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Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet]. York (UK): Centre for Reviews and Dissemination (UK); 1995-.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews.

Diagnostic accuracy of intravascular ultrasound derived minimal lumen area compared to fractional flow reserve – meta-analysis

Review published: 2013.

Bibliographic details: Nascimento BR, de Sousa MR, Koo BK, Samady H, Bezerra HG, Ribeiro AL, Costa MA.  Diagnostic accuracy of intravascular ultrasound derived minimal lumen area compared to fractional flow reserve - meta-analysis. Catheterization and Cardiovascular Interventions 2013: epub. [PubMed: 23737441]


Introduction: Although intravascular ultrasound minimal luminal area (IVUS-MLA) is one of many anatomic determinants of lesion severity, it has been proposed as an alternative to fractional flow reserve (FFR) to assess severity of coronary artery disease. Objective: Pool the diagnostic performance of IVUS-MLA and determine its overall accuracy to predict the functional significance of coronary disease using FFR (0.75 or 0.80) as the gold standard. Methods: Studies comparing IVUS and FFR to establish the best MLA cut-off value that correlates with significant coronary stenosis were reviewed from a Medline search using the terms "fractional flow reserve" and "ultrasound". DerSimonian Laird method was applied to obtain pooled accuracy. Results: Eleven clinical trials, including 2 left main (LM) trials (total N= 1759 patients, 1953 lesions) were included. The weighted overall mean MLA cut-off was 2.61 mm(2) in non-LM trials and 5.35 mm(2) in LM trials. For non-LM lesions, the pooled sensitivity of MLA was 0.79 (CI 0.76 - 0.83) and specificity was 0.65 (CI 0.62 - 0.67). Positive likelihood ratio (LR) was 2.26 (CI 1.98 - 2.57) and LR- was 0.32 (CI 0.24 - 0.44). Area under the sROC curve for all trials was 0.848. Pooled LM trials had better accuracy: sensitivity = 0.90, specificity = 0.90, LR+ = 8.79, LR- = 0.120. Conclusion: Given its limited pooled accuracy, IVUS MLA's impact on clinical decision in this scenario is low and may lead to misclassification in up to 20% of the lesions. Pooled analysis points towards lower MLA cut-offs than the ones used in current practice. © 2013 Wiley Periodicals, Inc.

Copyright © 2013 Wiley Periodicals, Inc., a Wiley company.

CRD has determined that this article meets the DARE scientific quality criteria for a systematic review.

Copyright © 2013 University of York.

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