1
|
Sakamoto T, Usui E, Hoshino M, Hada M, Nagamine T, Hanyu Y, Nogami K, Ueno H, Setoguchi M, Tahara T, Matsuda K, Mineo T, Wakasa N, Sugiyama T, Yonetsu T, Sasano T, Kakuta T. Association of Coronary Computed Tomography-Defined Myocardial Bridge With Pre- and Post-Procedural Fractional Flow Reserve in Patients Undergoing Elective Percutaneous Coronary Intervention. Circ J 2024:CJ-23-0934. [PMID: 38763754 DOI: 10.1253/circj.cj-23-0934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/21/2024]
Abstract
BACKGROUND Myocardial bridge (MB) is a common coronary anomaly characterized by a tunneled course through the myocardium. Coronary computed tomography angiography (CCTA) can identify MB. The impact of MB detected by CCTA on coronary physiological parameters before and after percutaneous coronary intervention (PCI) is unknown.Methods and Results: We investigated 141 consecutive patients who underwent pre-PCI CCTA and fractional flow reserve (FFR)-guided elective PCI for de novo single proximal lesions in the left anterior descending artery (LAD). We compared clinical demographics and physiological parameters between patients with and without CCTA-defined MB. MB was identified in 46 (32.6%) patients using pre-PCI CCTA. The prevalence of diabetes was higher among patients with MB. Median post-PCI FFR values were significantly lower among patients with than without MB (0.82 [interquartile range 0.79-0.85] vs. 0.85 [interquartile range 0.82-0.89]; P=0.003), whereas pre-PCI FFR values were similar between the 2 groups. Multivariable linear regression analysis revealed that the presence of MB and greater left ventricular mass volume in the LAD territory were independently associated with lower post-PCI FFR values. Multivariable logistic regression analysis also revealed that the presence of MB and lower pre-PCI FFR values were independent predictors of post-PCI FFR values ≤0.80. CONCLUSIONS CCTA-defined MB independently predicted both lower post-PCI FFR as a continuous variable and ischemic FFR as a categorical variable in patients undergoing elective PCI for LAD.
Collapse
Affiliation(s)
- Tatsuya Sakamoto
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital
| | - Eisuke Usui
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital
| | - Masahiro Hoshino
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital
| | - Masahiro Hada
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital
| | | | - Yoshihiro Hanyu
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital
| | - Kai Nogami
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital
| | - Hiroki Ueno
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital
| | - Mirei Setoguchi
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital
| | - Tomohiro Tahara
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital
| | - Kazuki Matsuda
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital
| | - Takashi Mineo
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital
| | - Nobutaka Wakasa
- Department of Clinical Laboratory, Tsuchiura Kyodo General Hospital
| | - Tomoyo Sugiyama
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University
| | - Taishi Yonetsu
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University
| | - Tetsuo Sasano
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University
| | - Tsunekazu Kakuta
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital
| |
Collapse
|
2
|
Liu J, Li B, Yang Y, Huang S, Sun H, Liu J, Liu Y. A comprehensive approach to prediction of fractional flow reserve from deep-learning-augmented model. Comput Biol Med 2024; 169:107967. [PMID: 38194780 DOI: 10.1016/j.compbiomed.2024.107967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 12/22/2023] [Accepted: 01/02/2024] [Indexed: 01/11/2024]
Abstract
The underuse of invasive fractional flow reserve (FFR) in clinical practice has motivated research towards non-invasive prediction of FFR. Although the non-invasive derivation of FFR (FFRCT) using computational fluid dynamics (CFD) principles has become a common practice, its clinical application has been limited due to the considerable time required for computation of resulting changes in haemodynamic conditions. An alternative to CFD technology is incorporating a neural network into the computational process to reduce the time necessary for running an effective model. In this study we propose a cascade of data-driven and physic-based neural networks (DP-NN) for predicting FFR (DL-FFRCT). The first network of cascade network DP-NN includes geometric features, and the second network includes physical features. We compare the differences between data-driven neural network (D-NN) and DP-NN for predicting FFR. The training and testing datasets were obtained by solving the three-dimensional incompressible Navier-Stokes equations. Coronary flow and geometric features were used as inputs to train D-NN. In DP-NN the training process involves first training a D-NN to output resting ΔP as one input feature to the DP-NN. Secondly, the physics-based microcirculatory resistance as another input feature to the DP-NN. Using clinically measured FFR as the "gold standard", we validated the computational accuracy of DL-FFRCT in 77 patients. Compared to D-NN, DP-NN improved the prediction of ΔP (R2 = 0.87 vs. R2 = 0.92). Statistical analysis demonstrated that the diagnostic accuracy of DL-FFRCT was not inferior to FFRCT (85.71 % vs. 88.3 %) and the computational time was reduced by a factor of approximately 3000 (4.26 s vs. 3.5 h). DP-NN represents a near real-time, interpretable, and highly accurate deep-learning network, which contributes to the development of high-performance computational methods for haemodynamics. We anticipate that DP-NN will enable near real-time prediction of DL-FFRCT in personalized narrow blood vessels and provide guidance for cardiovascular disease treatments.
Collapse
Affiliation(s)
- Jincheng Liu
- Department of Biomedical Engineering, College of Chemistry and Life Sciences, Beijing University of Technology, Beijing, China
| | - Bao Li
- Department of Biomedical Engineering, College of Chemistry and Life Sciences, Beijing University of Technology, Beijing, China
| | - Yang Yang
- Department of Biomedical Engineering, College of Chemistry and Life Sciences, Beijing University of Technology, Beijing, China
| | - Suqin Huang
- Department of Biomedical Engineering, College of Chemistry and Life Sciences, Beijing University of Technology, Beijing, China
| | - Hao Sun
- Department of Biomedical Engineering, College of Chemistry and Life Sciences, Beijing University of Technology, Beijing, China
| | - Jian Liu
- Cardiovascular Department, Peking University People's Hospital, Beijing, China
| | - Youjun Liu
- Department of Biomedical Engineering, College of Chemistry and Life Sciences, Beijing University of Technology, Beijing, China.
| |
Collapse
|
3
|
Lee HS, Kim U, Yang S, Murasato Y, Louvard Y, Song YB, Kubo T, Johnson TW, Hong SJ, Omori H, Pan M, Doh JH, Kinoshita Y, Banning AP, Nam CW, Shite J, Lefèvre T, Gwon HC, Hikichi Y, Chatzizisis YS, Lassen JF, Stankovic G, Koo BK. Physiological Approach for Coronary Artery Bifurcation Disease: Position Statement by Korean, Japanese, and European Bifurcation Clubs. JACC Cardiovasc Interv 2022; 15:1297-1309. [PMID: 35717395 DOI: 10.1016/j.jcin.2022.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 04/28/2022] [Accepted: 05/03/2022] [Indexed: 10/18/2022]
Abstract
Coronary artery bifurcation lesions are frequently encountered in cardiac catheterization laboratories and are associated with more complex procedures and worse clinical outcomes than nonbifurcation lesions. Therefore, anatomical and physiological assessment of bifurcation lesions before, during, and after percutaneous coronary intervention is of paramount clinical importance. Physiological assessment can help interventionalists appreciate the hemodynamic significance of coronary artery disease and guide ischemia-directed revascularization. However, it is important to understand that the physiological approach for bifurcation disease is more important than simply using physiological indexes for its assessment. This joint consensus document by the Korean, Japanese, and European bifurcation clubs presents the concept of a physiological approach for coronary bifurcation lesions, as well as current knowledge, practical tips, pitfalls, and future directions of applying physiological indexes in bifurcation percutaneous coronary intervention. This document aims to guide interventionalists in performing appropriate physiology-based assessments and treatment decisions for coronary bifurcation lesions.
Collapse
Affiliation(s)
- Hak Seung Lee
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Ung Kim
- Division of Cardiology, Department of Internal Medicine, Yeungnam University Medical Center, Yeungnam University College of Medicine, Daegu, Korea
| | - Seokhun Yang
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Yoshinobu Murasato
- Department of Cardiology, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Yves Louvard
- Institut Cardiovasculaire Paris Sud, Hopital Privé Jacques Cartier, Massy, France
| | - Young Bin Song
- Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Takashi Kubo
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Thomas W Johnson
- University of Bristol, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
| | - Soon Jun Hong
- Division of Cardiology, Department of Cardiovascular Center, Korea University Anam Hospital, Seoul, Korea
| | - Hiroyuki Omori
- Department of Cardiovascular Medicine, Gifu Heart Center, Gifu, Japan; Department of Cardiology, Gifu Prefectural General Medical Center, Gifu, Japan
| | - Manuel Pan
- Cardiology Department of Reina Sofia Hospital, Maimonides Institute of Biomedical Research of Cordoba, University of Cordoba, Cordoba, Spain
| | - Joon-Hyung Doh
- Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Yoshihisa Kinoshita
- Department of Cardiovascular Medicine, Toyohashi Heart Center, Toyohashi, Japan
| | - Adrian P Banning
- Division of Cardiovascular Medicine, British Heart Foundation Centre of Research Excellence, University of Oxford, Oxford, United Kingdom
| | - Chang-Wook Nam
- Department of Internal Medicine and Cardiovascular Research Institute, Keimyung University Dongsan Hospital, Daegu, Korea
| | - Junya Shite
- Division of Cardiology, Osaka Saiseikai Nakatsu Hospital, Osaka, Japan
| | - Thierry Lefèvre
- Institut Cardiovasculaire Paris Sud, Hopital Privé Jacques Cartier, Massy, France
| | - Hyeon-Cheol Gwon
- Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yutaka Hikichi
- Department of Cardiovascular Medicine, Saga Medical Center KOSEIKAN, Saga, Japan
| | - Yiannis S Chatzizisis
- Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Jens Flensted Lassen
- Department of Cardiology B, Odense Universitates Hospital and University of Southern Denmark, Odense C, Denmark
| | - Goran Stankovic
- Department of Cardiology, University Clinical Center of Serbia, and Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
| | - Bon-Kwon Koo
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea.
| |
Collapse
|
4
|
Geng L, Yuan Y, Du P, Gao L, Wang Y, Li J, Guo W, Huang Y, Zhang Q. Association of quantitative flow ratio-derived microcirculatory indices with anatomical-functional discordance in intermediate coronary lesions. Int J Cardiovasc Imaging 2021; 37:2803-2813. [PMID: 34059977 DOI: 10.1007/s10554-021-02292-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 05/16/2021] [Indexed: 12/18/2022]
Abstract
Discrepancy between coronary lesion severity and functional significance has always been a relevant issue in the management of patients undergoing coronary angiography and/or revascularization. We sought to investigate the relationship between quantitative flow ratio (QFR)-derived microcirculatory indices and anatomical-functional mismatch/reverse mismatch in intermediate coronary lesions. Intravascular ultrasound (IVUS) imaging and QFR were analyzed in 117 de novo intermediate coronary lesions. Lesions with QFR ≤ 0.8 were considered hemodynamically significant. Anatomical significance of the lesions was defined according to the best cutoff value of combined IVUS parameters for predicting QFR ≤ 0.8. QFR-derived microcirculatory indices including contrast-flow QFR minus fixed-flow QFR (cQFR-fQFR), hyperemic flow velocity and angiography-derived index of microcirculatory resistance (IMRangio) were calculated. The best cutoff values of IVUS parameters for predicting QFR ≤ 0.8 were minimum lumen area (MLA) 3.1mm2 and plaque burden (PB) 70%, with area under the curve of 0.635 and 0.703, respectively. The total discordance rate of lesion functional significance between IVUS and QFR assessments was 26.5%, with 21 lesions (17.9%) being classified as mismatch (MLA ≤ 3.1mm2 and PB ≥ 70% and QFR > 0.8) and 10 lesions (8.5%) as reverse-mismatch (MLA > 3.1 mm2 or PB < 70% and QFR ≤ 0.8). At multivariate analysis, IMRangio was identified as an independent predictor of mismatch (OR1.675, 95%CI:1.176-2.386, P = 0.004), whereas hyperemic flow velocity was identified as an independent predictor of reverse-mismatch (OR 1.233, 95%CI:1.073-1.416, P = 0.003). In intermediate coronary lesions, although MLA 3.1mm2 and PB 70% determined by IVUS are predictive of QFR-defined functional significance, the discordance rate remains substantial. QFR-derived microcirculatory indices are independently associated with anatomical-functional discordance between IVUS and QFR assessments.
Collapse
Affiliation(s)
- Liang Geng
- Department of Cardiology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, 200092, China.,Department of Cardiology, JI'AN Hospital, Shanghai East Hospital, Ji An, 343006, China
| | - Yuan Yuan
- Department of Cardiology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, 200092, China
| | - Peizhao Du
- Department of Cardiology, Baoshan Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai, 201900, China
| | - Liming Gao
- Department of Cardiology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, 200092, China
| | - Yunkai Wang
- Department of Cardiology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, 200092, China
| | - Jiming Li
- Department of Cardiology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, 200092, China
| | - Wei Guo
- Department of Cardiology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, 200092, China
| | - Ying Huang
- Department of Cardiology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, 200092, China
| | - Qi Zhang
- Department of Cardiology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, 200092, China.
| |
Collapse
|
5
|
Kanaji Y, Hirano H, Sugiyama T, Hoshino M, Horie T, Misawa T, Nogami K, Ueno H, Hada M, Yamaguchi M, Sumino Y, Hamaya R, Usui E, Yonetsu T, Sasano T, Kakuta T. Pre-percutaneous Coronary Intervention Pericoronary Adipose Tissue Attenuation Evaluated by Computed Tomography Predicts Global Coronary Flow Reserve After Urgent Revascularization in Patients With Non-ST-Segment-Elevation Acute Coronary Syndrome. J Am Heart Assoc 2020; 9:e016504. [PMID: 32856503 PMCID: PMC7660767 DOI: 10.1161/jaha.120.016504] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Background Impaired global coronary flow reserve (g‐CFR) is related to worse outcomes. Inflammation has been postulated to play a role in atherosclerosis. This study aimed to evaluate the relationship between pre‐procedural pericoronary adipose tissue inflammation and g‐CFR after the urgent percutaneous coronary intervention in patients with first non–ST‐segment–elevation acute coronary syndrome. Methods and Results Phase‐contrast cine‐magnetic resonance imaging was performed to obtain g‐CFR by quantifying coronary sinus flow at 1 month after percutaneous coronary intervention in a total of 116 first non–ST‐segment–elevation acute coronary syndrome patients who underwent pre‐percutaneous coronary intervention computed tomography angiography. On proximal 40‐mm segments of 3 major coronary vessels on computed tomography angiography, pericoronary adipose tissue attenuation was assessed by the crude analysis of mean computed tomography attenuation value. The patients were divided into 2 groups with and without impaired g‐CFR divided by the g‐CFR value of 1.8. There were significant differences in age, culprit lesion location, N‐terminal pro‐B‐type natriuretic peptide levels, high‐sensitivity C‐reactive protein (hs‐CRP) levels, mean pericoronary adipose tissue attenuation between patients with impaired g‐CFR and those without (g‐CFR, 1.47 [1.16, 1.68] versus 2.66 [2.22, 3.28]; P<0.001). Multivariable logistic regression analysis revealed that age (odds ratio [OR], 1.060; 95% CI, 1.012–1.111, P=0.015) and mean pericoronary adipose tissue attenuation (OR, 1.108; 95% CI, 1.026–1.197, P=0.009) were independent predictors of impaired g‐CFR (g‐CFR <1.8). Conclusions Mean pericoronary adipose tissue attenuation, a marker of perivascular inflammation, obtained by computed tomography angiography performed before urgent percutaneous coronary intervention, but not hs‐CRP, a marker of systemic inflammation was significantly associated with g‐CFR at 1‐month after revascularization. Our results may suggest the pathophysiological mechanisms linking perivascular inflammation and g‐CFR in patients with non–ST‐segment–elevation acute coronary syndrome.
Collapse
Affiliation(s)
- Yoshihisa Kanaji
- Division of Cardiovascular Medicine Tsuchiura Kyodo General Hospital Ibaraki Japan
| | - Hidenori Hirano
- Division of Cardiovascular Medicine Tsuchiura Kyodo General Hospital Ibaraki Japan
| | - Tomoyo Sugiyama
- Division of Cardiovascular Medicine Tsuchiura Kyodo General Hospital Ibaraki Japan
| | - Masahiro Hoshino
- Division of Cardiovascular Medicine Tsuchiura Kyodo General Hospital Ibaraki Japan
| | - Tomoki Horie
- Division of Cardiovascular Medicine Tsuchiura Kyodo General Hospital Ibaraki Japan
| | - Toru Misawa
- Division of Cardiovascular Medicine Tsuchiura Kyodo General Hospital Ibaraki Japan
| | - Kai Nogami
- Division of Cardiovascular Medicine Tsuchiura Kyodo General Hospital Ibaraki Japan
| | - Hiroki Ueno
- Division of Cardiovascular Medicine Tsuchiura Kyodo General Hospital Ibaraki Japan
| | - Masahiro Hada
- Division of Cardiovascular Medicine Tsuchiura Kyodo General Hospital Ibaraki Japan
| | - Masao Yamaguchi
- Division of Cardiovascular Medicine Tsuchiura Kyodo General Hospital Ibaraki Japan
| | - Yohei Sumino
- Division of Cardiovascular Medicine Tsuchiura Kyodo General Hospital Ibaraki Japan
| | - Rikuta Hamaya
- Division of Cardiovascular Medicine Tsuchiura Kyodo General Hospital Ibaraki Japan
| | - Eisuke Usui
- Division of Cardiovascular Medicine Tsuchiura Kyodo General Hospital Ibaraki Japan
| | - Taishi Yonetsu
- Department of Cardiovascular Medicine Tokyo Medical and Dental University Tokyo Japan
| | - Tetsuo Sasano
- Department of Cardiovascular Medicine Tokyo Medical and Dental University Tokyo Japan
| | - Tsunekazu Kakuta
- Division of Cardiovascular Medicine Tsuchiura Kyodo General Hospital Ibaraki Japan
| |
Collapse
|
6
|
Hirano H, Kanaji Y, Sugiyama T, Hoshino M, Horie T, Misawa T, Nogami K, Ueno H, Hada M, Yamaguchi M, Sumino Y, Hamaya R, Usui E, Murai T, Lee T, Yonetsu T, Kakuta T. Impact of pericoronary adipose tissue inflammation on left ventricular hypertrophy and regional physiological indices in stable coronary artery disease patients with preserved systolic function. Heart Vessels 2020; 36:24-37. [PMID: 32638076 DOI: 10.1007/s00380-020-01658-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 06/26/2020] [Indexed: 10/23/2022]
Abstract
Systemic low-grade inflammation has been shown to be associated with left ventricular hypertrophy (LVH). However, the relationship between pericoronary adipose tissue attenuation (PCATA) and both LVH and regional physiological indices remains unknown. This study aimed to evaluate the association of PCATA with LVH and regional physiological indices in stable coronary artery disease (CAD) patients with preserved systolic function. A total of 114 CAD patients who underwent coronary CT angiography (CTA) and invasive physiological tests showing ischemia due to a single de novo lesion were included in the study. On proximal 40-mm segments of all three major coronary vessels on CTA, PCATA was assessed by the crude analysis of the mean CT attenuation value [- 190 to - 30 Hounsfield units [HU)] and the culprit vessel PCATA was used for the analysis. Regional physiological indices were invasively obtained by pressure-temperature sensor-tipped wire. The patients were divided into three groups by culprit vessel PCATA tertiles, and clinical, CTA-derived, and physiological indices were compared. Univariable and multivariable analyses were further performed to determine the predictors of LVH. Angiographic stenosis severity, culprit lesion locations, culprit vessel fractional flow reserve, coronary flow reserve, index of microcirculatory resistance, total and target vessel coronary calcium score, and biomarkers including high-sensitivity C-reactive protein were not different among the groups. The left ventricular (LV) mass, LV mass index (LVMI), and LV mass at risk were all significantly different in the three groups with the greatest values in the highest tertile group (all, P < 0.05). On multivariable analysis, male gender, NT-proBNP, and PCATA were independent predictors of LVMI. Culprit vessel PCATA was significantly associated with LVMI, but not with regional physiology in CAD patients with functionally significant lesions and preserved systolic function. Our results may offer insight into the pathophysiological mechanisms linking pericoronary inflammation and LVH to worse prognosis.
Collapse
Affiliation(s)
- Hidenori Hirano
- Department of Cardiology, Tsuchiura Kyodo General Hospital, 4-1-1 Otsuno, Tsuchiura, Ibaraki, 300-0028, Japan
| | - Yoshihisa Kanaji
- Department of Cardiology, Tsuchiura Kyodo General Hospital, 4-1-1 Otsuno, Tsuchiura, Ibaraki, 300-0028, Japan
| | - Tomoyo Sugiyama
- Department of Cardiology, Tsuchiura Kyodo General Hospital, 4-1-1 Otsuno, Tsuchiura, Ibaraki, 300-0028, Japan
| | - Masahiro Hoshino
- Department of Cardiology, Tsuchiura Kyodo General Hospital, 4-1-1 Otsuno, Tsuchiura, Ibaraki, 300-0028, Japan
| | - Tomoki Horie
- Department of Cardiology, Tsuchiura Kyodo General Hospital, 4-1-1 Otsuno, Tsuchiura, Ibaraki, 300-0028, Japan
| | - Toru Misawa
- Department of Cardiology, Tsuchiura Kyodo General Hospital, 4-1-1 Otsuno, Tsuchiura, Ibaraki, 300-0028, Japan
| | - Kai Nogami
- Department of Cardiology, Tsuchiura Kyodo General Hospital, 4-1-1 Otsuno, Tsuchiura, Ibaraki, 300-0028, Japan
| | - Hiroki Ueno
- Department of Cardiology, Tsuchiura Kyodo General Hospital, 4-1-1 Otsuno, Tsuchiura, Ibaraki, 300-0028, Japan
| | - Masahiro Hada
- Department of Cardiology, Tsuchiura Kyodo General Hospital, 4-1-1 Otsuno, Tsuchiura, Ibaraki, 300-0028, Japan
| | - Masao Yamaguchi
- Department of Cardiology, Tsuchiura Kyodo General Hospital, 4-1-1 Otsuno, Tsuchiura, Ibaraki, 300-0028, Japan
| | - Yohei Sumino
- Department of Cardiology, Tsuchiura Kyodo General Hospital, 4-1-1 Otsuno, Tsuchiura, Ibaraki, 300-0028, Japan
| | - Rikuta Hamaya
- Department of Cardiology, Tsuchiura Kyodo General Hospital, 4-1-1 Otsuno, Tsuchiura, Ibaraki, 300-0028, Japan
| | - Eisuke Usui
- Department of Cardiology, Tsuchiura Kyodo General Hospital, 4-1-1 Otsuno, Tsuchiura, Ibaraki, 300-0028, Japan
| | - Tadashi Murai
- Department of Cardiology, Tsuchiura Kyodo General Hospital, 4-1-1 Otsuno, Tsuchiura, Ibaraki, 300-0028, Japan
| | - Tetsumin Lee
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Taishi Yonetsu
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tsunekazu Kakuta
- Department of Cardiology, Tsuchiura Kyodo General Hospital, 4-1-1 Otsuno, Tsuchiura, Ibaraki, 300-0028, Japan.
| |
Collapse
|
7
|
Ramasamy A, Chen Y, Zanchin T, Jones DA, Rathod K, Jin C, Onuma Y, Zhang YJ, Amersey R, Westwood M, Ozkor M, O’Mahony C, Lansky A, Crake T, Serruys PW, Mathur A, Baumbach A, Bourantas CV. Optical coherence tomography enables more accurate detection of functionally significant intermediate non-left main coronary artery stenoses than intravascular ultrasound: A meta-analysis of 6919 patients and 7537 lesions. Int J Cardiol 2020; 301:226-234. [DOI: 10.1016/j.ijcard.2019.09.067] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 07/19/2019] [Accepted: 09/25/2019] [Indexed: 01/18/2023]
|
8
|
Incremental Value of Subtended Myocardial Mass for Identifying FFR-Verified Ischemia Using Quantitative CT Angiography. JACC Cardiovasc Imaging 2019; 12:707-717. [DOI: 10.1016/j.jcmg.2017.10.027] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 10/13/2017] [Accepted: 10/31/2017] [Indexed: 12/19/2022]
|
9
|
Kang SJ, Kim YH, Lee JG, Kang DY, Lee PH, Ahn JM, Park DW, Lee SW, Lee CW, Park SW, Park SJ, Koo HJ, Yun SC, Jung J, Kim N, Kweon J, Kang JW, Lim TH, Yang DH. Impact of Subtended Myocardial Mass Assessed by Coronary Computed Tomographic Angiography-Based Myocardial Segmentation. Am J Cardiol 2019; 123:757-763. [PMID: 30545479 DOI: 10.1016/j.amjcard.2018.11.042] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 11/21/2018] [Accepted: 11/26/2018] [Indexed: 11/27/2022]
Abstract
Although decision-making for revascularization is based on the extent of ischemic myocardium, the prognostic implication of supplying myocardial territories has not yet been studied. To evaluate the clinical impact of the coronary artery-based myocardial segmentation (CAMS)-derived myocardial volume subtended to the poststenotic segment, and to determine clinically relevant coronary lesions, coronary computed tomography angiography, invasive coronary angiography, and preprocedure fractional flow reserve (FFR) data were analyzed in 664 deferred lesions (in 577 patients) and 401 treated lesions (in 369 patients) with drug-eluting stent implantation, respectively. Using CAMS method, the myocardial volume subtended to a stenotic coronary segment (Vsub) was assessed. The primary composites included target vessel-related major adverse cardiac event (MACE) including cardiac death, myocardial infarction, and target vessel revascularization over 3 years. Independent predictors of 3-year MACE in deferred lesions were Vsub (adjusted hazard ratio [HR] 1.02), FFR (adjusted HR per 0.1 = 0.60), and distal reference luminal diameter (adjusted HR 2.04, all p < 0.05). A Vsub ≥ 36.2cc was predictive of MACE in deferred lesions with a sensitivity 72% and a specificity 67% (area under curve 0.71, 95% confidence interval 0.67 to 0.74, p < 0.001). Vsub was not associated with target vessel-related MACE. For the prediction of FFR < 0.80, the area under curve of Vsub/MLD4 > 6.3 was greater than those of angiographic diameter stenosis (0.78 vs 0.69) and minimal luminal diameter (0.78 vs 0.71), (all p < 0.05). CAMS-derived Vsub predicted 3-year clinical outcomes in untreated coronary lesions, and improved the diagnostic performance of angiography-derived parameters to identify ischemia-producing lesions.
Collapse
|
10
|
Hae H, Kang SJ, Kim WJ, Choi SY, Lee JG, Bae Y, Cho H, Yang DH, Kang JW, Lim TH, Lee CH, Kang DY, Lee PH, Ahn JM, Park DW, Lee SW, Kim YH, Lee CW, Park SW, Park SJ. Machine learning assessment of myocardial ischemia using angiography: Development and retrospective validation. PLoS Med 2018; 15:e1002693. [PMID: 30422987 PMCID: PMC6233920 DOI: 10.1371/journal.pmed.1002693] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 10/11/2018] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Invasive fractional flow reserve (FFR) is a standard tool for identifying ischemia-producing coronary stenosis. However, in clinical practice, over 70% of treatment decisions still rely on visual estimation of angiographic stenosis, which has limited accuracy (about 60%-65%) for the prediction of FFR < 0.80. One of the reasons for the visual-functional mismatch is that myocardial ischemia can be affected by the supplied myocardial size, which is not always evident by coronary angiography. The aims of this study were to develop an angiography-based machine learning (ML) algorithm for predicting the supplied myocardial volume for a stenosis, as measured using coronary computed tomography angiography (CCTA), and then to build an angiography-based classifier for the lesions with an FFR < 0.80 versus ≥ 0.80. METHODS AND FINDINGS A retrospective study was conducted using data from 1,132 stable and unstable angina patients with 1,132 intermediate lesions who underwent invasive coronary angiography, FFR, and CCTA at the Asan Medical Center, Seoul, Korea, between 1 May 2012 and 30 November 2015. The mean age was 63 ± 10 years, 76% were men, and 72% of the patients presented with stable angina. Of these, 932 patients (assessed before 31 January 2015) constituted the training set for the algorithm, and 200 patients (assessed after 1 February 2015) served as a test cohort to validate its diagnostic performance. Additionally, external validation with 79 patients from two centers (CHA University, Seongnam, Korea, and Ajou University, Suwon, Korea) was conducted. After automatic contour calibration using the caliber of guiding catheter, quantitative coronary angiography was performed using the edge-detection algorithms (CAAS-5, Pie-Medical). Clinical information was provided by the Asan BiomedicaL Research Environment (ABLE) system. The CCTA-based myocardial segmentation (CAMS)-derived myocardial volume supplied by each vessel (right coronary artery [RCA], left anterior descending [LAD], left circumflex [LCX]) and the myocardial volume subtended to a stenotic segment (CAMS-%Vsub) were measured for labeling. The ML for (1) predicting vessel territories (CAMS-%LAD, CAMS-%LCX, and CAMS-%RCA) and CAMS-%Vsub and (2) identifying the lesions with an FFR < 0.80 was constructed. Angiography-based ML, employing a light gradient boosting machine (GBM), showed mean absolute errors (MAEs) of 5.42%, 8.57%, and 4.54% for predicting CAMS-%LAD, CAMS-%LCX, and CAMS-%RCA, respectively. The percent myocardial volumes predicted by ML were used to predict the CAMS-%Vsub. With 5-fold cross validation, the MAEs between ML-predicted percent myocardial volume subtended to a stenotic segment (ML-%Vsub) and CAMS-%Vsub were minimized by the elastic net (6.26% ± 0.55% for LAD, 5.79% ± 0.68% for LCX, and 2.95% ± 0.14% for RCA lesions). Using all attributes (age, sex, involved vessel segment, and angiographic features affecting the myocardial territory and stenosis degree), the ML classifiers (L2 penalized logistic regression, support vector machine, and random forest) predicted an FFR < 0.80 with an accuracy of approximately 80% (area under the curve [AUC] = 0.84-0.87, 95% confidence intervals 0.71-0.94) in the test set, which was greater than that of diameter stenosis (DS) > 53% (66%, AUC = 0.71, 95% confidence intervals 0.65-0.78). The external validation showed 84% accuracy (AUC = 0.89, 95% confidence intervals 0.83-0.95). The retrospective design, single ethnicity, and the lack of clinical outcomes may limit this prediction model's generalized application. CONCLUSION We found that angiography-based ML is useful to predict subtended myocardial territories and ischemia-producing lesions by mitigating the visual-functional mismatch between angiographic and FFR. Assessment of clinical utility requires further validation in a large, prospective cohort study.
Collapse
Affiliation(s)
- Hyeonyong Hae
- Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Soo-Jin Kang
- Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
- * E-mail:
| | - Won-Jang Kim
- Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - So-Yeon Choi
- Department of Cardiology, Ajou University, Suwon, Korea
| | - June-Goo Lee
- Biomedical Engineering Research Center, Asan Institute for Life Sciences, Seoul, Korea
| | - Youngoh Bae
- Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Hyungjoo Cho
- Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Dong Hyun Yang
- Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Joon-Won Kang
- Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Tae-Hwan Lim
- Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Cheol Hyun Lee
- Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Do-Yoon Kang
- Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Pil Hyung Lee
- Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jung-Min Ahn
- Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Duk-Woo Park
- Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Seung-Whan Lee
- Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Young-Hak Kim
- Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Cheol Whan Lee
- Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Seong-Wook Park
- Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Seung-Jung Park
- Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| |
Collapse
|
11
|
|
12
|
Diagnostic performance of machine-learning-based computed fractional flow reserve (FFR) derived from coronary computed tomography angiography for the assessment of myocardial ischemia verified by invasive FFR. Int J Cardiovasc Imaging 2018; 34:1987-1996. [PMID: 30062537 DOI: 10.1007/s10554-018-1419-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 07/23/2018] [Indexed: 12/27/2022]
Abstract
To explore the diagnostic performance of a machine-learning-based (ML-based) computed fractional flow reserve (cFFR) derived from coronary computed tomography angiography (CCTA) in identifying ischemia-causing lesions verified by invasive FFR in catheter coronary angiography (ICA). We retrospectively studied 117 intermediate coronary artery lesions [40-80% diameter stenosis (DS)] from 105 patients (mean age 62 years, 32 female) who had undergone invasive FFR. CCTA images were used to compute cFFR values on the workstation. DS and the myocardium jeopardy index (MJI) of coronary stenosis were also assessed with CCTA. The diagnostic performance of cFFR was evaluated, including its correlation with invasive FFR and its diagnostic accuracy. Then, its performance was compared to that of combined DS and MJI. Of the 117 lesions, 36 (30.8%) had invasive FFR ≤ 0.80; 22 cFFR were measured as true positives and 74 cFFR as true negatives. The average time of cFFR assessment was 18 ± 7 min. The cFFR correlated strongly to invasive FFR (Spearman's coefficient 0.665, p < 0.01). When diagnosing invasive FFR ≤ 0.80, the accuracy of cFFR was 82% with an AUC of 0.864, which was significantly higher than that of DS (accuracy 75%, AUC 0.777, p = 0.013). The AUC of cFFR was not significantly different from that of combined DS and MJI (0.846, p = 0.743). cFFR ≤ 0.80 based on CCTA showed good diagnostic performance for detecting ischemia-producing lesions verified by invasive FFR. The short calculation time required renders cFFR promising for clinical use.
Collapse
|
13
|
Wang Y, Mintz GS, Gu Z, Qi Y, Wang Y, Liu M, Wu X. Meta-analysis and systematic review of intravascular ultrasound versus angiography-guided drug eluting stent implantation in left main coronary disease in 4592 patients. BMC Cardiovasc Disord 2018; 18:115. [PMID: 29898668 PMCID: PMC6001000 DOI: 10.1186/s12872-018-0843-z] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 05/21/2018] [Indexed: 12/11/2022] Open
Abstract
Background Although several meta-analyses have demonstrated the utility of intravascular ultrasound (IVUS) in guiding drug-eluting stent (DES) implantation compared to angiography-guidance, there has been a dearth of evidence in the left main coronary artery (LMCA) lesion subset. Methods We performed a meta-analysis to compare clinical outcomes of IVUS versus conventional angiography guidance during implantation of DES for patients with LMCA disease. Pubmed, Cochrane Library, Embase were searched. Results A total of 1002 publications were reviewed; and finally, seven clinical studies - one prospective randomized controlled trial and six observational studies with 4592 patients (1907 IVUS-guided and 2685 angiography-guided) - were included in the meta-analysis. IVUS guidance was associated with a significant reduction in major adverse cardiac events (relative ratio [RR] 95% CI 0.61; 95% confidence interval [CI] 0.53 to 0.70; P < 0.001), all-cause death (RR 0.55; 95% CI 0.42 to 0.71; P < 0.001), cardiac death (RR 0.45; 95% CI 0.32 to 0.62; P < 0.001), myocardial infarction (RR 0.66; 95% CI 0.55 to 0.80; P < 0.001), and stent thrombosis (RR 0.48; 95% CI 0.27 to 0.84; P = 0.01) compared with angiographic guidance. However, there was no significant difference regarding target lesion revascularization (RR 0.60; 95% CI 0.31 to 1.18; P = 0.099) and target vessel revascularization (RR 0.64; 95% CI 0.26 to 1.56; P = 0. 322). Conclusions Compared to angiographic guidance, IVUS-guided DES implantation was associated with better clinical outcomes for patients with LMCA lesions, especially hard endpoints of death, myocardial infarction, and stent thrombosis.
Collapse
Affiliation(s)
- Yue Wang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China
| | - Gary S Mintz
- Cardiovascular Research Foundation, New York, NY, USA
| | - Zhichun Gu
- Department of Pharmacy, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China
| | - Yue Qi
- Department of Epidemiology, The Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yue Wang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China
| | - Mengru Liu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China
| | - Xiaofan Wu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China.
| |
Collapse
|
14
|
Myocardial segmentation based on coronary anatomy using coronary computed tomography angiography: Development and validation in a pig model. Eur Radiol 2017; 27:4044-4053. [PMID: 28342101 DOI: 10.1007/s00330-017-4793-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 12/18/2016] [Accepted: 03/07/2017] [Indexed: 01/03/2023]
Abstract
OBJECTIVES To validate a method for performing myocardial segmentation based on coronary anatomy using coronary CT angiography (CCTA). METHODS Coronary artery-based myocardial segmentation (CAMS) was developed for use with CCTA. To validate and compare this method with the conventional American Heart Association (AHA) classification, a single coronary occlusion model was prepared and validated using six pigs. The unstained occluded coronary territories of the specimens and corresponding arterial territories from CAMS and AHA segmentations were compared using slice-by-slice matching and 100 virtual myocardial columns. RESULTS CAMS more precisely predicted ischaemic area than the AHA method, as indicated by 95% versus 76% (p < 0.001) of the percentage of matched columns (defined as percentage of matched columns of segmentation method divided by number of unstained columns in the specimen). According to the subgroup analyses, CAMS demonstrated a higher percentage of matched columns than the AHA method in the left anterior descending artery (100% vs. 77%; p < 0.001) and mid- (99% vs. 83%; p = 0.046) and apical-level territories of the left ventricle (90% vs. 52%; p = 0.011). CONCLUSIONS CAMS is a feasible method for identifying the corresponding myocardial territories of the coronary arteries using CCTA. KEY POINTS • CAMS is a feasible method for identifying corresponding coronary territory using CTA • CAMS is more accurate in predicting coronary territory than the AHA method • The AHA method may underestimate the ischaemic territory of LAD stenosis.
Collapse
|
15
|
Chu M, Dai N, Yang J, Westra J, Tu S. A systematic review of imaging anatomy in predicting functional significance of coronary stenoses determined by fractional flow reserve. Int J Cardiovasc Imaging 2017; 33:975-990. [PMID: 28265791 DOI: 10.1007/s10554-017-1085-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 01/28/2017] [Indexed: 01/06/2023]
Abstract
Fractional flow reserve (FFR) is the current gold standard to assess the physiological significance of coronary stenoses. With the development of coronary imaging techniques, several anatomic parameters have been investigated in vivo and their associations with FFR have been studied. The aim of this review is to summarize the accuracy of anatomic parameters derived by the present coronary imaging techniques including invasive coronary angiography, coronary computed tomography angiography, intravascular ultrasound and optical coherence tomography, in predicting a significant FFR. The impact of patient characteristics, lesion locations, variability of FFR and imaging resolution on the predictive ability are discussed.
Collapse
Affiliation(s)
- Miao Chu
- Biomedical Instrument Institute, School of Biomedical Engineering, Med-X Research Institute, Shanghai Jiao Tong University, No. 1954, Hua Shan Road, Shanghai, 200030, China
| | - Neng Dai
- Cardiovascular Department, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Junqing Yang
- The 3rd Division of Cardiology, Department of Cardiology, Guangdong General Hospital, Guangdong Provincial Cardiovascular Institute, Guangdong Academy of Medical Sciences, No.106, 2nd Zhongshan Road, Yuexiu district, Guangzhou, Guangdong, 510080, China.
| | - Jelmer Westra
- Department of Cardiology, Aarhus University Hospital, Skejby, Denmark
| | - Shengxian Tu
- Biomedical Instrument Institute, School of Biomedical Engineering, Med-X Research Institute, Shanghai Jiao Tong University, No. 1954, Hua Shan Road, Shanghai, 200030, China.
| |
Collapse
|
16
|
Kim HY, Doh JH, Lim HS, Nam CW, Shin ES, Koo BK, Lee JM, Park TK, Yang JH, Song YB, Hahn JY, Choi SH, Gwon HC, Lee SH, Kim SM, Choe Y, Choi JH. Identification of Coronary Artery Side Branch Supplying Myocardial Mass That May Benefit From Revascularization. JACC Cardiovasc Interv 2017; 10:571-581. [DOI: 10.1016/j.jcin.2016.11.033] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 10/20/2016] [Accepted: 11/17/2016] [Indexed: 10/20/2022]
|
17
|
Kim HJ, Kim SM, Choi JH, Choe YH. Influence of scan technique on intracoronary transluminal attenuation gradient in coronary CT angiography using 128-slice dual source CT: multi-beat versus one-beat scan. Int J Cardiovasc Imaging 2017; 33:937-946. [PMID: 28150085 DOI: 10.1007/s10554-017-1078-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 01/19/2017] [Indexed: 01/25/2023]
Abstract
The purpose of our study was to investigate the impact of temporal uniformity and adjustment by the contrast opacification enhancement in the aorta on the performance of transluminal attenuation gradient (TAG) for obstructive coronary artery disease. A total of 274 coronary arteries from 94 patients who underwent both multi- and single-beat scan using 128-slice scanner at the same time were enrolled. TAG and corrected coronary opacification (CCO) of both scan technique were compared against obstructive coronary arteries defined by diameter stenosis ≥50%. In per-vessel analysis, both TAG and CCO were slight but significantly different between multi- and single-beat scan in overall (-13.3 vs. -14.3 HU/10 mm; 0.31 vs. 0.38; p < 0.05, all). However, the difference was evident only in right coronary artery (p < 0.05) but not in left coronary arteries (p = NS). Correlation coefficient value are more than 0.8 for all coronary arteries (0.84) and each of the three vessels (RCA: 0.87, LAD: 0.84, LCX: 0.81) in TAG in single-beat versus multi-beat scans (p < 0.0001). Radiation exposure was significantly lower in single-beat scan compared to multi-beat scan (0.9 vs. 3.7 mSv, p < 0.001). TAGs of multi- and single beat scans well correlated each other in all coronary arteries and were not affected by temporal non-uniformity.
Collapse
Affiliation(s)
- Hae Jin Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sung Mok Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea. .,Cardiovascular Imaging Center, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| | - Jin-Ho Choi
- Cardiovascular Imaging Center, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea. .,Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| | - Yeon Hyeon Choe
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Cardiovascular Imaging Center, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| |
Collapse
|