International Journal of Cardiology and Cardiovascular Research

IJCCR

Vol. 3(1), pp. 012-018, January, 2016. www.premierpublishers.org. ISSN: 2146-3133

Research Article

Assessment of Intermediate Coronary Artery Lesion

with Fractional Flow Reserve (FFR) versus
Intravascular Ultrasound (IVUS)
Mohamed A. Tabl1*, Osama Sanad1, Hisham Abo Elanin1, Hazim Khamis2, Wail Tawfik1
1*

Department of Cardiology, Benha Faculty of Medicine, Benha University, Benha, Egypt.

Wadi El Nile Hospital , Cairo , Egypt.

Fraction flow reserve (FFR) is considered the gold standard for assessing intermediate coronary
lesions. Retrospective data analyses showed variable relationship between intravascular
ultrasound (IVUS) parameters and FFR results. This study aimed to determine the optimal
minimum lumen area (MLA) by IVUS that correlates with FFR and to assess the correlation
between two modalities in assessing intermediate coronary lesions. Methods: Fifty eight
intermediate coronary lesions mainly located in proximal and mid segments of large main
coronary vessels with RVD (3-4mm) were analyzed using both IVUS and FFR to assess the
significance of coronary stenting and to determine the optimal IVUS-MLA that correlates with
2
FFR value < 0.8. Results: IVUS-MLA ranged from 2.5 to 4.2 mm had a highly significant positive
correlation with FFR value < 0.8 (p < 0.0001). Using the ROC curve analysis, IVUS-MLA < 3.9
2
mm (84.2% sensitivity, 80% specificity, area under curve (AUC) = 0.68) was the best threshold
value for identifying FFR <0.8 in coronary vessels with RVD (3-4 mm). Conclusion: Anatomic
measurements of intermediate coronary lesions obtained by IVUS show a good correlation with
FFR measurements. IVUS-MLA 3.9 mm was the best cut off value for identifying FFR < 0.8 in
coronary vessels with RVD (3-4mm). Different MLA cutoffs should be used for different vessel
diameters.
Key words: Fractional Flow Reserve, Intravascular Ultrasonography, Intermediate stenosis.

INTRODUCTION
Assessment of intermediate coronary stenosis defined
angiographically as 40% to 80% luminal narrowing,
continues to be a challenge for cardiologists. The
appropriate criteria for revascularization of such lesions
have been under debate (Stone et al, 2004). There is
significant inter observer and intra-observer variability to
assess the severity of intermediate coronary stenosis
using visual estimation via angiography or quantification
by quantitative coronary angiography (QCA) (Bashore et
al, 2012). Cross-sectional anatomic imaging obtained
from histopathological specimens and intravascular
ultrasound (IVUS) has highlighted limitations of coronary
angiography (Tobis et al, 1993). Owing to the increased
sensitivity of IVUS in identifying disease and its close

correlation with pathology, IVUS has become the more

accurate standard for defining the anatomy of
atherosclerosis in vivo (Jennifer et al, 2011).

*Corresponding
author:
Mohamed
Abdelshafy
Mohamady Tabl, Department of Cardiology, Benha
Faculty of Medicine, Benha University, Benha, Egypt. EMail: mshafytabl@yahoo.com, Tel.: +2001223723050.
Banha university post office NO, 13518.

Assessment of Intermediate Coronary Artery Lesion with Fractional Flow Reserve (FFR) versus Intravascular Ultrasound (IVUS)

Tabl et al.

012

Figure 1. Reference lumen area, minimal lumen area and percent of stenotic area by using
direct manual planimetry.

The capabilities of IVUS imaging in facilitating the

revascularization decision process based on the
contribution of the lumen diameter stenosis to ischemia
has only been reported in retrospective analyses and is in
question (Nishioka et al, 1999). Fractional flow reserve
(FFR) is considered the gold standard for assessing
intermediate coronary lesions. Measurements of 0.8 are
considered clinically significant and indicative of
physiological ischemia (Pijls et al, 2007). To date,
available data regarding the relationship between
anatomic IVUS parameters and functional FFR results
have been from retrospective data analyses and are
variable. Additionally accurate cutoff values of minimal
lumen area (MLA) assessed by IVUS that correlates with
FFR values < 0.8 had not been well determined (Kang et
al, 2011). The traditional MLA cutoff values in previous
studies has been 4.0 mm2. Recent publications have
deemed this cutoff to be too generous. Other studies
reported different MLA cutoffs for different vessel
diameters. However, these series except for the FIRST
study were all retrospective, and the majority had small
sample sizes (Waksman et al, 2013). The current study
aimed to assess the strength of correlation between IVUS
and FFR measures in assessing the significance of
intermediate coronary artery lesions also to detect the
best cut off levels for IVUS measures which can identify
functionally significant stenosis.
Patients and Methods
Study population
The current study was one center prospective trial
conducted in the cath lab of Wady El Nile Hospital from
September 2012 to April 2015. 58 patients who
underwent elective diagnostic coronary angiography and
had intermediate coronary stenosis were enrolled. All
patients underwent both Intravascular Ultrasound (IVUS)
and Fractional Flow Reserve (FFR) assessment.
Exclusions included patients with myocardial infarction
within 72 h, lesions located in left main (LM) vessel or
saphenous vein graft, osteal lesions or lesions in vessels

with < 3 or > 4 mm reference vessel diameter (RVD), or

with more than one lesion in the studied vessel.

METHODS
All included patients were subjected to complete and
detailed medical history, laboratory investigations, resting
standard 12 leads electrocardiogram and transthoracic
echocardiography.
Diagnostic coronary angiography
All the procedures were performed using the standard
femoral approach. Anatomic and accurate visualisation of
coronary arteries plus quantitative coronary angiography
(QCA) was obtained. QCA analysis was performed by an
independent technician blinded to the results of both
IVUS and FFR. Intermediate coronary lesion was defined
as a luminal narrowing with a diameter stenosis 40%
and 70%. All lesions included were located in coronary
vessels with RVD ranged between 3 4 mm.
IVUS analysis
IVUS were performed using rotational mechanical probe
(Atlantis SR Pro-Boston Scientific) which uses a driving
cable to rotate at 1800 rpm (30 images per second). The
probe emits an ultrasound beam typically at a frequency
40 MHz which is perpendicular to the catheter and vessel
and the signal is reflected from surrounding tissue and
reconstructed into a real-time tomographic gray-scale
image. Once the index artery is cannulated by guiding
catheter the IVUS probe is advanced over a 0.014 guide
wire beyond the lesion then pulled back slowly at a
constant speed within the sheath either manually or
motorized (usually 0.5 mm/s) which permits volumetric
evaluation of the lesion and plaque dimensions after
longitudinal or 3-dimensional reconstruction. Using direct
manual planimetry at the site of intermediate lesion,
reference lumen area (RLA) and minimal lumen area
(MLA) were calculated (Figure 1). The percent of stenotic

Assessment of Intermediate Coronary Artery Lesion with Fractional Flow Reserve (FFR) versus Intravascular Ultrasound (IVUS)

Int. J. Cardiol. Cardiovasc. Res.

013

Figure 2. Certus pressure wire system.

area in comparison to the reference lumen area was

obtained by using the following equation:

age of the study population was 55.517 10.866 years.

41 patients (70.69%) were males and only 17 patients
(29.31%) were females. Demographic data was shown in
(Table 1).

FFR analysis

Angiographic findings

To assess FFR, a 0.014-inch pressure guide wire Certus

(Saint Jude Medical Systems Inc., Uppsala, Sweden)
was deployed (Figure 2). Distal pressure was measured
immediately distal to the distal edge of the stenosis
during a period of maximum hyperemia induced by
intravenous adenosine (120 g/kg/min for the right
coronary artery and 150 g/kg/min for the left coronary
artery).Aortic pressure was measured through the guiding
catheter (6- or 7-F). FFR was calculated as the ratio of
the coronary pressure distal to the lesion measured by
the pressure wire to the mean aortic pressure measured
by the guiding catheter. Intermediate lesion with FFR
value < 8 was considered significant. Based on the
results of these 3 methods, the analyses correlated the
IVUS and QCA parameters with FFR results.
Percutaneous coronary intervention (PCI) was not
mandatory and was left to the operator's discretion.

All the target lesions in this study were located in vessels

with RVD ranged between (3-4 mm). The majority of
lesions (84.48%) were located in the main vessels with
only 9 lesions (15.52%) in side branches. The target
lesions mainly located in Left anterior descending artery
(LAD) (46.55%). Fifty four lesions (94.4%) were located
in the proximal and mid segments of the vessels. All
angiographic data was shown in (Table 1).

Statistical analysis of the collected data

Fractional flow reserve FFR measurements:

The collected data were tabulated and analyzed using

SPSS version 16 software (SpssInc, Chicago, ILL
Company). Categorical data were presented as number
and percentages while quantitative data were expressed
as mean standard deviation, median, range and IQR.
ROC curve was used to determine cutoff values of IVUS
MLA with optimum sensitivity and specificity in correlation
to FFR. The accepted level of significance in this work
was stated at 0.05 (P <0.05 was considered significant).

Among 58 intermediate lesions measured by FFR in this

study only 38 lesions (65.5%) were significant (FFR value
< 0.8) while 20 (34.5%) lesions were non significant (FFR
> 0.8) (Table 1).

RESULTS
This non randomized one arm study included 58
intermediate coronary lesions (58 patients). The mean

Intravascular ultrasound (IVUS) measurements

The Minimal lumen area (MLA) among population of the
study group ranged from 2.5 mm to 8.5 mm (Mean SD
= 4.290.9mm), reference lumen area (RLA) ranged
from 5.6 mm to 14.9 mm with (mean SD = 9.65
2.270 mm), IVUS percentage of stenosis ranged from
21% to 75% (Table 1).

Correlation between measurements of IVUS and FFR

Among 38 intermediate coronary lesions with measured
FFR values < 0.8, the results showed significantly lower
MLA and significantly higher % stenosis measured by
IVUS in comparison to 20 lesions with FFR values 0.8
(3.490.45mm vs 5.11.5 mm) and (62.35.9 vs
45.510) (P-value < 0.001) (Table 2)(Figure 3). Results of
RLA measured by IVUS showed insignificant differences
among study population.

Assessment of Intermediate Coronary Artery Lesion with Fractional Flow Reserve (FFR) versus Intravascular Ultrasound (IVUS)

Tabl et al.

014

Table 1. Demographic, angiographic, IVUS and FFR results of the study

Variable
Demographic results of 58 patients:

Value (%)

Mean age
Male/Female
Diabetic patients
Hypertensive patients

55.51710.866 years
41(70.69%) / 17(28.31%)
32(55.17%)
28(48.28%)

Smokers
Patients with dyslipidemia
Angiographic results of 58 lesions:
RVD from 3 to 3.5 mm
RVD from 3.5 to 4 mm
Lesions in Main vessels
Lesions in side branches

28(48.28%)
31(53.45%)

Lesions in LAD
Lesions in RCA
Lesions in LCX
Lesions in diagonal branch or other
Lesions in proximal segments
Lesions in mid segments
Lesions in distal segments
Mean RVD for all population
IVUS results of 58 lesions:
MLA ( range and meanSD)
RLA (range and meanSD)
Percent stenosis% (range and mean)
FFR results of 58 lesions:
< 0.8
0.8

27 lesions (46.55%)
13 lesions (22.4%)
9 lesions (15.52%)
9 lesions (15.52%)
26 lesions (47.2%)
26 lesions (47.2%)
4 lesions (5.6%)
3.50.6 mm

34(58.6%)
24(41.3%)
49 lesions (84.48%)
9 lesions (15.57%)

2.5 mm to 8.5 mm ( 4.290.9mm)

5.6 mm to 14.9 mm (9.65 2.270mm)
21% to 75% (47.5%)
38 lesions (65.5%)
20 lesions (34.5%)

SD = Standard deviation. IVUS= Intravascular ultrasound, FFR= fractional flow reserve

Table 2. Study population as regard IVUS measures in correlation with FFR values.

Variable

FFR 0.8

FFR < 0.8

t test

P value

MLAmm
Range (Mean SD)
RLA
Range (Mean SD)
IVUS % of Stenosis
Range (Mean SD)

3.2- 8.5 (5.11.5)

2.5-4.2 (3.490.45)

4.5

<0.001*

5.6-14.5 (9.692.87)

6.9-14.9 (9.631.96)

0.075

0.941

21-69(45.410.1)

50-75(62.35.9)

7.9

< 0.001*

As regard the target vessel and the site of lesion, we

found no statistically significant differences in the
measurements of both IVUS and FFR values (P-value >
0.05). All angiographic results were shown in (Table 3).

(FFR) < 0.8. MLA 3.9 mm (sensitivity 84.2%, specificity

80 %) was the best cut off value for identifying fractional
flow reserve (FFR) < 0.8 (Table 4) (Figure 4).

Receiver operating characteristic curve analysis

(ROC) curve

DISCUSSION

Receiver operating characteristic curve analysis was

conducted to identify minimum lumen area (MLA) by
intravascular ultrasound (IVUS) with the best
discriminatory value for identifying fractional flow reserve

Decisions regarding coronary intervention should be

based on objective evidence of functional significance of
coronary stenosis (Pijls et al, 2007). Angiography is
inaccurate in assessing the functional significance of
intermediate coronary stenosis when compared with FFR

Assessment of Intermediate Coronary Artery Lesion with Fractional Flow Reserve (FFR) versus Intravascular Ultrasound (IVUS)

Int. J. Cardiol. Cardiovasc. Res.

015

Figure 3. (Case no. 8) Cine Angiographic Frame showing Intermediate stenosis estimated at 60% by quantitative
coronary angiography (QCA) of mid LAD, Fractional Flow Reserve (FFR) value was 0.72. IVUS measurements of same
lesion showing MLA= 2.89mm, RLA=6.94mm with percentage of stenosis = 58%.

Table 3. Showing the study group populations as regard target vessel and site of the lesion in correlation with FFR
value, RLA, MLA and IVUS of stenosis.

FFR value

IVUS RLA

IVUS MLA mm2

IVUS % of
stenosis

LAD

0.770.075

9.92.2

3.90.9

58.99.3

RCA

0.7650.076

9.31.9

3.81.1

58.211.6

LCX

0.7920.105

10.42.0

4.91.9

52.89.6

0.8070.1

7.82.5

3.71.1

51.79.5

0.7940.095

7.61.6

3.60.8

50.418.6

P value

0.9

0.07

0.09

0.3

Proximal

0.770.07

9.61.8

4.11.1

56.411.9

Mid

0.780.09

9.92.5

3.91.3

57.610.5

Distal

0.830.11

6.80.3

3.30.4

51.38.1

0.5

0.1

0.5

0.7

Diagonal
Other branches

P value

RLA = reference luminal area, MLA = minimum luminal area.

Table 4. Showing the best cut-off level of MLA in relation to FFR

ROC curve between FFR and MLA

Cutoff
3.9

AUC
0.86

Sensitivity

Specificity

84.2

80

AUC = area under the curve.

(Kang et al, 2011). Currently, FFR is used in routine

clinical practice as a diagnostic test to determine whether
intervention should be performed in those lesions (Okabe
et al, 2007). Over the years, the use of IVUS has been

established to assess lesion and plaque morphology and

has been proven to optimize stent implantation with the
potential to reduce the rates of subacute stent thrombosis
(Roy et al, 2008).

Assessment of Intermediate Coronary Artery Lesion with Fractional Flow Reserve (FFR) versus Intravascular Ultrasound (IVUS)

Tabl et al.

016

Figure 4. ROC curve for detection of the best cut-off value of MLA in
relation FFR value.

The attempt to use the anatomic findings to determine

the functional significance of intermediate lesions was
first reported in 1999. Prior studies suggested that MLA
2
4 mm by IVUS had a diagnostic accuracy of 89% to
defer coronary intervention in intermediate coronary
lesions. Surprisingly, other studies suggested different
MLA values to predict FFR < 0.8. Kang et al. found much
2
lower cutoff of MLA < 2.0 mm to predict FFR < 0.80
(Kang et al, 2011). Another study reported that IVUS
2
MLA < 4 mm predicts ischemic FFR < 0.75 (Andrea et
al, 1999). It is important to understand that MLA is only
one variable. Other factors could affect the MLA cutoff
value as vessel size, entrance and exit angles and forces
plus the amount of myocardium subtended by the lesion.
The current study analyzed 58 intermediate coronary
lesions located in large coronary vessels with RVD
ranged between (3-4 mm). Majority of the targeted
lesions (94.4%) were located in the proximal and mid
coronary segments. (84.48%) were located in the main
coronary vessels with only 9 lesions (15.52%) in side
branches. We aimed with these selection criteria to
minimize the effect of other factors which could affect the
MLA cutoff value in comparison to previous trials. The
results of current study showed that MLA ranged from 2.5
2
to 4.2 mm had a significant positive correlation with FFR
value < 0.8 (p < 0.0001). Using the ROC curve analysis,
MLA 3.9 mm was the best cut off value for identifying
FFR < 0.8 with sensitivity (84.2%) , specificity (80 %) and
AUC =0.86.
In the FIRST study presented by Waksman et al. which
was the first prospective, multinational, multicenter
registry to examine the correlation of anatomic IVUS
criteria with physiological FFR values in intermediate

coronary lesions, IVUS had a moderate correlation with

FFR values. The weakest correlation in FIRST was for
RVDs of 2.5 to 3.0 mm (r = 0.22, p = 0.003) with a
gradual increase in correlation with 3.0 to 3.5 mm and
slightly more with >3.5-mm vessels (r = 0.27, p = 0.01
and r = 0.34, p = 0.007, respectively). MLA < 3.07 mm2
was the best overall threshold value for identifying
ischemic FFR in different RVD (64.0% sensitivity, 64.9%
specificity and AUC=0.65). They concluded that the utility
of IVUS MLA as an alternative to FFR to guide
intervention in intermediate lesions may be limited in
accuracy and should be confirmed clinically (Waksman et
al, 2013).
The major differences between current study and the
FIRST trial that the best cutoff value of MLA in current
study was more than that obtained in FIRST study (3.07
mm2 and 3.9 mm2) with better sensitivity and specificity
(84.2% and 80% versus 64.0% and 64.9% respectively).
This was explained by different inclusion criteria of two
trials. Unlike the FIRST trial which included patients with
small coronary vessels with RVD < 3 mm, the current
study was performed on larger vessels with RVD
between (3-4 mm). The majority of targeted lesions in this
study located in proximal and mid segments of main
coronary vessels not in distal segments or side branches.
The current study conclude that IVUS-MLA had a
significant correlation with FFR <0.8 in intermediate
coronary lesions located in large vessels with RVD >
3mm. IVUS-MLA < 3.9 mm2 may basically confirm
functionally significant of intermediate lesions mainly
located in proximal and mid segments of large coronary
vessels with higher sensitivity and specificity (84.2% and
80%) in comparison to the FIRST trial. Finally, this small

Assessment of Intermediate Coronary Artery Lesion with Fractional Flow Reserve (FFR) versus Intravascular Ultrasound (IVUS)

Int. J. Cardiol. Cardiovasc. Res.

non randomized trial consider one of the first trials in

Egypt and Middle East that comparing IVUS different
parameters in comparison with FFR.
The answer of the question that IVUS-MLA could replace
FFR to decide regarding coronary interventions in
intermediate coronary lesions needs larger randomized
clinical trials (Ben-Dor et al, 2011). Until such studies are
conducted, physicians should primarily use their clinical
judgment and FFR because FFR is the most accurate
tool to detect ischemia (Lee et al, 2010). However, IVUSMLA cutoff values should be considered as an alternative
to FFR in addition to the known anatomical role of IVUS.
Study Limitations
The limited number of patients included in this study is
too small to make definitive conclusions. The cutoff points
of MLA proposed in our study cannot be applied alone as
an accurate diagnostic tool for assessment of severity of
coronary artery stenosis. Other parameters such as
lesion length and plaque burden should be incorporated
in order to improve diagnostic accuracy.

CONCLUSION
Anatomic measurements of intermediate coronary lesions
obtained by IVUS-MLA show a significant correlation with
FFR measurements in large coronary vessels with RVD >
3mm especially in proximal and mid segments and in
main vessels rather than small branches. IVUS MLA
3.9 mm (sensitivity 84.2%, specificity 80 %) was the best
cut off value for identifying FFR <0.8 in such vessels.
Different MLA cutoffs should be used for different vessel
diameters. The utility of IVUS-MLA as an alternative to
FFR to guide intervention in intermediate lesions need
larger randomized trials.

CONFLICT OF INTEREST
The authors declare no conflict of interests.

ACKNOWLEDGEMENT
The author acknowledged the contributions of Dr.
Jingkuang Chen, Dr. Nilrat Wannasilp, Dr. Aristida
Georgescu, Dr. Sujit Bhattacharya for donating their time,
critical evaluation, constructive comments, and invaluable
assistance toward the improvement of this very
manuscript.

REFERENCES
Andrea SA, Gary SM, Mehran R, Abizaid A, Lansky AJ,

017

Pichard AD (1999). Long-term follow-up after

percutaneous transluminal coronary angioplasty was
not performed based on intravascular ultrasound
findings: importance of lumen dimensions. Circulation,
100:25661.
Bashore TM, Bates ER, Berger PB, Clark DA, Cusma JT,
Dehmer GJ (2012). American College of Cardiology
Foundation/Society for Cardiovascular Angiography
and Interventions expert consensus document on
cardiac catheterization laboratory standards update. A
report of the American College of Cardiology
Foundation Task Force on Expert Consensus
documents. J Am Coll Cardiol. 59:22212305.
Ben-Dor I, Torguson R, Gaglia MA, Gonzalez MA,
Maluenda G, Bui AB (2011). Correlation between
fractional flow reserve and intravascular ultrasound
lumen area in intermediate coronary artery stenosis.
Euro Intervention (7); 22533.
Jennifer A, Koizumi T, Aiden OD, Yeung AC (2011).
Intramural hematoma appearing as new lesion after
coronary stenting JACC Cardiovascular Interventions,
4(1):129-30.
Kang SJ, Lee JY, Ahn JM, Mintz GS, Kim WJ, Park DW
(2011). Validation of intravascular ultrasound-derived
parameters with fractional flow reserve for assessment
of coronary stenosis severity Circulation Cardiovasc
Interv,4;6571.
Lee CH, Tai BC, Soon CY, Low AF, Poh KK, Yeo TC
(2010). New set of intravascular ultrasoundderived
anatomic criteria for defining functionally significant
stenoses in small coronary arteries (results from
Intravascular Ultrasound Diagnostic Evaluation of
Atherosclerosis in Singapore [IDEAS] study). Am J
Cardiol, (105);137884.
Nishioka T, Amanullah A.M, Luo H , Berglund H, Kim CJ,
Nagai T, et al (1999): Clinical validation of intravascular
ultrasound imaging for
assessment of coronary
stenosis severity: comparison with stress myocardial
perfusion imaging J Am Coll Cardiol., 33: 187078.
Okabe T, Mintz GS, Buch AN, Roy P, Hong YJ, Smith
KA, et al (2007): Intravascular ultrasound parameters
associated with stent thrombosis after drug-eluting
stent deployment Am J Cardiol,100;61520.
Pijls NH, van Schaardenburgh P, Manoharan G,
Boersma E, Bech JW, Veer M (2007). Percutaneous
coronary intervention of functionally nonsignificant
stenosis: 5-year follow-up of the DEFER Study J Am
Coll Cardiol,49;210511.
Roy P, Steinberg DH, Sushinsky SJ, Okabe T, Pinto
Slottow TL, Kaneshige K (2008). The potential clinical
utility of intravascular ultrasound guidance in patients
undergoing percutaneous coronary intervention with
drug eluting stents. Eur Heart J, 29(15):18511857.
Stone GW, Ellis SG, Cox DA, Hermiller J,
OShaughnessy C, Mann JT (2004). One-year clinical
results with the slow- release, polymer-based, paclitaxel-

Assessment of Intermediate Coronary Artery Lesion with Fractional Flow Reserve (FFR) versus Intravascular Ultrasound (IVUS)

Tabl et al.

018

eluting TAXUS stent: the TAXUS-IV trial Circulation;

109:1942-47.
Tobis JM, Mahon DJ, Goldberg SL, Nakamura S,
Colombo A (1993). Lessons from intravascular
ultrasonography: observations during interventional
angioplasty procedures. J Clin Ultrasound; 21(9):589607.
Waksman R, Legutko J, Singh J, Orlando Q, Marso S,
Schloss T, et al (2013): FIRST: Fractional Flow
Reserve and Intravascular Ultrasound Relationship
Study Journal of the American College of
Cardiology,61;91723.
Accepted December 03, 2015.
Citation: Tabl MA, Sanad O, Elanin HA, Khamis H, Tawfik
W (2016). Assessment of Intermediate Coronary Artery
Lesion with Fractional Flow Reserve (FFR) versus
Intravascular Ultrasound (IVUS). International Journal of
Cardiology and Cardiovascular Research, 3(1): 012-018.

Copyright: 2016 Tabl et al. This is an open-access

article distributed under the terms of the Creative
Commons Attribution License, which permits unrestricted
use, distribution, and reproduction in any medium,
provided the original author and source are cited.

Assessment of Intermediate Coronary Artery Lesion with Fractional Flow Reserve (FFR) versus Intravascular Ultrasound (IVUS)