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Cardiovasc Diagn Ther. 2019 Oct;9(5):481-491. doi: 10.21037/cdt.2019.09.07.

Accuracy of 3-dimensional and 2-dimensional quantitative coronary angiography for predicting physiological significance of coronary stenosis: a FAVOR II substudy.

Author information

Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai 200030, China.
Shanghai Med-X Engineering Research Center, Shanghai Jiao Tong University, Shanghai 200030, China.
Department of Cardiology, Guangdong Provincial People's Hospital, Guangzhou 510055, China.
Department of Cardiology, Aarhus University Hospital, Skejby, Denmark.
Department of Cardiology, PLA General Hospital, Beijing 100853, China.
Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing 100037, China.



Three-dimensional quantitative coronary angiography (3D-QCA) enables reconstruction of a coronary artery in 3D from two angiographic image projections. This study compared the diagnostic accuracy of 3D-QCA vs. 2-dimensional (2D) QCA in predicting physiologically significant coronary stenosis, using fractional flow reserve (FFR) as the reference standard.


All interrogated vessels in the FAVOR II China study and the FAVOR II Europe-Japan study were assessed by 2D-QCA and 3D-QCA according to standard operating procedures in core laboratories. QCA analysts were blinded to the corresponding FFR values.


A total of 645 vessels from 576 patients with 3D-QCA, 2D-QCA, and FFR were analyzed. Using the conventional cut-off value of 50% for percent diameter stenosis (DS%), 3D-QCA was more accurate in predicting FFR ≤0.80 than 2D-QCA [accuracy 74.0% (95% CI: 69.9-77.7%) vs. 64.9% (95% CI: 61.3-68.7%), difference: 9.1%, P<0.001]. Sensitivity was higher by 3D-QCA compared with 2D-QCA [69.1% (95% CI: 63.0-75.1%) vs. 47.1% (95% CI: 40.5-53.6%), difference: 22.0%, P<0.001] and specificity was similar [76.5% (95% CI: 72.5-80.6%) vs. 74.4% (95% CI: 70.2-78.6%), difference: 2.1%, P=0.40]. Area under the receiver operating characteristic curve was significantly higher for 3D-QCA than for 2D-QCA [0.81 (95% CI: 0.77-0.84) vs. 0.66 (95% CI: 0.62-0.71), P<0.001].


3D-QCA demonstrated better diagnostic performance in predicting physiologically significant coronary stenosis compared with 2D-QCA, when FFR was used as the reference standard.


Coronary physiology; fractional flow reserve (FFR); ischemia; quantitative coronary angiography (QCA)

Conflict of interest statement

Conflicts of Interest: S Tu received a research grant from Medis medical imaging and Pulse medical imaging technology. N Holm received research grants from Medis medical imaging, Abbot, and Boston Scientific. The other authors have no conflicts of interest to declare.

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