Minimum lumen area indexed to left ventricular mass accurately identified hemodynamically-significant left main coronary stenoses (AUC 0.91; 95% CI 0.83-0.99; p<0.001).
Observational (n=52)
Yes
Does indexing IVUS-derived minimum lumen area to left ventricular mass improve diagnostic accuracy for detecting hemodynamically-significant left main coronary stenoses compared to unindexed MLA in patients with angiographically-intermediate isolated LMCA lesions?
Indexing IVUS-derived minimum lumen area to left ventricular mass provides high diagnostic accuracy and negative predictive value for ruling out functionally significant left main coronary stenoses, though FFR remains necessary to definitively rule them in.
Effect estimate: AUC 0.91 (95% CI 0.83-0.99)
p-value: p=<0.001
Abstract Background Diagnosing significant left main coronary artery (LMCA) stenoses based on anatomical criteria remains challenging. Purpose The ARMYDA FINISH multicenter study evaluated whether indexing intravascular ultrasound (IVUS)-derived minimum lumen area (MLA) provides greater diagnostic accuracy than unindexed MLA for detecting hemodynamically-significant LMCA stenoses, defined as a fractional flow reserve (FFR) ≤0.80. Methods Fifty-two patients with angiographically-intermediate isolated LMCA lesion were prospectively enrolled. All patients underwent IVUS and FFR measurements. Primary endpoint was the diagnostic accuracy of MLA indexed to height, body surface area (BSA), body mass index (BMI) and left ventricular (LV) echocardiographic mass in identifying hemodynamically-significant LMCA stenoses compared to unindexed MLA. Secondary endpoints were the diagnostic sensitivity, specificity, and predictive values of indexed vs unindexed MLA cutoffs. Results Overall, 40 patients (77%) had FFR 0.80 and 12 (23%) FFR ≤0.80. MLA indexed to LV mass achieved the highest area under the receiver operating characteristic curve (AUC=0.91, 95% CI 0.83–0.99; p0.001), overcoming both unindexed MLA (AUC=0.86) and MLA indexed to height, BSA or BMI (AUC range=0.84–0.85). At a cutoff of 29 mm²/kg for MLA/LV mass, sensitivity and negative predictive value (NPV) were both 100%, and specificity was 70%. All MLA thresholds (whether indexed and unindexed) exhibited low positive predictive value (PPV), ranging from 46% to 55%. Conclusions MLA/LV mass ratio represents an accurate diagnostic tool for "ruling out" flow-limiting LMCA lesions. Given the low PPV across all MLA-based thresholds, FFR assessment remains essential to definitely "rule in" LMCA stenoses for revascularization.Figure 1 Figure 2
Grisafi et al. (Sat,) conducted a observational in Angiographically-intermediate isolated left main coronary artery (LMCA) lesions (n=52). IVUS-derived minimum lumen area (MLA) indexed to left ventricular (LV) mass vs. Unindexed MLA and MLA indexed to height, BSA, or BMI was evaluated on Diagnostic accuracy of MLA indexed to height, BSA, BMI and LV echocardiographic mass in identifying hemodynamically-significant LMCA stenoses compared to unindexed MLA (AUC 0.91, 95% CI 0.83-0.99, p=<0.001). Minimum lumen area indexed to left ventricular mass accurately identified hemodynamically-significant left main coronary stenoses (AUC 0.91; 95% CI 0.83-0.99; p<0.001).