering IVUS values, MLA correlated with FFR value (r=0.43, P<0.001). Also, 3D-QCA MLA was well correlated with IVUS MLA (r=0.61, P<0.001). The area under the ROC curve (AUC) for3D-QCA MLA was 0.77, and the best cut-off value was 2.37 (sensitivity: 73%, specificity: 71%). The AUC for IVUS MLA was 0.73, and the best cut-off value was 3.01 (sensitivity: 71%, specificity: 65%). There was no significant difference in AUC for 3D-MLA and IVUS-MLA (P=0.27).Conclusions: 3D-QCA is not inferior to IVUS for functional assessment of intermediate coronary lesions.We can consider 3D-QCA as a suitable substitute for IVUS or FFR in determining coronary intervention.

Quantitative Angiography: The Dawn of a New Era in Cardiovascular Medicine

“…Numerous studies have undertaken a comparative analysis of these techniques, revealing, for instance, IVUS's heightened sensitivity in detecting calcium in stable patients compared to angiography [ 12 ]. Another study compared three-dimensional QCA (3D-QCA) and IVUS in predicting functionally significant coronary lesions, establishing their comparable diagnostic accuracy [ 13 ]. Although QCA has found widespread application in clinical research and practice, it does have limitations, relying on image quality and facing challenges in evaluating complex lesions like those involving thrombus or calcification [ 7 ].…”

“…Although QCA has found widespread application in clinical research and practice, it does have limitations, relying on image quality and facing challenges in evaluating complex lesions like those involving thrombus or calcification [ 7 ]. Angioscopy and IVUS each have distinctive advantages and limitations, and the choice of technique hinges on the clinical scenario and the specific information sought [ 11 - 13 ]. Numerous studies have conducted comparative analyses of quantitative angiography, angioscopy, and IVUS, affirming that while each method bears its unique strengths and weaknesses, they are invaluable tools in diagnosing and treating cardiovascular diseases.…”

“…Numerous studies have conducted comparative analyses of quantitative angiography, angioscopy, and IVUS, affirming that while each method bears its unique strengths and weaknesses, they are invaluable tools in diagnosing and treating cardiovascular diseases. The selection among these techniques is contingent upon the clinical context and the precise information required [ 11 - 13 ].…”