{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T06:12:03Z","timestamp":1790143923715,"version":"4.0.1"},"reference-count":22,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T00:00:00Z","timestamp":1790035200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T00:00:00Z","timestamp":1790035200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cathet Cardio Intervent"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Intermediate left main coronary artery (LMCA) disease poses a significant diagnostic challenge. Intravascular ultrasound (IVUS) is the guideline\u2010recommended reference standard for anatomical assessment, whereas quantitative flow ratio (QFR) provides a wire\u2010free physiological estimate. Conventional coronary angiography (CCA) remains the most widely available assessment modality. However, a systematic three\u2010way comparison of these modalities in LMCA disease is lacking.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>To compare the diagnostic performance, agreement, and correlations of CCA and QFR with IVUS for the assessment of intermediate LMCA disease.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This prospective single\u2010center study enrolled 135 patients with LMCA lesions who underwent CCA, IVUS, and offline QFR (QAngio XA 3D) between January 2024 and June 2025. IVUS\u2010derived minimum lumen area (MLA)\u2009&lt;\u20096 mm\n                      <jats:sup>2<\/jats:sup>\n                      was defined as anatomically significant disease and served as the reference standard. QFR\u2009&lt;\u20090.80 defined functional significance, while CCA diameter stenosis (DS)\u2009\u2265\u200950% defined angiographic significance. Diagnostic performance, inter\u2010modality agreement, correlation, and Bland\u2013Altman agreement were assessed.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The mean age was 63.4\u2009\u00b1\u20099.7 years, and 88.1% of patients were male. IVUS identified significant disease in 92 patients (68.1%), compared with 68 (50.4%) by CCA and 50 (37.0%) by QFR. Against the IVUS reference standard, CCA demonstrated 67.4% sensitivity and 86.0% specificity (\u03ba\u2009=\u20090.465; AUC\u2009=\u20090.824; optimal threshold DS\u2009\u2265\u200947%), whereas QFR demonstrated 54.3% sensitivity and 100% specificity (\u03ba\u2009=\u20090.426; AUC\u2009=\u20090.848; Youden\u2010optimal cutoff QFR\u2009\u2264\u20090.49). CCA correlated moderately with IVUS\u2010derived MLA (r\u2009=\u2009\u22120.384;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) and QFR (r\u2009=\u2009\u22120.512;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Both CCA and QFR systematically underestimated vessel dimensions relative to IVUS (Bland\u2013Altman bias: CCA\u2009\u2212\u20092.50 mm\n                      <jats:sup>2<\/jats:sup>\n                      ; QFR\u2009\u2212\u20092.21 mm\n                      <jats:sup>2<\/jats:sup>\n                      ). On multivariable analysis, CCA DS\u2009\u2265\u200950% (OR 2.87; p\u2009=\u20090.011), decreasing QFR value per 0.1\u2010unit (OR 0.61;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.019), and distal bifurcation location (OR 2.38;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.045) independently predicted IVUS\u2010defined significant disease.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>QFR demonstrated perfect specificity and may serve as a rule\u2010in tool, whereas CCA provided greater sensitivity for initial triage. Neither modality can replace IVUS for anatomical characterization and procedural planning. A multimodality approach may therefore be appropriate for the assessment of intermediate LMCA stenosis.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ccd.70918","type":"journal-article","created":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T05:40:18Z","timestamp":1790142018000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Head\u2010to\u2010Head Comparison of Quantitative Flow Ratio, Intravascular Ultrasound, and Coronary Angiography in Left Main Coronary Artery Disease"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-2543-6658","authenticated-orcid":false,"given":"\u0130skan","family":"Zengin","sequence":"first","affiliation":[{"name":"Department of Cardiology Kayseri City Hospital Kayseri Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6414-3743","authenticated-orcid":false,"given":"Fuat","family":"Polat","sequence":"additional","affiliation":[{"name":"Department of Cardiology Dr. Siyami Ersek Thoracic and Cardiovascular Surgery, Educat\u0131on Research Hosp\u0131tal \u0130stanbul Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0992-1415","authenticated-orcid":false,"given":"Deniz","family":"El\u00e7ik","sequence":"additional","affiliation":[{"name":"Department of Cardiology Erciyes University Faculty of Medicine Kayseri Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-3724-2961","authenticated-orcid":false,"given":"Erlan","family":"Abibulaev","sequence":"additional","affiliation":[{"name":"Memorial Hospital Kayseri Kayseri Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7115-7326","authenticated-orcid":false,"given":"Ramazan","family":"Ozan","sequence":"additional","affiliation":[{"name":"Department of Cardiology A\u011fr\u0131 State Hospital A\u011fr\u0131 Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1160-6564","authenticated-orcid":false,"given":"R\u0131dvan","family":"Yurt","sequence":"additional","affiliation":[{"name":"Department of Cardiology Edirne Uzunk\u00f6pr\u00fc State Hospital Edirne Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5800-7094","authenticated-orcid":false,"given":"Nihat","family":"Kalay","sequence":"additional","affiliation":[{"name":"Department of Cardiology Erciyes University Faculty of Medicine Kayseri Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6249-9220","authenticated-orcid":false,"given":"Saban","family":"Kele\u015fo\u011flu","sequence":"additional","affiliation":[{"name":"Department of Cardiology Erciyes University Faculty of Medicine Kayseri Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0108-2824","authenticated-orcid":false,"given":"Cuma","family":"S\u00fcleymano\u011flu","sequence":"additional","affiliation":[{"name":"Department of Cardiology Osmaniye State Hospital Osmaniye Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-6284-6693","authenticated-orcid":false,"given":"\u0130smail","family":"D\u00fczg\u00fcn","sequence":"additional","affiliation":[{"name":"Kayseri State Hospital Kayseri Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4748-882X","authenticated-orcid":false,"given":"Nam\u0131k Kemal","family":"Eryol","sequence":"additional","affiliation":[{"name":"Department of Cardiology Erciyes University Faculty of Medicine Kayseri Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,22]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.57.5.947"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/ccd.20709"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(94)91963-1"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.92.8.2333"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/ccd.25222"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehy394"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2021.09.006"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2011.02.064"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2011.08.009"},{"issue":"8","key":"e_1_2_12_11_1","first-page":"868","article-title":"Intravascular Ultrasound\u2010Derived Minimal Lumen Area Criteria for Functionally Significant Left Main Coronary Artery Stenosis","volume":"7","author":"Park S. 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