Quantitative Coronary Arteriography and Its Assessment of Atherosclerosis

Abstract

Assessment of coronary artery disease by quantitative coronary arteriography (QCA), while highly accurate, is more expensive than visual estimates of disease and involves the measurement of numerous variables requiring specialized equipment and personnel, thereby reducing its clinical applicability. In part 1 of this paper, the independent variables that influence flow of 1040 coronary artery segments were analyzed. Using the information previously reported in part 1 of this paper, we set out to determine the importance of each of the independent variables (percent diameter and area stenosis, length, absolute diameter, entry and exit angles) in the prediction of stenosis flow reserve (SFR). Analysis of variance (ANOVA) was used to determine the importance of each of these variables, as well as their interactions, on the determination of SFR. Only percent diameter stenosis (%DS) demonstrated statistical significance (P < 0.001) in determining stenosis flow reserve. When the results of SFR were plotted against %DS, a quadratic relationship was demonstrated with an R2 value of 0.903 (r = 0.95). To verify the quadratic equation, the %DS of 100 different arterial stenoses was measured and used to calculate an SFR by the quadratic formula. The QCA and quadratic (calculated) determined SFRs compared favorably, with a correlation of 0.97. The ability to calculate SFR directly from measured %DS allows the incorporation of calculated SFR into the clinical setting, where cardiologists can interpret lesion severity both anatomically and hemodynamically. This incorporation can be done without additional cost to the physician, hospital, patient, or third-party payers.