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In Kim Y, Roh JH, Kweon J, Kwon H, Chae J, Park K, Lee JH, Jeong JO, Kang DY, Lee PH, Ahn JM, Kang SJ, Park DW, Lee SW, Lee CW, Park SW, Park SJ, Kim YH. Artificial intelligence-based quantitative coronary angiography of major vessels using deep-learning. Int J Cardiol 2024; 405:131945. [PMID: 38479496 DOI: 10.1016/j.ijcard.2024.131945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 01/24/2024] [Accepted: 03/05/2024] [Indexed: 03/21/2024]
Abstract
BACKGROUND Quantitative coronary angiography (QCA) offers objective and reproducible measures of coronary lesions. However, significant inter- and intra-observer variability and time-consuming processes hinder the practical application of on-site QCA in the current clinical setting. This study proposes a novel method for artificial intelligence-based QCA (AI-QCA) analysis of the major vessels and evaluates its performance. METHODS AI-QCA was developed using three deep-learning models trained on 7658 angiographic images from 3129 patients for the precise delineation of lumen boundaries. An automated quantification method, employing refined matching for accurate diameter calculation and iterative updates of diameter trend lines, was embedded in the AI-QCA. A separate dataset of 676 coronary angiography images from 370 patients was retrospectively analyzed to compare AI-QCA with manual QCA performed by expert analysts. A match was considered between manual and AI-QCA lesions when the minimum lumen diameter (MLD) location identified manually coincided with the location identified by AI-QCA. Matched lesions were evaluated in terms of diameter stenosis (DS), MLD, reference lumen diameter (RLD), and lesion length (LL). RESULTS AI-QCA exhibited a sensitivity of 89% in lesion detection and strong correlations with manual QCA for DS, MLD, RLD, and LL. Among 995 matched lesions, most cases (892 cases, 80%) exhibited DS differences ≤10%. Multiple lesions of the major vessels were accurately identified and quantitatively analyzed without manual corrections. CONCLUSION AI-QCA demonstrates promise as an automated tool for analysis in coronary angiography, offering potential advantages for the quantitative assessment of coronary lesions and clinical decision-making.
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Affiliation(s)
- Young In Kim
- Department of Medical Science, Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jae-Hyung Roh
- Department of Cardiology, Chungnam National University Sejong Hospital, Chungnam National University School of Medicine, Sejong, Republic of Korea
| | - Jihoon Kweon
- Department of Biomedical Engineering, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
| | - Hwi Kwon
- Department of Biomedical Engineering, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jihye Chae
- Department of Medical Science, Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Keunwoo Park
- Department of Biomedical Engineering, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jae-Hwan Lee
- Department of Cardiology, Chungnam National University Sejong Hospital, Chungnam National University School of Medicine, Sejong, Republic of Korea
| | - Jin-Ok Jeong
- Division of Cardiology, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Do-Yoon Kang
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Pil Hyung Lee
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jung-Min Ahn
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Soo-Jin Kang
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Duk-Woo Park
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seung-Whan Lee
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Cheol Whan Lee
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seong-Wook Park
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seung-Jung Park
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Young-Hak Kim
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
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Chang SS, Lin CT, Wang WC, Hsu KC, Wu YL, Liu CH, Fann YC. Optimizing ensemble U-Net architectures for robust coronary vessel segmentation in angiographic images. Sci Rep 2024; 14:6640. [PMID: 38503839 PMCID: PMC10951254 DOI: 10.1038/s41598-024-57198-5] [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: 10/17/2023] [Accepted: 03/15/2024] [Indexed: 03/21/2024] Open
Abstract
Automated coronary angiography assessment requires precise vessel segmentation, a task complicated by uneven contrast filling and background noise. Our research introduces an ensemble U-Net model, SE-RegUNet, designed to accurately segment coronary vessels using 100 labeled angiographies from angiographic images. SE-RegUNet incorporates RegNet encoders and squeeze-and-excitation blocks to enhance feature extraction. A dual-phase image preprocessing strategy further improves the model's performance, employing unsharp masking and contrast-limited adaptive histogram equalization. Following fivefold cross-validation and Ranger21 optimization, the SE-RegUNet 4GF model emerged as the most effective, evidenced by performance metrics such as a Dice score of 0.72 and an accuracy of 0.97. Its potential for real-world application is highlighted by its ability to process images at 41.6 frames per second. External validation on the DCA1 dataset demonstrated the model's consistent robustness, achieving a Dice score of 0.76 and an accuracy of 0.97. The SE-RegUNet 4GF model's precision in segmenting blood vessels in coronary angiographies showcases its remarkable efficiency and accuracy. However, further development and clinical testing are necessary before it can be routinely implemented in medical practice.
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Affiliation(s)
- Shih-Sheng Chang
- Division of Cardiovascular Medicine, China Medical University Hospital, Taichung, Taiwan
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
| | - Ching-Ting Lin
- Artificial Intelligence Center, China Medical University Hospital, Taichung, Taiwan
| | - Wei-Chun Wang
- Department of Neurology, China Medical University Hospital, Taichung, Taiwan
- Neuroscience and Brain Disease Center, China Medical University, Taichung, Taiwan
- Artificial Intelligence Center, China Medical University Hospital, Taichung, Taiwan
| | - Kai-Cheng Hsu
- Artificial Intelligence Center, China Medical University Hospital, Taichung, Taiwan
- Department of Neurology, China Medical University Hospital, Taichung, Taiwan
- Neuroscience and Brain Disease Center, China Medical University, Taichung, Taiwan
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
| | - Ya-Lun Wu
- Artificial Intelligence Center, China Medical University Hospital, Taichung, Taiwan
| | - Chia-Hao Liu
- Division of Cardiovascular Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Yang C Fann
- Division of Intramural Research, National Institute of Neurological Disorders and Stroke, National Institutes of Health, 35 Convent Dr., Bethesda, MD, 20892, USA.
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3
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Ninomiya K, Serruys PW, Kotoku N, Zhou J, Kageyama S, Masuda S, Revaiah PC, Wang B, He X, Tsai TY, Kageyama M, Sevestre E, Sharif F, Garg S, Akasaka T, Escaned J, Patel MR, Onuma Y. Anonymous Comparison of Various Angiography-Derived Fractional Flow Reserve Software With Pressure-Derived Physiological Assessment. JACC Cardiovasc Interv 2023:S1936-8798(23)00760-4. [PMID: 37191608 DOI: 10.1016/j.jcin.2023.04.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 04/12/2023] [Accepted: 04/18/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND Software to compute angiography-derived fractional flow reserve (angio-FFR) have been validated against pressure wire-derived fractional flow reserve (PW-FFR) with an area under the receiver-operating characteristic curve (AUC) of 0.93 to 0.97. OBJECTIVES The aim of this study was to investigate diagnostic accuracies of 5 angio-FFR software/methods by an independent core lab in a prospective cohort of 390 vessels with carefully documented sites of PW-FFR and pressure wire-derived instantaneous wave-free ratio. METHODS One "matcher investigator" colocalized on angiography the sites of pressure wire measurement with angio-FFR measurements and provided the same 2 optimal angiographic views and frame selection to independent analysts who were blinded to invasive physiological results and results from other software. The results were anonymized and randomly presented. The AUC of each angio-FFR was compared with 2-dimensional quantitative coronary angiography (QCA) percent diameter stenosis (%DS) using a 2-tailed paired comparison of AUC. RESULTS All 5 software/methods yielded a high proportion of analyzable vessels (A: 100%, B: 100%, C: 92.1%, D: 99.5%, and E: 92.1%). The AUCs for predicting fractional flow reserve ≤0.8 for software A, B, C, D, E, and 2-dimensional QCA %DS were 0.75, 0.74, 0.74, 0.73, 0.73, and 0.65, respectively. The AUC for each angio-FFR was significantly greater than that for 2-dimensional QCA %DS. CONCLUSIONS This head-to-head comparison by an independent core lab demonstrated that the diagnostic accuracy of various angio-FFR software for predicting PW-FFR ≤0.80 was useful, with a higher discrimination compared with 2-dimensional QCA %DS; however, it did not reach the diagnostic accuracy previously reported in validation studies of various vendors. Therefore, the intrinsic clinical value of "angiography-derived fractional flow reserve" requires confirmation in large clinical trials.
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Affiliation(s)
- Kai Ninomiya
- Department of Cardiology, National University of Ireland, Galway, Galway, Ireland
| | - Patrick W Serruys
- Department of Cardiology, National University of Ireland, Galway, Galway, Ireland; National Heart and Lung Institute, Imperial College London, London, United Kingdom.
| | - Nozomi Kotoku
- Department of Cardiology, National University of Ireland, Galway, Galway, Ireland
| | - Jinying Zhou
- Department of Cardiology, National University of Ireland, Galway, Galway, Ireland
| | - Shigetaka Kageyama
- Department of Cardiology, National University of Ireland, Galway, Galway, Ireland
| | - Shinichiro Masuda
- Department of Cardiology, National University of Ireland, Galway, Galway, Ireland
| | - Pruthvi C Revaiah
- Department of Cardiology, National University of Ireland, Galway, Galway, Ireland
| | - Bo Wang
- Department of Cardiology, National University of Ireland, Galway, Galway, Ireland
| | - Xingqiang He
- Department of Cardiology, National University of Ireland, Galway, Galway, Ireland
| | - Tsung-Ying Tsai
- Department of Cardiology, National University of Ireland, Galway, Galway, Ireland
| | - Momoko Kageyama
- Department of Cardiology, National University of Ireland, Galway, Galway, Ireland
| | - Emelyne Sevestre
- Department of Cardiology, National University of Ireland, Galway, Galway, Ireland
| | - Faisal Sharif
- Department of Cardiology, National University of Ireland, Galway, Galway, Ireland
| | - Scot Garg
- Department of Cardiology, Royal Blackburn Hospital, Blackburn, United Kingdom
| | - Takashi Akasaka
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Javier Escaned
- Hospital Clínico San Carlos Instituto de Investigación Sanitaria San Carlos, Universidad Complutense de Madrid, Madrid, Spain
| | - Manesh R Patel
- Division of Cardiology and Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA
| | - Yoshinobu Onuma
- Department of Cardiology, National University of Ireland, Galway, Galway, Ireland
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4
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Intravascular Imaging-Based Physiologic Assessment. Interv Cardiol Clin 2023; 12:289-298. [PMID: 36922069 DOI: 10.1016/j.iccl.2022.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
Intravascular imaging (IVI), including intravascular ultrasound (IVUS) and optical coherence tomography (OCT), is clinically useful for assessing the luminal size, lesion length, and plaque characteristics, as well as for evaluating stent deployment; however, it is not designed to estimate myocardial ischemia accurately. Thus, several types of IVI-derived fractional flow reserve (FFR) (IVI-derived FFR) have been developed and reported. In general, the algorithms of virtual FFR are based on basic fluid dynamics equations (mainly Poiseuille and Borda-Carnot equations) and original microvascular models (fixed velocity or calculating coronary flow reserve). Although the models and assumptions used in the past reports were mostly based on the standard population (not independent patient data), the developed software calculated FFR with high accuracy (88% to 94%) with strong correlations between IVI-derived FFR and wire-based FFR (0.69 to 0.89). Given several other less invasive virtual FFR methods currently available for clinical use, IVI-derived FFR would be limited for the sole use of pre-percutaneous coronary intervention (PCI) physiological evaluation; however, it may play a unique role at PCI guidance and optimization, potentially allowing comprehensive and time/cost-saving assessment of both anatomical and physiological lesion properties using a single diagnostic device.
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5
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Ono M, Kageyama S, O’Leary N, El-Kurdi MS, Reinöhl J, Solien E, Bianco RW, Doss M, Meuris B, Virmani R, Cox M, Onuma Y, Serruys PW. 1-Year Patency of Biorestorative Polymeric Coronary Artery Bypass Grafts in an Ovine Model. JACC. BASIC TO TRANSLATIONAL SCIENCE 2022; 8:19-34. [PMID: 36777172 PMCID: PMC9911320 DOI: 10.1016/j.jacbts.2022.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 06/29/2022] [Accepted: 06/29/2022] [Indexed: 11/10/2022]
Abstract
Many attempts have been made to inhibit or counteract saphenous vein graft (SVG) failure modes; however, only external support for SVGs has gained momentum in clinical utility. This study revealed the feasibility of implantation, and showed good patency out to 12 months of the novel biorestorative graft, in a challenging ovine coronary artery bypass graft model. This finding could trigger the first-in-man trial of using the novel material instead of SVG. We believe that, eventually, this novel biorestorative bypass graft can be one of the options for coronary artery bypass graft patients who have difficulty harvesting SVG.
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Key Words
- CABG, coronary artery bypass grafting
- CPB, cardiopulmonary bypass
- IH, intimal hyperplasia
- LAD, left anterior descending artery
- OCT, optical coherence tomography
- QCA, quantitative coronary angiography
- QFR, quantitative flow ratio
- RVG, restorative vascular graft
- SVG, saphenous vein graft
- coronary artery bypass graft
- coronary artery disease
- coronary revascularization
- ePTFE, expanded polytetrafluoroethylene
- polymeric bypass graft
- preclinical model
- quantitative flow ratio
- restorative vascular graft
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Affiliation(s)
- Masafumi Ono
- Amsterdam Universitair Medische Centra, University of Amsterdam, Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
| | - Shigetaka Kageyama
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
| | - Neil O’Leary
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
| | | | | | - Eric Solien
- American Preclinical Services, LLC, Minneapolis, Minnesota, USA
| | - Richard W. Bianco
- Experimental Surgical Services, University of Minnesota, Minneapolis, Minnesota, USA
| | - Mirko Doss
- Department of Cardiac Surgery, Helios Clinic, Siegburg, Germany
| | - Bart Meuris
- Department of Cardiac Surgery, University Hospital Leuven, Leuven, Belgium
| | - Renu Virmani
- CVPath Institute, Inc, Gaithersburg, Maryland, USA
| | | | - Yoshinobu Onuma
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
| | - Patrick W. Serruys
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
- NHLI, Imperial College London, London, United Kingdom
- Address for correspondence: Dr Patrick W. Serruys, National University of Ireland, Galway (NUIG), University Road, Galway H91 TK33, Ireland.
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6
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Ben Ali W, Pesaranghader A, Avram R, Overtchouk P, Perrin N, Laffite S, Cartier R, Ibrahim R, Modine T, Hussin JG. Implementing Machine Learning in Interventional Cardiology: The Benefits Are Worth the Trouble. Front Cardiovasc Med 2021; 8:711401. [PMID: 34957230 PMCID: PMC8692711 DOI: 10.3389/fcvm.2021.711401] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 11/08/2021] [Indexed: 12/23/2022] Open
Abstract
Driven by recent innovations and technological progress, the increasing quality and amount of biomedical data coupled with the advances in computing power allowed for much progress in artificial intelligence (AI) approaches for health and biomedical research. In interventional cardiology, the hope is for AI to provide automated analysis and deeper interpretation of data from electrocardiography, computed tomography, magnetic resonance imaging, and electronic health records, among others. Furthermore, high-performance predictive models supporting decision-making hold the potential to improve safety, diagnostic and prognostic prediction in patients undergoing interventional cardiology procedures. These applications include robotic-assisted percutaneous coronary intervention procedures and automatic assessment of coronary stenosis during diagnostic coronary angiograms. Machine learning (ML) has been used in these innovations that have improved the field of interventional cardiology, and more recently, deep Learning (DL) has emerged as one of the most successful branches of ML in many applications. It remains to be seen if DL approaches will have a major impact on current and future practice. DL-based predictive systems also have several limitations, including lack of interpretability and lack of generalizability due to cohort heterogeneity and low sample sizes. There are also challenges for the clinical implementation of these systems, such as ethical limits and data privacy. This review is intended to bring the attention of health practitioners and interventional cardiologists to the broad and helpful applications of ML and DL algorithms to date in the field. Their implementation challenges in daily practice and future applications in the field of interventional cardiology are also discussed.
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Affiliation(s)
- Walid Ben Ali
- Service Médico-Chirurgical, Valvulopathies-Chirurgie Cardiaque-Cardiologie Interventionelle Structurelle, Hôpital Cardiologique de Haut Lévèque, Bordeaux, France.,Structural Heart Program and Interventional Cardiology, Université de Montréal, Montreal Heart Institute, Montréal, QC, Canada
| | - Ahmad Pesaranghader
- Faculty of Medicine, Research Center, Montreal Heart Institute, Université de Montréal, Montréal, QC, Canada.,Computer Science and Operations Research Department, Mila (Quebec Artificial Intelligence Institute), Montreal, QC, Canada
| | - Robert Avram
- Faculty of Medicine, Research Center, Montreal Heart Institute, Université de Montréal, Montréal, QC, Canada
| | - Pavel Overtchouk
- Interventional Cardiology and Cardiovascular Surgery Centre Hospitalier Regional Universitaire de Lille (CHRU de Lille), Lille, France
| | - Nils Perrin
- Structural Heart Program and Interventional Cardiology, Université de Montréal, Montreal Heart Institute, Montréal, QC, Canada
| | - Stéphane Laffite
- Service Médico-Chirurgical, Valvulopathies-Chirurgie Cardiaque-Cardiologie Interventionelle Structurelle, Hôpital Cardiologique de Haut Lévèque, Bordeaux, France
| | - Raymond Cartier
- Structural Heart Program and Interventional Cardiology, Université de Montréal, Montreal Heart Institute, Montréal, QC, Canada
| | - Reda Ibrahim
- Structural Heart Program and Interventional Cardiology, Université de Montréal, Montreal Heart Institute, Montréal, QC, Canada
| | - Thomas Modine
- Service Médico-Chirurgical, Valvulopathies-Chirurgie Cardiaque-Cardiologie Interventionelle Structurelle, Hôpital Cardiologique de Haut Lévèque, Bordeaux, France
| | - Julie G Hussin
- Faculty of Medicine, Research Center, Montreal Heart Institute, Université de Montréal, Montréal, QC, Canada
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Othman F, Abid AR, AlQahtani A, Gehani A, Al Suwaidi J, Arabi A. Exaggeration of Non-Culprit Coronary Artery Stenosis in the Setting of Primary Percutaneous Coronary Intervention: A Single Center Observational Study. RESEARCH REPORTS IN CLINICAL CARDIOLOGY 2021. [DOI: 10.2147/rrcc.s280661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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8
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Montarello NJ, Nelson AJ, Verjans J, Nicholls SJ, Psaltis PJ. The role of intracoronary imaging in translational research. Cardiovasc Diagn Ther 2020; 10:1480-1507. [PMID: 33224769 DOI: 10.21037/cdt-20-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Atherosclerotic cardiovascular disease is a key public health concern worldwide and leading cause of morbidity, mortality and health economic costs. Understanding atherosclerotic plaque microstructure in relation to molecular mechanisms that underpin its initiation and progression is needed to provide the best chance of combating this disease. Evolving vessel wall-based, endovascular coronary imaging modalities, including intravascular ultrasound (IVUS), optical coherence tomography (OCT) and near-infrared spectroscopy (NIRS), used in isolation or as hybrid modalities, have been advanced to allow comprehensive visualization of the pathological substrate of coronary atherosclerosis and accurately measure temporal changes in both the vessel wall and plaque characteristics. This has helped further our appreciation of the natural history of coronary artery disease (CAD) and the risk for major adverse cardiovascular events (MACE), evaluate the responsiveness to conventional and experimental therapeutic interventions, and assist in guiding percutaneous coronary intervention (PCI). Here we review the use of different imaging modalities for these purposes and the lessons they have provided thus far.
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Affiliation(s)
- Nicholas J Montarello
- Department of Cardiology, Central Adelaide Local Health Network, Adelaide, Australia
| | - Adam J Nelson
- Adelaide Medical School, University of Adelaide, Adelaide, Australia.,Duke Clinical Research Institute, Durham, NC, USA
| | - Johan Verjans
- Department of Cardiology, Central Adelaide Local Health Network, Adelaide, Australia.,Adelaide Medical School, University of Adelaide, Adelaide, Australia.,Vascular Research Centre, Heart and Vascular Program, Lifelong Health Theme, South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Stephen J Nicholls
- Monash Cardiovascular Research Centre, Monash University, Clayton, Australia
| | - Peter J Psaltis
- Department of Cardiology, Central Adelaide Local Health Network, Adelaide, Australia.,Adelaide Medical School, University of Adelaide, Adelaide, Australia.,Vascular Research Centre, Heart and Vascular Program, Lifelong Health Theme, South Australian Health and Medical Research Institute, Adelaide, Australia
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9
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Collet C, Grundeken MJ, Asano T, Onuma Y, Wijns W, Serruys PW. State of the art: coronary angiography. EUROINTERVENTION 2018; 13:634-643. [PMID: 28844026 DOI: 10.4244/eij-d-17-00465] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
In the early days of coronary angiography, the precise quantification of luminal narrowing was challenging. The introduction of balloon angioplasty (percutaneous transluminal coronary angioplasty [PTCA]) by Andreas Grüntzig in 1977 was perhaps the greatest incentive to the development of quantitative coronary angiography (QCA). QCA has played a crucial role in evaluating interventional techniques and assessing the results of new technologies. With the advent of drug-eluting stents (DES), QCA metrics such as late lumen loss and diameter stenosis (restenosis) proved to be instrumental in assessing new technologies. Refinements in QCA with the advent of dedicated bifurcation analysis and three-dimensional (3D) QCA have broadened the application of QCA. Beyond angiographic metrics, new developments in the field of QCA have introduced the functional component in the assessment of coronary lesions. Angiography-derived fractional flow reserve (FFR) may be a good tool for diagnosing ischaemia-producing lesions in patients with non-complex coronary artery disease. Furthermore, the incremental functional information can be used to expand the traditional late lumen loss (LLL) and restenosis concepts.
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Affiliation(s)
- Carlos Collet
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
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10
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Dabiri AE, Kassab GS. Injection-Less Conductance Method for Vascular Sizing. Front Physiol 2018; 9:371. [PMID: 29706898 PMCID: PMC5906715 DOI: 10.3389/fphys.2018.00371] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Accepted: 03/27/2018] [Indexed: 11/30/2022] Open
Abstract
Lumen vessel sizing is important for optimization of interventional outcomes for treatment of vascular disease. The objective of this study is to develop an injection-less method to determine the lumen diameter, using multiple frequencies that eliminates the need for saline injections. We utilize the same electrical conductance devices developed for the two-injection method. A mathematical electrical model was devised to estimate the lumen area and diameter of the arteries. In vitro experiments were used to validate the method for various lumen diameters with both 5-5-5 (peripheral) and 2-2-2 (coronary) spacing conductance guidewires. The majority of 11 vessel data fall within one standard deviation and all the data fall within two standard deviations. The results indicate that the two-frequency model can reasonably predict the lumen diameter in an in-vitro test set-up. Our findings show that this approach can potentially translate to in vivo which would enable pull-back to reconstruct the lumen area profile of the vessel.
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Affiliation(s)
| | - Ghassan S Kassab
- California Medical Innovations Institute, San Diego, CA, United States
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11
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Gultekin SS, Sadic M, Bilgin M, Koca G, Acikel S, Yeter E, Korkmaz M. The value of transient ischemic dilation for detecting restenosis after coronary artery revascularization. J Nucl Cardiol 2018; 25:586-592. [PMID: 27663249 DOI: 10.1007/s12350-016-0607-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 07/11/2016] [Indexed: 11/29/2022]
Abstract
AIM Transient ischemic dilation (TID) is a marker of severe coronary artery disease (CAD). We aimed to assess the incremental value of TID in a cohort of patients with known significant CAD who had recurrence of symptoms after revascularization. METHODS We identified in our databases 104 patients who had recent coronary revascularization and recurrence of symptoms. 62 patients had PCI (75 arteries) and 42 patients had CABG (104 arteries). All had follow-up stress SPECT MPI and repeat coronary angiography. Myocardial perfusion findings of ischemia and TID were correlated with presence of significant obstructive CAD (>70% stenosis). RESULTS Follow-up stress Tc-99m Sestamibi SPECT MPI revealed inducible ischemia in 38 patients (36.5%) and TID > 1.20 in 49 patients (47%). Subsequent coronary angiography showed significant obstructive CAD in 44 patients (42%). The sensitivity for detecting obstructive CAD was 61% for SPECT MPI alone, but increased significantly to 93% by the addition of TID as a diagnostic criterion (P < 0.0001). CONCLUSIONS In this selected patient cohort with prior coronary revascularization, TID is an important marker of obstructive CAD and has incremental value over SPECT MPI alone.
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Affiliation(s)
- Salih Sinan Gultekin
- Department of Nuclear Medicine, Ministry of Health, Diskapi Yildirim Beyazit Training and Research Hospital, Etlik, Ankara, Turkey.
| | - Murat Sadic
- Department of Nuclear Medicine, Ministry of Health, Ankara Training and Research Hospital, Ulucanlar Street, 06560, Ankara, Turkey
| | - Murat Bilgin
- Department of Cardiology, Ministry of Health, Diskapi Yildirim Beyazit Training and Research Hospital, Altindag, Ankara, Turkey
| | - Gökhan Koca
- Department of Nuclear Medicine, Ministry of Health, Ankara Training and Research Hospital, Ulucanlar Street, 06560, Ankara, Turkey
| | - Sadik Acikel
- Department of Cardiology, Ministry of Health, Diskapi Yildirim Beyazit Training and Research Hospital, Altindag, Ankara, Turkey
| | - Ekrem Yeter
- Department of Cardiology, Ministry of Health, Diskapi Yildirim Beyazit Training and Research Hospital, Altindag, Ankara, Turkey
| | - Meliha Korkmaz
- Department of Nuclear Medicine, Ministry of Health, Ankara Training and Research Hospital, Ulucanlar Street, 06560, Ankara, Turkey
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12
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Two-by-two cross-over study to evaluate agreement between versions of a quantitative coronary analysis system (QAngio XA). Int J Cardiovasc Imaging 2017; 33:779-787. [DOI: 10.1007/s10554-017-1068-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Accepted: 01/05/2017] [Indexed: 10/20/2022]
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13
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Andrews J, Puri R, Kataoka Y, Nicholls SJ, Psaltis PJ. Therapeutic modulation of the natural history of coronary atherosclerosis: lessons learned from serial imaging studies. Cardiovasc Diagn Ther 2016; 6:282-303. [PMID: 27500089 DOI: 10.21037/cdt.2015.10.02] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Despite advances in risk prediction, preventive and therapeutic strategies, atherosclerotic cardiovascular disease remains a major public health challenge worldwide, carrying considerable morbidity, mortality and health economic burden. There continues to be a need to better understand the natural history of this disease to guide the development of more effective treatment, integral to which is the rapidly evolving field of coronary artery imaging. Various imaging modalities have been refined to enable detailed visualization of the pathological substrate of atherosclerosis, providing accurate and reproducible measures of coronary plaque burden and composition, including the presence of high-risk characteristics. The serial application of such techniques, including coronary computed tomography angiography (CTA), intravascular ultrasound (IVUS) and optical coherence tomography (OCT) have uncovered important insights into the progression of coronary plaque over time in patients with stable and unstable coronary artery disease (CAD), and its responsiveness to therapeutic interventions. Here we review the use of different imaging modalities for the surveillance of coronary atherosclerosis and the lessons they have provided about the modulation of CAD by both traditional and experimental therapies.
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Affiliation(s)
- Jordan Andrews
- Vascular Research Centre, Heart Health Theme, South Australian Health and Medical Research Institute & School of Medicine, University of Adelaide, Adelaide, Australia
| | - Rishi Puri
- Québec Heart & Lung Institute (IUCPQ), Hospital Laval, Québec (Québec), Canada; ; Cleveland Clinic Coordinating Center for Clinical Research (C5R), Cleveland, Ohio, USA
| | - Yu Kataoka
- National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Stephen J Nicholls
- Vascular Research Centre, Heart Health Theme, South Australian Health and Medical Research Institute & School of Medicine, University of Adelaide, Adelaide, Australia
| | - Peter J Psaltis
- Vascular Research Centre, Heart Health Theme, South Australian Health and Medical Research Institute & School of Medicine, University of Adelaide, Adelaide, Australia
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14
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van Lier MGJTB, Oost E, Spaan JAE, van Horssen P, van der Wal AC, vanBavel E, Siebes M, van den Wijngaard JPHM. Transmural distribution and connectivity of coronary collaterals within the human heart. Cardiovasc Pathol 2016; 25:405-12. [PMID: 27421093 DOI: 10.1016/j.carpath.2016.06.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Revised: 06/10/2016] [Accepted: 06/28/2016] [Indexed: 11/30/2022] Open
Abstract
Despite the importance of collateral vessels in human hearts, a detailed analysis of their distribution within the coronary vasculature based on three-dimensional vascular reconstructions is lacking. This study aimed to classify the transmural distribution and connectivity of coronary collaterals in human hearts. One normotrophic human heart and one hypertrophied human heart with fibrosis in the inferior wall from a previous infarction were obtained. After filling the coronary arteries with fluorescent replica material, hearts were frozen and alternately cut and block-face imaged using an imaging cryomicrotome. Transmural distribution, connectivity, and diameter of collaterals were determined. Numerous collateral vessels were found (normotrophic heart: 12.3 collaterals/cm(3); hypertrophied heart: 3.7 collaterals/cm(3)), with 97% and 92%, respectively, of the collaterals located within the perfusion territories (intracoronary collaterals). In the normotrophic heart, intracoronary collaterals {median diameter [interquartile range (IQR)]: 91.4 [73.0-115.7] μm} were most prevalent (74%) within the left anterior descending (LAD) territory. Intercoronary collaterals [median diameter (IQR): 94.3 (79.9-107.4) μm] were almost exclusively (99%) found between the LAD and the left circumflex artery (LCX). In the hypertrophied heart, intracoronary collaterals [median diameter (IQR): 101.1 (84.8-126.0) μm] were located within both the LAD (48%) and LCX (46%) territory. Intercoronary collaterals [median diameter (IQR): 97.8 (89.3-111.2) μm] were most prevalent between the LAD-LCX (68%) and LAD-right coronary artery (28%). This study shows that human hearts have abundant coronary collaterals within all flow territories and layers of the heart. The majority of these collaterals are small intracoronary collaterals, which would have remained undetected by clinical imaging techniques.
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Affiliation(s)
- Monique G J T B van Lier
- Department of Biomedical Engineering and Physics, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - Elco Oost
- Department of Biomedical Engineering and Physics, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - Jos A E Spaan
- Department of Biomedical Engineering and Physics, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - Pepijn van Horssen
- Department of Biomedical Engineering and Physics, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - Allard C van der Wal
- Department of Pathology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - Ed vanBavel
- Department of Biomedical Engineering and Physics, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - Maria Siebes
- Department of Biomedical Engineering and Physics, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - Jeroen P H M van den Wijngaard
- Department of Biomedical Engineering and Physics, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands.
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Inter–Core Lab Variability in Analyzing Quantitative Coronary Angiography for Bifurcation Lesions. JACC Cardiovasc Interv 2015; 8:305-314. [DOI: 10.1016/j.jcin.2014.12.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 12/04/2014] [Accepted: 12/17/2014] [Indexed: 11/17/2022]
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16
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Ozaki Y, Ohota M, Ismail TF, Okumura M, Ishikawa M, Muramatsu T. Thin Cap Fibroatheroma Defined as Lipid Core Abutting Lumen (LCAL) on Integrated Backscatter Intravascular Ultrasound – Comparison With Optical Coherence Tomography and Correlation With Peri-Procedural Myocardial Infarction –. Circ J 2015; 79:808-17. [DOI: 10.1253/circj.cj-14-0758] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Yukio Ozaki
- Department of Cardiology, Fujita Health University Hospital
| | - Masaya Ohota
- Department of Cardiology, Fujita Health University Hospital
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17
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Ishibashi Y, Grundeken MJ, Nakatani S, Iqbal J, Morel MA, Généreux P, Girasis C, Wentzel JJ, Garcia-Garcia HM, Onuma Y, Serruys PW. In vitro validation and comparison of different software packages or algorithms for coronary bifurcation analysis using calibrated phantoms: Implications for clinical practice and research of bifurcation stenting. Catheter Cardiovasc Interv 2014; 85:554-63. [DOI: 10.1002/ccd.25618] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 07/21/2014] [Indexed: 11/08/2022]
Affiliation(s)
- Yuki Ishibashi
- Thoraxcenter; Erasmus Medical Center; Rotterdam The Netherlands
| | - Maik J. Grundeken
- The Heart Center; Academic Medical Center; Amsterdam The Netherlands
| | | | - Javaid Iqbal
- Thoraxcenter; Erasmus Medical Center; Rotterdam The Netherlands
| | | | - Philippe Généreux
- New York - Presbyterian Hospital and Columbia University Medical Center, New York; New York - Cardiovascular Research Foundation; New York
| | - Chrysafios Girasis
- Thoraxcenter; Erasmus Medical Center; Rotterdam The Netherlands
- The Onassis Cardiac Surgery Center; Kallithea Greek
| | | | | | - Yoshinobu Onuma
- Thoraxcenter; Erasmus Medical Center; Rotterdam The Netherlands
- Cardialysis B.V; Rotterdam The Netherlands
| | - Patrick W. Serruys
- International Centre for Circulatory Health, NHL 1; Imperial College London; London United Kingdom
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18
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Discrepancies in vessel sizing between angiography and intravascular ultrasound varies according to the vessel evaluated. Int J Cardiol 2013; 168:3791-6. [DOI: 10.1016/j.ijcard.2013.06.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Revised: 01/01/2013] [Accepted: 06/15/2013] [Indexed: 11/22/2022]
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19
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Shah DJ, Kim HW, James O, Parker M, Wu E, Bonow RO, Judd RM, Kim RJ. Prevalence of regional myocardial thinning and relationship with myocardial scarring in patients with coronary artery disease. JAMA 2013; 309:909-18. [PMID: 23462787 PMCID: PMC3979456 DOI: 10.1001/jama.2013.1381] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
IMPORTANCE Regional left ventricular (LV) wall thinning is believed to represent chronic transmural myocardial infarction and scar tissue. However, recent case reports using delayed-enhancement cardiovascular magnetic resonance (CMR) imaging raise the possibility that thinning may occur with little or no scarring. OBJECTIVE To evaluate patients with regional myocardial wall thinning and to determine scar burden and potential for functional improvement. DESIGN, SETTING, AND PATIENTS Investigator-initiated, prospective, 3-center study conducted from August 2000 through January 2008 in 3 parts to determine (1) in patients with known coronary artery disease (CAD) undergoing CMR viability assessment, the prevalence of regional wall thinning (end-diastolic wall thickness ≤5.5 mm), (2) in patients with thinning, the presence and extent of scar burden, and (3) in patients with thinning undergoing coronary revascularization, any changes in myocardial morphology and contractility. MAIN OUTCOMES AND MEASURES Scar burden in thinned regions assessed using delayed-enhancement CMR and changes in myocardial morphology and function assessed using cine-CMR after revascularization. RESULTS Of 1055 consecutive patients with CAD screened, 201 (19% [95% CI, 17% to 21%]) had regional wall thinning. Wall thinning spanned a mean of 34% (95% CI, 32% to 37% [SD, 15%]) of LV surface area. Within these regions, the extent of scarring was 72% (95% CI, 69% to 76% [SD, 25%]); however, 18% (95% CI, 13% to 24%) of thinned regions had limited scar burden (≤50% of total extent). Among patients with thinning undergoing revascularization and follow-up cine-CMR (n = 42), scar extent within the thinned region was inversely related to regional (r = -0.72, P < .001) and global (r = -0.53, P < .001) contractile improvement. End-diastolic wall thickness in thinned regions with limited scar burden increased from 4.4 mm (95% CI, 4.1 to 4.7) to 7.5 mm (95% CI, 6.9 to 8.1) after revascularization (P < .001), resulting in resolution of wall thinning. On multivariable analysis, scar extent had the strongest association with contractile improvement (slope coefficient, -0.03 [95% CI, -0.04 to -0.02]; P < .001) and reversal of thinning (slope coefficient, -0.05 [95% CI, -0.06 to -0.04]; P < .001). CONCLUSIONS AND RELEVANCE Among patients with CAD referred for CMR and found to have regional wall thinning, limited scar burden was present in 18% and was associated with improved contractility and resolution of wall thinning after revascularization. These findings, which are not consistent with common assumptions, warrant further investigation.
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Affiliation(s)
- Dipan J Shah
- Duke Cardiovascular MRI Center, DUMC 3934, Durham, NC 27710, USA
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20
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Optical coherence tomography guided in-stent thrombus removal in patients with acute coronary syndromes. Int J Cardiovasc Imaging 2013; 29:989-96. [PMID: 23412883 DOI: 10.1007/s10554-013-0191-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Accepted: 01/30/2013] [Indexed: 02/08/2023]
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21
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Quantitative PET/CT Measures of Myocardial Flow Reserve and Atherosclerosis for Cardiac Risk Assessment and Predicting Adverse Patient Outcomes. Curr Cardiol Rep 2013; 15:344. [DOI: 10.1007/s11886-012-0344-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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22
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Kakouros N, Rybicki FJ, Mitsouras D, Miller JM. Coronary pressure-derived fractional flow reserve in the assessment of coronary artery stenoses. Eur Radiol 2012. [PMID: 23179519 DOI: 10.1007/s00330-012-2670-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVES Catheter-based angiography is the reference-standard to establish coronary anatomy. While routinely employed clinically, lumen assessment correlates poorly with physiological measures of ischaemia. Moreover, functional studies to identify and localise ischaemia before elective angiography are often not available. This article reviews fractional flow reserve (FFR) and its role in guiding patient management for patients with a potentially haemodynamic significant coronary lesion. METHODS This review discusses the theory, evidence, indications, and limitations of FFR. Also included are emerging non-invasive imaging FFR surrogates currently under evaluation for accuracy with respect to standard FFR. RESULTS Coronary pressure-derived fractional flow reserve (FFR) rapidly assesses the haemodynamic significance of individual coronary artery lesions and can readily be performed in the catheterisation laboratory. The use of FFR has been shown to effectively guide coronary revascularization procedures leading to improved patient outcomes. CONCLUSIONS FFR is an invaluable modality in guiding coronary disease treatment decisions. It is safe, cost-effective and leads to improved patient outcomes. Non-invasive imaging modalities to assess the physiologic significance of CAD are currently being developed and evaluated.
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Affiliation(s)
- Nikolaos Kakouros
- Division of Cardiology, Johns Hopkins Hospital and Johns Hopkins University, 600 N. Wolfe Street, Blalock 536, Baltimore, MD 21287, USA
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23
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Ohota M, Kawasaki M, Ismail TF, Hattori K, Serruys PW, Ozaki Y. A Histological and Clinical Comparison of New and Conventional Integrated Backscatter Intravascular Ultrasound (IB-IVUS). Circ J 2012; 76:1678-86. [DOI: 10.1253/circj.cj-11-1157] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Masaya Ohota
- Department of Cardiology, Fujita Health University Hospital
- Department of Cardiology, Fujita Health University Hospital
| | - Masanori Kawasaki
- Department of Cardiology, Graduate School of Medicine, Gifu University
- Department of Cardiology, Graduate School of Medicine, Gifu University
| | - Tevfik F. Ismail
- Royal Brompton Hospital & Imperial College
- Royal Brompton Hospital & Imperial College
| | - Kousuke Hattori
- Department of Cardiology, Fujita Health University Hospital
- Department of Cardiology, Fujita Health University Hospital
| | | | - Yukio Ozaki
- Department of Cardiology, Fujita Health University Hospital
- Department of Cardiology, Fujita Health University Hospital
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24
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De Backer G, Petrella RJ, Goudev AR, Radaideh GA, Rynkiewicz A, Pathak A. Design and methodology of POWER, an open-label observation of the effect of primary care interventions on total cardiovascular risk in patients with hypertension. Fundam Clin Pharmacol 2011; 27:210-5. [PMID: 22049922 DOI: 10.1111/j.1472-8206.2011.01006.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Guy De Backer
- Department of Public Health, Ghent University, Ghent, Belgium.
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25
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Shin DH, Koo BK, Waseda K, Park KW, Kim HS, Corral M, Lansky A, Honda Y, Fearon WF, Fitzgerald PJ. Discrepancy in the assessment of jailed side branch lesions by visual estimation and quantitative coronary angiographic analysis. Catheter Cardiovasc Interv 2011; 78:720-6. [DOI: 10.1002/ccd.23049] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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26
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Onuma Y, Girasis C, Aben JP, Sarno G, Piazza N, Lokkerbol C, Morel MA, Serruys P. A novel dedicated 3-dimensional quantitative coronary analysis methodology for bifurcation lesions. EUROINTERVENTION 2011; 7:629-35. [DOI: 10.4244/eijv7i5a100] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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27
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Ozaki Y, Okumura M, Ismail TF, Motoyama S, Naruse H, Hattori K, Kawai H, Sarai M, Takagi Y, Ishii J, Anno H, Virmani R, Serruys PW, Narula J. Coronary CT angiographic characteristics of culprit lesions in acute coronary syndromes not related to plaque rupture as defined by optical coherence tomography and angioscopy. Eur Heart J 2011; 32:2814-23. [PMID: 21719455 DOI: 10.1093/eurheartj/ehr189] [Citation(s) in RCA: 113] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
AIMS Pathological and clinical optical coherence tomography (OCT) studies have indicated that acute coronary syndrome (ACS) lesions have either ruptured fibrous caps (RFC-ACS) or intact fibrous caps (IFC-ACS). Although computed tomographic (CT) angiographic characteristics of RFC-ACS include low-attenuation plaques and positive plaque remodelling, features associated with IFC-ACS have not been previously described. The aim of this study was to assess the CT characteristics of IFC-ACS lesions. METHODS AND RESULTS Seventy-four patients with ACS/stable angina consented to multimodality imaging, of which 66 underwent CT angiography. Of these, 57 culprit lesions in 57 patients were evaluated with sufficient image quality from all four of OCT, angioscopy, intravascular ultrasound, and CT angiography. Intraluminal thrombus was assessed by OCT/angioscopy, and culprit lesions further classified by OCT-based demonstration of fibrous cap integrity. Of 35 culprit lesions with ACS, OCT revealed IFC with thrombus in 10 (29%) and RFC in the remaining 25 (71%); all 22 lesions with stable angina had intact fibrous caps. Fibrous caps were significantly thinner in RFC-ACS than IFC-ACS and stable angina (45 ± 12, 131 ± 57, and 321 ± 146 μm, respectively; P = 0.001). CT angiography revealed that low-attenuation plaques were more frequently observed in RFC-ACS than IFC-ACS and stable angina (88, 40, and 18%; P = 0.001) lesions. Similarly, positive remodelling was more predominantly seen in RFC-ACS than IFC-ACS and stable angina (96, 20, and 14%; P = 0.001). However, none of the specific CT angiography features clearly distinguished IFC-ACS from stable lesions. CONCLUSION In contrast to the situation with RFC-ACS, distinct culprit lesion characteristics associated with non-rupture-related mechanisms are not identified by CT angiography. It will therefore not be possible to differentiate plaques likely to develop IFC-ACS from stable plaques.
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Affiliation(s)
- Yukio Ozaki
- Department of Cardiology, Fujita Heath University Hospital, 1-98 Dengaku, Kutsukake, Toyoake 470-1192, Japan.
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Arbab-Zadeh A, Hoe J. Quantification of coronary arterial stenoses by multidetector CT angiography in comparison with conventional angiography methods, caveats, and implications. JACC Cardiovasc Imaging 2011; 4:191-202. [PMID: 21329905 DOI: 10.1016/j.jcmg.2010.10.011] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2010] [Revised: 10/06/2010] [Accepted: 10/12/2010] [Indexed: 12/14/2022]
Abstract
Multidetector computed tomography (MDCT) is a rapidly evolving technology for performing noninvasive coronary angiography. Despite good sensitivity and specificity for detecting significant coronary artery disease in patients, disagreement on individual coronary arterial stenosis severity is common between MDCT and the current gold standard, conventional angiography. The reasons for such disagreement are numerous, but are at least partly inherent to MDCT's modest spatial and temporal resolution at present. Less well acknowledged, however, is the fact that MDCT and conventional angiography are fundamentally different technologies, rendering good agreement on the degree of lumen narrowing rather unrealistic, given both of their respective limitations. Discrepant stenosis assessment by MDCT and conventional angiography receives remarkable attention, whereas its significance for patient outcome is less certain. On the other hand, the ability to noninvasively assess coronary arterial plaque characteristics and composition in addition to lumen obstruction shows strong promise for improved risk assessment and may at last enable us to move beyond mere coronary stenosis assessment for the management of patients with coronary artery disease.
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Affiliation(s)
- Armin Arbab-Zadeh
- Division of Cardiology, Johns Hopkins University, Baltimore, Maryland, USA.
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29
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Girasis C, Schuurbiers JC, Onuma Y, Serruys PW, Wentzel JJ. Novel bifurcation phantoms for validation of quantitative coronary angiography algorithms. Catheter Cardiovasc Interv 2011; 77:790-7. [DOI: 10.1002/ccd.22704] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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30
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Mintz G, Garcia-Garcia H, Nicholls S, Weissman N, Bruining N, Crowe T, Tardif JC, Serruys P. Clinical expert consensus document on standards for acquisition, measurement and reporting of intravascular ultrasound regression/progression studies. EUROINTERVENTION 2011; 6:1123-30, 9. [DOI: 10.4244/eijv6i9a195] [Citation(s) in RCA: 116] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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31
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Ozaki Y, Lemos PA, Yamaguchi T, Suzuki T, Nakamura M, Ismail TF, Kitayama M, Nishikawa H, Kato O, Serruys PW. A quantitative coronary angiography-matched comparison between a prospective randomised multicentre cutting balloon angioplasty and bare metal stent trial (REDUCE III) and the Rapamycin-Eluting Stent Evaluation At Rotterdam Cardiology Hospital (RESEARCH) study. EUROINTERVENTION 2011; 6:400-6. [PMID: 20884421 DOI: 10.4244/eijv6i3a66] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS There remains significant concern about the long-term safety of drug-eluting stents (DES). However, bare metal stents (BMS) have been used safely for over two decades. There is therefore a pressing need to explore alternative strategies for reducing restenosis with BMS. This study was designed to examine whether IVUS-guided cutting balloon angioplasty (CBA) with BMS could convey similar restenosis rates to DES. METHODS AND RESULTS In the randomised REstenosis reDUction by Cutting balloon angioplasty Evaluation (REDUCE III) study, 521 patients were divided into four groups based on device and IVUS use before BMS (IVUS-CBA-BMS: 137 patients; Angio-CBA-BMS: 123; IVUS-BA-BMS: 142; and Angio-BA-BMS: 119). At follow-up, the IVUS-CBA-BMS group had a significantly lower restenosis rate (6.6%) than the other groups (p=0.016). We performed a quantitative coronary angiography (QCA) based matched comparison between an IVUS-guided CBA-BMS strategy (REDUCE III) and a DES strategy (Rapamycin-Eluting-Stent Evaluation At Rotterdam Cardiology Hospital, the RESEARCH study). We matched the presence of diabetes, vessel size, and lesion severity by QCA. Restenosis (>50% diameter stenosis at follow-up) and target vessel revascularisation (TVR) were examined. QCA-matched comparison resulted in 120-paired lesions. While acute gain was significantly greater in IVUS-CBA-BMS than DES (1.65±0.41 mm vs. 1.28±0.57 mm, p=0.001), late loss was significantly less with DES than with IVUS-CBA-BMS (0.03±0.42 mm vs. 0.80±0.47 mm, p=0.001). However, no difference was found in restenosis rates (IVUS-CBA-BMS: 6.6% vs. DES: 5.0%, p=0.582) and TVR (6.6% and 6.6%, respectively). CONCLUSIONS An IVUS-guided CBA-BMS strategy yielded restenosis rates similar to those achieved by DES and provided an effective alternative to the use of DES.
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Affiliation(s)
- Yukio Ozaki
- Fujita Health University Hospital, Toyoake, Japan.
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32
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Girasis C, Schuurbiers JC, Onuma Y, Aben JP, Weijers B, Boersma E, Wentzel JJ, Serruys PW. Two-dimensional quantitative coronary angiographic models for bifurcation segmental analysis. Catheter Cardiovasc Interv 2011; 77:830-9. [DOI: 10.1002/ccd.22844] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2010] [Accepted: 09/20/2010] [Indexed: 11/06/2022]
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Schindler TH, Schelbert HR, Quercioli A, Dilsizian V. Cardiac PET imaging for the detection and monitoring of coronary artery disease and microvascular health. JACC Cardiovasc Imaging 2010; 3:623-40. [PMID: 20541718 DOI: 10.1016/j.jcmg.2010.04.007] [Citation(s) in RCA: 278] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2010] [Revised: 04/21/2010] [Accepted: 04/26/2010] [Indexed: 12/11/2022]
Abstract
Positron emission tomography (PET) myocardial perfusion imaging in concert with tracer-kinetic modeling affords the assessment of regional myocardial blood flow (MBF) of the left ventricle in absolute terms (milliliters per gram per minute). Assessment of MBF both at rest and during various forms of vasomotor stress provides insight into early and subclinical abnormalities in coronary arterial vascular function and/or structure, noninvasively. The noninvasive evaluation and quantification of MBF and myocardial flow reserve (MFR) extend the scope of conventional myocardial perfusion imaging from detection of end-stage, advanced, and flow-limiting, epicardial coronary artery disease (CAD) to early stages of atherosclerosis or microvascular dysfunction. Recent studies have shown that impaired hyperemic MBF or MFR with PET, with or without accompanying CAD, is predictive of increased relative risk of death or progression of heart failure. Quantitative approaches that measure MBF with PET identify multivessel CAD and offer the opportunity to monitor responses to lifestyle and/or risk factor modification and to therapeutic interventions. Whether improvement or normalization of hyperemic MBF and/or the MFR will translate to improvement in long-term cardiovascular outcome remains clinically untested. In the meantime, absolute measures of MBF with PET can be used as a surrogate marker for coronary vascular health, and to monitor therapeutic interventions. Although the assessment of myocardial perfusion with PET has become an indispensable tool in cardiac research, it remains underutilized in clinical practice. Individualized, image-guided cardiovascular therapy may likely change this paradigm in the near future.
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Affiliation(s)
- Thomas H Schindler
- Nuclear Cardiology and Cardiac Imaging, Division of Cardiology, Department of Medicine, University Hospitals of Geneva, Geneva, Switzerland.
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Ozaki Y, Okumura M, Ismail TF, Naruse H, Hattori K, Kan S, Ishikawa M, Kawai T, Takagi Y, Ishii J, Prati F, Serruys PW. The fate of incomplete stent apposition with drug-eluting stents: an optical coherence tomography-based natural history study. Eur Heart J 2010; 31:1470-6. [PMID: 20363765 DOI: 10.1093/eurheartj/ehq066] [Citation(s) in RCA: 150] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AIMS To assess the fate of incomplete stent apposition (ISA) after deployment of sirolimus-eluting stents (SESs). METHODS AND RESULTS Thirty-two patients having intravascular ultrasound (IVUS)-guided PCI with SESs underwent assessment of stent deployment with quantitative coronary angiography, IVUS, and optical coherence tomography (OCT) pre-procedure, post-procedure, and at 10 months follow-up. Incomplete stent apposition was defined as separation of a stent strut from the inner vessel wall by >160 microm. At follow-up, 4.67% of struts with ISA at deployment failed to heal and 7.59% which were well apposed did not develop neointimal hyperplasia even after 10 months. Lesion remodelling was responsible for the development of late ISA in only 0.37% of struts. Failure of adequate neointimal hyperplasia was quantitatively the most important mechanism responsible for persistent acute ISA, classified in previous studies, which relied only on follow-up OCT, as late ISA. Thrombus was visualized in 20.6% of struts with ISA at follow-up and in 2.0% of struts with a good apposition (P < 0.001). CONCLUSION In patients with SESs, ISA can fail to heal and even complete apposition can be associated with no neointimal hyperplasia. Incomplete stent apposition without neointimal hyperplasia was significantly associated with the presence of OCT-detected thrombus at follow-up, and may constitute a potent substrate for late stent thrombosis.
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Affiliation(s)
- Yukio Ozaki
- Department of Cardiology, Fujita Heath University Hospital, 1-98 Dengaku, Kutsukake, Toyoake 470-1192, Japan.
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Uno K, Bayturan O, Lavoie A, Nicholls SJ. Rationale and approach to evaluation of the impact of medical therapies on progression of atherosclerosis with arterial wall imaging. Curr Med Res Opin 2010; 26:737-44. [PMID: 20092389 DOI: 10.1185/03007990903547533] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Despite the benefit of medical therapies, there remains a substantial residual risk of cardiovascular events. Atherosclerosis imaging has been used to assess new therapies. SCOPE A selective review of current imaging techniques used to evaluate novel anti-atherosclerotic therapies. FINDINGS Noninvasive and invasive arterial wall imaging permits characterization of the quantity and composition of atherosclerotic plaque. Serial imaging enables assessment of the impact of therapies on the natural history of disease progression. CONCLUSION Both noninvasive and invasive imaging modalities can be used in development programs to provide an early assessment of the impact of novel anti-atherosclerotic agents.
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Candell-Riera J, Santana-Boado C, Castell-Conesa J, Aguadé-Bruix S, Olona-Cabases M, Domingo E, Permanyer-Miralda G, Soler-Soler J. Culprit lesion and jeopardized myocardium: correlation between coronary angiography and single-photon emission computed tomography. Clin Cardiol 2009; 20:345-50. [PMID: 9098593 PMCID: PMC6656251 DOI: 10.1002/clc.4960200409] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND The term "culprit lesion" is used to designate the coronary stenosis responsible for the symptoms of the patient with coronary artery disease. Its detection is essential when partial revascularization is contemplated. The term "jeopardized myocardium" is commonly used to mean the amount of myocardium put in danger by all the stenotic lesions; however, it should be restricted to the amount of myocardium that could become infarcted if only the most severe stenoses were occluded. HYPOTHESIS The aim of this study was to investigate (1) the agreement between coronary myocardial single-photon emission computed tomography (SPECT) and coronary angiography for the identification of the culprit lesion, and (2) the correlation of the two studies in the quantification of jeopardized myocardium. METHODS In all, 159 patients with coronary artery disease without previous myocardial infarction were included in the study. A score for myocardial SPECT was correlated with the angiographic scores by Califf and Gensini and with the authors' score which includes adjustment for collateral circulation. RESULTS The agreement between coronary angiography and SPECT for the diagnosis of the culprit lesion was 84% (87/104). The correlations between the scores of angiography and SPECT to assess jeopardized myocardium when all coronary stenoses were taken into account were significant (p < 0.0001), but their coefficients were suboptimal (r = 0.48 for Califf, r = 0.48 for Gensini, and r = 0.65 for the authors' score). When only the jeopardized myocardium resulting from the culprit lesion was considered, the correlation clearly improved (r = 0.85). CONCLUSION Thus, in 84% of patients with multivessel disease, an agreement between coronary angiography and myocardial SPECT for the diagnosis of the culprit lesion was observed. The correlation between these techniques for the quantification of jeopardized myocardium from the culprit lesion was satisfactory.
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Affiliation(s)
- J Candell-Riera
- Servei de Cardiologia, Hospital General Universitari Vall d'Hebron, Barcelona, Spain
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Assessment of the Vessel Lumen Diameter and Degree of Stenosis in the Superficial Femoral Artery before Intervention: Comparison of Different Algorithms. J Vasc Interv Radiol 2009; 20:192-202. [DOI: 10.1016/j.jvir.2008.10.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2008] [Revised: 10/07/2008] [Accepted: 10/13/2008] [Indexed: 11/19/2022] Open
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Wild PS, Funke B, Geisler T, Abushi A, Zotz RJ. Fragment reconstruction of coronary arteries using transesophageal echocardiography for coronary diagnostics. EUROPEAN JOURNAL OF ECHOCARDIOGRAPHY 2008; 9:796-802. [PMID: 18490291 DOI: 10.1093/ejechocard/jen142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
AIMS Ultrasound differs procedurally from the established methods for non-invasive coronary visualization and is therefore an interesting alternative for non-invasive diagnostics. In this study, fragment reconstruction of coronary arteries by transesophageal echocardiography (FRC-TEE) was investigated for the first time in a patient population being evaluated for coronary angiography. METHODS AND RESULTS Ultrasonic and angiographic findings were compared visually and using quantitative measurements in 50 patients. One hundred and seventy-one vessels were examined by FRC-TEE. The total lengths visualized were 9.6 +/- 1.7 cm for the right coronary artery, 7.0 +/- 1.1 cm for left circumflex, 3.9 +/- 1.2 cm for left anterior descending (LAD), and 1.5 +/- 0.8 cm for the left main coronary artery. There was high concordance between results of both procedures. Sixty-three stenoses were detected using FRC-TEE. The mean difference in degree of stenosis between techniques was 0.2 +/- 5.1%. Stents could be visualized in 19 segments. FRC-TEE detected distal stenoses of the coronary arteries to only a limited extent: 14 stenoses and 2 stents, predominantly in the LAD artery (n = 13), were not identified. CONCLUSIONS FRC-TEE is a potential method for diagnosing coronary artery disease. FRC-TEE and angiography yield comparable findings during the evaluation of coronary lesions. Further investigations are needed to verify the encouraging findings and define FRC-TEE's applications.
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Affiliation(s)
- Philipp S Wild
- Department of Medicine II, Johannes Gutenberg-University Mainz, Langenbeckstr. 27, 55101 Mainz, Germany.
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Ramcharitar S, Daeman J, Patterson M, van Guens RJ, Boersma E, Serruys PW, van der Giessen WJ. First direct in vivo comparison of two commercially available three-dimensional quantitative coronary angiography systems. Catheter Cardiovasc Interv 2008; 71:44-50. [PMID: 18098181 DOI: 10.1002/ccd.21418] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
AIM The in vivo comparison of the accuracy of two 3-dimensional quantitative coronary angiography (QCA) systems. METHODS Precision-drilled plexiglass phantoms with five different luminal diameters (0.5-1.9 mm) were percutaneously inserted into the coronary arteries of four Yorkshire pigs. Twenty-one angiographic images of these stenotic phantoms were acquired for in vivo validation testing. Quantitative assessments of the minimum, maximum, and mean luminal diameters together with the minimum luminal area were determined using two 3D QCA systems, the CardiOp-B and CAAS 5. RESULTS The CardiOp-B system significantly underestimated the minimum luminal diameter MLD whilst both systems significantly overestimated the maximum luminal diameter at the minimal luminal area (MLA) over the phantom's true value. The CAAS 5 system had a greater degree of accuracy/mm (mean difference = 0.01 vs. 0.03) and precision/mm (SD = 0.09 vs. 0.23) than the CardiOp-B in assessing the minimal LD. An increased precision/mm (SD = 0.01 vs. 0.29) and accuracy/mm (mean difference = 0.03 vs. 0.11) in the mean LD was observed with the CAAS 5. In comparing the MLA/mm(2) the CAAS 5 was more precise/mm(2) (SD = 0.14 vs. 0.55) and accurate/mm(2) (mean difference = 0.12 vs. 0.02) to the true phantom MLA compared to the CardiOp-B system. CONCLUSIONS In a 21 phantom study, the CAAS 5 3D QCA system had a greater degree of accuracy and precision in both the luminal and area measurements than the CardiOp-B 3D QCA system.
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Mor-Avi V, Koch R, Holper EM, Goonewardena S, Coon PD, Min JK, Fedson S, Ward RP, Lang RM. Value of vasodilator stress myocardial contrast echocardiography and magnetic resonance imaging for the differential diagnosis of ischemic versus nonischemic cardiomyopathy. J Am Soc Echocardiogr 2008; 21:425-32. [PMID: 18187290 DOI: 10.1016/j.echo.2007.10.034] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2007] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Noninvasive differentiation of ischemic versus nonischemic cardiomyopathy (CM) remains challenging because of the low specificity of imaging-based tests in these patients. We hypothesized that myocardial contrast echocardiography (MCE) and cardiac magnetic resonance (CMR), combined with vasodilator stress, could provide accurate alternatives for determining the cause of CM. METHODS To allow side-by-side comparisons between these techniques with coronary angiography as a reference, we studied 16 patients referred for coronary angiography after abnormal nuclear perfusion studies. Both MCE and CMR images were acquired within 48 hours with infusion of adenosine. MCE included flash-echo imaging during intravenous infusion of echocardiographic contrast solution. CMR included gadolinium injections for first-pass perfusion and delayed enhancement imaging. MCE and CMR images were reviewed by experienced investigators, blinded to the findings of the other modality and angiography. For each technique, each myocardial segment was classified as normal or abnormal. Sensitivity and specificity of each technique were calculated against the angiography reference. These calculations were also performed using a perfusion territory as a unit of analysis. RESULTS Six of 16 patients had normal coronary arteries, and three patients had stenosis < 50%. By using this threshold for abnormal perfusion, segment-by-segment comparisons with angiography resulted in sensitivity of 0.88, 0.61, and 0.71 and specificity of 0.74, 0.86, and 0.94 for CMR perfusion, delayed enhancement scans, and MCE sequences, respectively. Using stenosis > 70% as a threshold resulted in a small decrease in both sensitivity and specificity (0.02-0.04) for all three techniques. Analysis of the ability of these techniques to detect an abnormality in at least one perfusion territory yielded sensitivity of 1.00, 1.00, and 0.86 and specificity of 0.78, 0.78, and 0.89, correspondingly, which were threshold-independent. CONCLUSIONS Both CMR and MCE perfusion imaging may be used to differentiate between ischemic and nonischemic CM. These emerging diagnostic tools may prove useful in strategizing treatment in these patients and thus avoiding unnecessary invasive procedures.
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Ozaki Y, Yamaguchi T, Suzuki T, Nakamura M, Kitayama M, Nishikawa H, Inoue T, Hara K, Usuba F, Sakurada M, Awano K, Matsuo H, Ishiwata S, Yasukawa T, Ismail TF, Hishida H, Kato O. Impact of Cutting Balloon Angioplasty (CBA) Prior to Bare Metal Stenting on Restenosis A Prospective Randomized Multicenter Trial Comparing CBA With Balloon Angioplasty (BA) Before Stenting (REDUCE III). Circ J 2007; 71:1-8. [PMID: 17186970 DOI: 10.1253/circj.71.1] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND While stent restenosis and late thrombosis still occur even with drug-eluting-stents (DES), there remains a need to explore other strategies for preventing restenosis. METHODS AND RESULTS Five hundred and twenty-one patients were randomized: 260 to cutting-balloon angioplasty (CBA) before bare-metal stent (CBA-BMS) and 261 to balloon-angioplasty (BA) before BMS (BA-BMS). Intravascular ultrasound (IVUS)-guided procedures were performed in 279 (54%) patients and angiographic guidance was used in the remainder. Minimal lumen diameter was significantly greater in CBA-BMS than BA-BMS (2.65+/-0.40 mm vs 2.52+/-0.4 mm, p<0.01) and % diameter stenosis (%DS)-post was less in CBA-BMS than BA-BMS (14.0+/-5.9% vs 16.3+/-6.8%, p<0.01). %DS-follow-up was subsequently less in CBA-BMS than BA-BMS (32.4+/-15.1% vs 35.4+/-15.3%, p<0.05) associated with lower rates of restenosis in CBA-BMS than BA-BMS (11.8% vs 19.6%, p<0.05) and less target lesion revascularization (TLR) in CBA-BMS than BA-BMS (9.6% vs 15.3%, p<0.05). Patients were divided into 4 groups based on the device used before stenting and IVUS use (IVUS-CBA-BMS: 137 patients; Angio-CBA-BMS: 123; IVUS-BA-BMS: 142; and Angio-BA-BMS: 119). At follow-up IVUS-CBA-BMS had a significantly lower restenosis rate (6.6%) than Angio-CBA-BMS (17.9%), IVUS-BA-BMS (19.8%) and Angio-BA-BMS (18.2%, p<0.05). CONCLUSIONS Restenosis and TLR were significantly lower in CBA-BMS than BA-BMS. This favorable outcome was achieved because of the lower restenosis rate conferred by the IVUS-guided-CBA-BMS strategy (6.6%). The restenosis rates obtained with this strategy were comparable to those achieved with DES.
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Affiliation(s)
- Yukio Ozaki
- Division of Cardiology, Fujita Health University Hospital, Toyoake, Japan.
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Okumura M, Ozaki Y, Ishii J, Kan S, Naruse H, Matsui S, Ishikawa M, Hattori K, Gochi T, Nakano T, Yamada A, Kato S, Motoyama S, Sarai M, Takagi Y, Ismail TF, Nomura M, Hishida H. Restenosis and Stent Fracture Following Sirolimus-Eluting Stent (SES) Implantation A Serial Quantitative Coronary Angiography (QCA) and Intravascular Ultrasound (IVUS) Study. Circ J 2007; 71:1669-77. [DOI: 10.1253/circj.71.1669] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | - Yukio Ozaki
- Division of Cardiology, Fujita Health University Hospital
| | - Junichi Ishii
- Division of Cardiology, Fujita Health University Hospital
| | - Shino Kan
- Division of Cardiology, Fujita Health University Hospital
| | | | - Shigeru Matsui
- Division of Cardiology, Fujita Health University Hospital
| | | | | | - Tomoko Gochi
- Division of Cardiology, Fujita Health University Hospital
| | - Tadashi Nakano
- Division of Cardiology, Fujita Health University Hospital
| | - Akira Yamada
- Division of Cardiology, Fujita Health University Hospital
| | - Shigeru Kato
- Division of Cardiology, Fujita Health University Hospital
| | | | | | - Yasushi Takagi
- Division of Cardiology, Fujita Health University Hospital
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Dvir D, Marom H, Guetta V, Kornowski R. Three-dimensional coronary reconstruction from routine single-plane coronary angiograms: in vivo quantitative validation. ACTA ACUST UNITED AC 2006; 7:141-5. [PMID: 16243736 DOI: 10.1080/14628840500193398] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Current X-ray technology displays the complex 3-dimensional (3-D) geometry of the coronary arterial tree as 2-dimensional (2-D) images. To overcome this limitation, an algorithm was developed for the reconstruction of the 3-D pathway of the coronary arterial tree using routine single-plane 2-D angiographic imaging. This method provides information in real-time and is suitable for routine use in the cardiovascular catheterization laboratory. OBJECTIVES The purpose of this study was to evaluate the precision of this algorithm and to compare it with 2-D quantitative coronary angiography (QCA) system. METHODS Thirty-eight angiographic images were acquired from 11 randomly selected patients with coronary artery disease undergoing diagnostic cardiac catheterization. The 2-D images were analyzed using QCA software. For the 3-D reconstruction, an algorithm integrating information from at least two single-plane angiographic images taken from different angles was formulated. RESULTS 3-D acquisition was feasible in all patients and in all selected angiographic frames. Comparison between pairs of values yielded greater precision of the 3-D than the 2-D measurements of the minimal lesion diameter (P<0.005), minimal lesion area (P<0.05) and lesion length (P<0.01). CONCLUSIONS The study validates the 3-D reconstruction algorithm, which may provide new insights into vessel morphology in 3-D space. This method is a promising clinical tool, making it possible for cardiologists to appreciate the complex curvilinear structure of the coronary arterial tree and to quantify atherosclerotic lesions more precisely.
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Affiliation(s)
- Danny Dvir
- Division of Interventional Cardiology, Rabin Medical Center, Petach Tikva, Israel
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Van Herck PL, Vrints CJ, Carlier SG. Coronary Circulation and Interventional Cardiology. Ann Biomed Eng 2005; 33:1735-42. [PMID: 16389522 DOI: 10.1007/s10439-005-8778-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2005] [Accepted: 06/03/2005] [Indexed: 10/25/2022]
Abstract
Cardiovascular disease has long been the leading cause of death in developed countries and it is rapidly becoming the number one killer in developing countries. Sudden heart attacks remain the primary cause of death in the United States: over 1.4 million attacks are suffered every year, more than half of which prove fatal. Interventional Cardiology is aimed to alleviate symptoms of cardiac pains and poor coronary circulation, and reduce the risk of death and nonfatal myocardial infarction. Our understanding of the coronary circulation has improved several folds due to the introduction of advance technologies. Yet, the microcirculatory flow needs future investigation.
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Affiliation(s)
- P L Van Herck
- Department of Cardiology, Antwerp University, Belgium
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Cordeiro MAS, Miller JM, Schmidt A, Lardo AC, Rosen BD, Bush DE, Brinker JA, Bluemke DA, Shapiro EP, Lima JAC. Non-invasive half millimetre 32 detector row computed tomography angiography accurately excludes significant stenoses in patients with advanced coronary artery disease and high calcium scores. Heart 2005; 92:589-97. [PMID: 16251224 PMCID: PMC1860949 DOI: 10.1136/hrt.2005.074336] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To show an overall diagnostic accuracy > or = 90% for detection of > or = 50% stenoses by coronary half millimetre 32 detector row computed tomography angiography (32 x 0.5-MDCTA) in patients with advanced coronary artery disease (CAD) and a high likelihood of raised calcium scores. METHODS ECG gated 32 x 0.5-MDCTA (32 x 0.5 mm cross sections, 0.35 x 0.35 x 0.35 mm3 isotropic voxels, 400 ms rotation) was performed after injection of iodixanol (120 ml, 320 mg/ml) in 30 consecutive patients (25 men, mean (SD) age 59 (13) years, body mass index 26.2 (4.9) kg/m2). Native arteries, including > or = 1.5 mm branches, and bypass grafts were screened for > or = 50% stenoses. Stents were excluded. Conventional coronary angiography (performed 18 (12) days before 32 x 0.5-MDCTA) was analysed by quantitative coronary angiography. RESULTS Median Agatston calcium score was 510 (range 3-5066). Sensitivity, specificity, and positive and negative predictive values for detection of > or = 50% stenoses in native arteries were 76% (29 of 38), 94% (190 of 202), 71% (29 of 41), and 96% (190 of 199), respectively. Overall diagnostic accuracy was 91% (219 of 240). Due to the following artefacts 20% (69 of 352) of the vessels were excluded: motion, noise, and low contrast enhancement isolated or in combination (45 of 69 (65%)); image distortion by implantable cardioverter-defibrillator or pacemaker leads (18 of 69 (26%)); and blooming secondary to severe calcification (6 of 69 (9%)). CONCLUSIONS Coronary 32 x 0.5-MDCTA accurately excludes > or = 50% stenoses in patients with advanced CAD and high calcium scores with an overall diagnostic accuracy of 91%.
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Affiliation(s)
- M A S Cordeiro
- Division of Cardiology, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Van Herck PL, Gavit L, Gorissen P, Wuyts FL, Claeys MJ, Bosmans JM, Benali K, Vrints CJ. Quantitative coronary arteriography on digital flat-panel system. Catheter Cardiovasc Interv 2005; 63:192-200. [PMID: 15390252 DOI: 10.1002/ccd.20117] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
On images acquired with a digital flat-panel (DFP) detector, known for its better image quality, the performance of a validated quantitative coronary arteriography (QCA) software, CAASII (Cardiovascular Angiography Analysis System or CAAS), and a DFP-dedicated QCA algorithm (flat-panel analysis software or FPAS) was compared in a phantom and a patient study. On phantom, FPAS performed with higher accuracy the quantification of the smallest tubes and the calibration of an empty catheter. The overall accuracy and precision for the quantification procedure was better for FPAS (0.07 +/- 0.04 mm) than for the CAAS (0.19 +/- 0.06 mm; P = 0.03 and P < 0.01, respectively). In the patient study, the main difference between the two algorithms was found in the small diameters: CAAS almost always gave higher values than FPAS for the minimal luminal diameter (P < 0.001) and could only give values up to 70% for diameter stenosis. In conclusion, the FPAS can be considered more appropriate for assessing severe stenoses on digital flat-panel images.
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Affiliation(s)
- Paul L Van Herck
- Department of Cardiology, Antwerp University Hospital, Edegem, Belgium.
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Alfonso F, García P, Fleites H, Pimentel G, Sabaté M, Hernández R, Escaned J, Bañuelos C, Pérez-Vizcayno MJ, Moreno R, Macaya C. Repeat stenting for the prevention of the early lumen loss phenomenon in patients with in-stent restenosis. Angiographic and intravascular ultrasound findings of a randomized study. Am Heart J 2005; 149:e1-8. [PMID: 15846250 DOI: 10.1016/j.ahj.2004.06.022] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Early lumen loss (ELL) may be detected in patients undergoing coronary interventions for in-stent restenosis. This phenomenon may contribute to recurrences. This prospective, randomized study was designed to determine if repeat stent implantation may prevent ELL in patients with in-stent restenosis. METHODS Forty patients were randomized: 20 were allocated to elective stent implantation and 20 to conventional balloon angioplasty. Quantitative coronary angiography and intravascular ultrasound (IVUS) volumetric studies were systematically performed (1) before the procedure, (2) immediately after intervention, and (3) 30 to 60 minutes later. RESULTS Baseline characteristics were similar in both groups. After the delay time interval (46 +/- 8 minutes), quantitative coronary angiography revealed a significant reduction in minimal lumen diameter (2.2 +/- 0.5 mm vs 1.7 +/- 0.5 mm, P < .001) in the balloon angioplasty arm. Likewise, in this group, IVUS demonstrated a reduction in mean lumen area (7.1 +/- 2 mm2 vs 6.2 +/- 2 mm2 , P < .001) and lumen volume (144 +/- 59 mm3 vs 126 +/- 54 mm3 , P < .001). In 4 of these patients, ELL was severe enough to require further intervention. In the stent arm, however, angiographic data and IVUS mean lumen area (7.7 +/- 3 mm2 vs 7.7 +/- 3 mm2) and lumen volume (161 +/- 72 mm3 vs 160 +/- 69 mm3) remained unchanged after the delay time interval. On multivariate analysis, stent implantation was an independent predictor of the absence of ELL by quantitative coronary angiography and by IVUS. In addition, patients with a larger ELL on IVUS had a lower event-free survival at 1 year (40% vs 79%, log rank P = .003). CONCLUSIONS This randomized study demonstrates that (1) ELL is frequently detected after treatment of in-stent restenosis with balloon angioplasty, that (2) ELL influences the long-term clinical outcome of these patients, and that (3) repeat stent implantation prevents ELL.
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Affiliation(s)
- Fernando Alfonso
- Interventional Cardiology Department, Cardiovascular Institute, San Carlos University Hospital, Madrid, Spain.
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Kageyama T, Satou T, Imazeki M, Satou H, Ueki S, Wakamatsu O, Amauchi H, Nakazawa Y. [Accuracy of quantitative coronary angiography for different directions of the coronary artery]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2005; 61:71-8. [PMID: 15682034 DOI: 10.6009/jjrt.kj00003326616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
We evaluated the effect of changes in the direction of the coronary artery in terms of the accuracy and precision of vessel diameter measurement in a quantitative coronary angiography system (QCA system). Vessel phantoms sized 0.3, 0.5, 1.0, 1.5, 2.0, and 2.5 mm in diameter were evaluated. The phantoms were aligned on an acrylic plate, and the angle to the television (TV) camera was altered. The deployed angles were 0 (perpendicular), 45, 90, and 135 degrees in clockwise order. The phantoms were imaged with matrices of 1024 x 1024 (1024(2)), 512 x 512 (512(2)), and 512 x 1024. Image size was 7 inches, and the frame rate was 15 frames per second. Minimal lumen diameters were measured on the ACA system. The results revealed that, in the 1024(2) matrix, overall accuracy for the 90-degree angle was significantly underestimated compared with the 0-degree angle (-0.14 vs. -0.014 mm; p=0.007). Accuracy for the 90-degree angle was better than that for the 0-degree angle when the vessel diameter was 1 mm or smaller (-0.02+/-0.16 vs. 0.10+/-0.22 mm). In addition, precision was better at the 90-degree angle than with the other angles in the 1024(2) matrix (overall precision=0.002 mm). In the 512(2) matrix, overall accuracy for the 90-degree angle was significantly underestimated compared with the 45-degree angle (-0.077 vs. 0.096 mm; p=0.02). In addition, accuracy for the 90-degree angle was better than that for the 45-degree angle below 1 mm (0.05+/-0.24 mm vs. 0.26+/-0.47 mm). In terms of overall accuracy, the 45-degree angle in the 512(2) matrix showed significant overestimation compared with that in the 1024(2) matrix (0.096 vs. -0.069 mm; p=0.015). There was no difference in accuracy in the 512 x 1024 matrix. Our results suggest that the direction of the vessel against the TV image affects accuracy of measurement in the QCA system.
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Schoenhagen P, White RD, Tuzcu EM. Comprehensive imaging of coronary artery disease: impact on contemporary treatment approaches. COMPREHENSIVE THERAPY 2005; 31:159-65. [PMID: 15901946 DOI: 10.1007/s12019-005-0012-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2005] [Accepted: 02/09/2005] [Indexed: 05/02/2023]
Abstract
Coronary artery disease remains a major cause of mortality. Together with novel therapeutic and preventive approaches, important advances of coronary imaging are currently emerging. This article describes the status of modern coronary imaging and outlines expected future developments.
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Affiliation(s)
- Paul Schoenhagen
- Department of Radiology, and Cardiovascular Medicine, The Cleveland Clinic Foundation, Cleveland, OH 44195, USA
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