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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

1
Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai 200030, China.
2
Shanghai Med-X Engineering Research Center, Shanghai Jiao Tong University, Shanghai 200030, China.
3
Department of Cardiology, Guangdong Provincial People's Hospital, Guangzhou 510055, China.
4
Department of Cardiology, Aarhus University Hospital, Skejby, Denmark.
5
Department of Cardiology, PLA General Hospital, Beijing 100853, China.
6
Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing 100037, China.

Abstract

Background:

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.

Methods:

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.

Results:

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].

Conclusions:

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

KEYWORDS:

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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