Impact of Lesion Length on Functional Significance in Intermediate Coronary Lesions

Abstract

Background: Myocardial fractional flow reserve (FFR) is useful in the evaluation of coronary lesion ischemia. However, the impact of lesion length on FFR has not been adequately assessed. Hypothesis: We hypothesized that lesion length would influence functional significance in intermediate coronary lesions. Methods: FFR measurements were assessed in 136 patients (163 lesions) with stable angina who had >40% stenotic coronary lesion by quantitative coronary angiography (QCA). One hundred sixty-three lesions were classified as intermediate (40%-70% stenosis; n=107; group I) or significant (≥70%; n=56; group S) by QCA. We assessed the relationships between lesion length, coronary stenosis, and FFR in these 163 lesions. Results: Regression analysis revealed an inverse correlation between the percentage of diameter stenosis (%DS) and FFR in group S (r = −0.83, P < 0.0001). In group I, no significant correlation was found between %DS and FFR (r = −0.06, P = 0.55), whereas lesion length was significantly inversely correlated with FFR (r = −0.79, P < 0.0001). Receiver operating characteristic curve analysis demonstrated that the best cutoff value for predicting an FFR value <0.80 was a lesion length >16.1 mm in group I (sensitivity, 86%; specificity, 94%). Conclusions: These study findings suggest that lesion length has a physiologically significant impact on intermediate-grade coronary lesions.

Impact of Lesion Length on Functional Significance in Intermediate Coronary Lesions

“…They also claimed that the ROC analysis revealed that a 10-mm lesion length was the best IVUS cutoff value for predicting the FFR values of less than 0.75 [15]; however, this cut-off value had high specificity (80%) and low sensitivity (41%), as compared to the current study. The research findings were approximately similar to those of by Igu Chi et al, indicating that a lesion length more than 16.1 mm in intermediate lesion was the predictor of FFR<80; additionally, another study in Singapore demonstrated that lesion length of >20mm was the best cut-off point for FFR < 0.75 [9][10][11][12]. The linear correlation between lesion length and coronary flow was previously demonstrated by parameters of quantitative angiography and classical fluid dynamic equations.…”

“…This issue has important implications for many physicians attempting to overcome angiography-dependent decision-making to avoid unnecessary revascularization procedures [4][5][6][7][8]. There are studies suggesting a correlation bertween lesion length and FFR values [9]; and have indicated that employing this parameter in the setting of inability to access FFR for prediction of significant stenosis could be useful [10]. There are various lesion lengths from 10 mm to 28 mm, which were considered as cut-off points for prediction of physiologically significant FFR (< 0.75) in multiple studies [9][10][11][12].…”

“…There are studies suggesting a correlation bertween lesion length and FFR values [9]; and have indicated that employing this parameter in the setting of inability to access FFR for prediction of significant stenosis could be useful [10]. There are various lesion lengths from 10 mm to 28 mm, which were considered as cut-off points for prediction of physiologically significant FFR (< 0.75) in multiple studies [9][10][11][12]. Thus, this study aimed at investigating the correlation between lesion length and FFR values.…”

Coronary Artery Disease (Cad); Intermediate Cad With FFR (Fraction Flow Reserve) Evaluation

“…1,2 Atherosclerosis is a diffuse process, so it is not uncommon to find diffuse intermediate coronary artery disease on coronary angiography producing blood turbulence in coronary lumen resulting impaired blood flow and myocardial ischemia. 3,4 Coronary artery lesions can be assessed both anatomical and physiologically. Coronary angiography is the gold standard method for anatomical evaluation while intravascular ultrasound (IVUS) further improves anatomical evaluation.…”

Response to Impact of Lesion Length on Functional Significance in Intermediate Coronary Lesions

“…1 The authors aimed to investigate the relationships between lesion length, coronary stenosis, and myocardial fractional flow reserve (FFR) of lesions. The study concluded that the regression analysis revealed an inverse correlation between the percentage of diameter stenosis (%DS) and FFR in patients with significant coronary artery stenosis (group S).…”