Diagnostic accuracy of intravascular ultrasound-derived minimal lumen area compared with fractional flow reserve.

INTRODUCTION: The use of fractional flow reserve (FFR) as the gold standard for functional assessment of intermediate coronary stenosis has been well documented. Intracoronary imaging techniques such as intravascular ultrasound (IVUS) have been used for additional coronary lesion resolution and some of its anatomic parameters have been studied as having possible correlation with FFR, particularly IVUS minimal lumen area (MLA). We performed a comprehensive review of the available literature in the area.

EVIDENCE ACQUISITION: A Pubmed search was performed for all the literature involving comparison of diagnostic accuracy of IVUS-MLA with FFR.

EVIDENCE SYNTHESIS: An extensive description of all the available data regarding IVUS-MLA diagnostic value regarding the FFR of stenotic lesions, for both non-left main (non-LM) and left main (LM) lesions.

CONCLUSIONS: For non-LM lesions IVUS-MLA cutoff values to identify specific FFR thresholds have marked heterogeneity and perform particularly poorly in terms of specificity and positive predictive value. For LM lesions IVUS-MLA performs better and shows a better correlation with FFR, though more data is needed to confirmed that trend.