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Liang L, Zhu Y, Li F, Guo K, Chang S, Li Q, Zhang Y, Li D. Comparative analysis of instantaneous wave-free ratio and quantitative real-time myocardial contrast echocardiography for the assessment of myocardial perfusion. Front Cardiovasc Med 2022; 9:893647. [DOI: 10.3389/fcvm.2022.893647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 10/06/2022] [Indexed: 01/10/2023] Open
Abstract
Background and hypothesisThe field of coronary artery physiology is developing rapidly and changing the practice of interventional cardiology. A new functional evaluation technique using the instantaneous wave-free ratio (iFR) has become an alternative to fractional flow reserve. Future research studies need to determine whether physiological indicators play a role in evaluating myocardial perfusion in the catheter room.Materials and methodsThirty-eight patients scheduled for coronary angiography and iFR evaluation underwent a real-time myocardial contrast echocardiography (RT-MCE) examination at rest. The myocardial perfusion parameters (A, β, and A × β) on the myocardial perfusion curve were quantitatively analyzed using Q-Lab software. Coronary angiography and iFR assessment were completed within 1 week after the RT-MCE examination in all patients. Correlation analysis was used to identify iFR- and MCE-related indicators. The sensitivity and specificity of iFR in the quantitative detection of coronary microcirculation were obtained.ResultsThe correlation coefficients between iFR and A, β, and A × β were 0.81, 0.66, and 0.82, respectively. The cut-off value for iFR was 0.85 for microvascular ischemia detection, while the sensitivity and specificity for the diagnosis of myocardial perfusion were 90.7 and 89.9%, respectively. The receiver operating characteristic (ROC) curve area for iFR was 0.946 in the segments related to myocardial blood flow.ConclusionThe iFR is an effective tool for detecting myocardial microcirculation perfusion, with satisfactory diagnostic performance and a demonstrated role in physiological indices used for the perfusion assessment.
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Ahmad A, Corban MT, Lerman A. Contrast fractional flow reserve vs adenosine fractional flow reserve: The impact of discordant results. Int J Cardiol 2020; 328:59-60. [PMID: 33316257 DOI: 10.1016/j.ijcard.2020.12.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 12/05/2020] [Indexed: 11/18/2022]
Affiliation(s)
- Ali Ahmad
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Michel T Corban
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Amir Lerman
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA.
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Gutiérrez-Barrios A, Noval-Morillas I, Camacho-Freire S, Puche JE, Gheorghe L, Silva E, Alarcon-Lastra I, Cañadas-Pruaño D, Gómez-Menchero A, Calle-Pérez G, Diaz-Fernandez JF, Vázquez-García R. Contrast FFR plus intracoronary injection of nitro-glycerine accurately predicts FFR for coronary stenosis functional assessment. Minerva Cardiol Angiol 2020; 69:449-457. [PMID: 33258564 DOI: 10.23736/s2724-5683.20.05354-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Fractional flow reserve (FFR) is the "gold standard" for assessing the physiological significance of coronary disease. In the last decade, several alternative adenosine-free indexes have been proposed in order to facilitate the dissemination of the functional evaluation of coronary stenosis. Our aim was to investigate whether radiographic contrast plus intracoronary nitroglycerin (cFFR-NTG) can predict functional assessment of coronary stenosis offering superior diagnostic agreement with FFR compared to non-hyperemic indexes and contrast mediated FFR (cFFR). METHODS Three hundred twenty-nine lesions evaluated with pressure wire in 266 patients were prospectively included in this multicenter study. RESULTS The ROC curves for cFFR-NTG using an FFR≤0.80 showed a higher accuracy in predicting FFR (AUC=0.97) than resting Pd/Pa (AUC=0.90, P<0.01) and cFFR (AUC=0.93.5, P<0.01). A significant (P<0.01) strong correlation was found between FFR and the four analyzed indexes: Pd/Pa (r=0.78); iFR/RFR (r=0.73); cFFR(r=0.89) and cFFR-NTG (r=0.93). cFFR-NTG showed the closest agreement at Bland-Altman analysis. The cFFR-NTG cut off value >0.84 showed the highest negative predictive value (88%), specificity (91%), sensitivity (94%) and accuracy (92%) of the studied indexes. CONCLUSIONS Submaximal hyperemic adenosine-free indexes are an efficient alternative to adenosine for the physiological assessment of epicardial coronary disease. The most accurate index in predicting the functional significance of coronary stenosis using FFR as reference was cFFR-NTG.
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Affiliation(s)
- Alejandro Gutiérrez-Barrios
- Department of Cardiology, Puerta del Mar University Hospital, Cádiz, Spain - .,Instituto de Investigación e Innovación en Ciencias Biomédicas de Cádiz (INiBICA), Cádiz, Spain -
| | - Inmaculada Noval-Morillas
- Department of Cardiology, Puerta del Mar University Hospital, Cádiz, Spain.,Instituto de Investigación e Innovación en Ciencias Biomédicas de Cádiz (INiBICA), Cádiz, Spain
| | | | - Juan E Puche
- Department of Cardiology, Puerta del Mar University Hospital, Cádiz, Spain
| | - Livia Gheorghe
- Department of Cardiology, Puerta del Mar University Hospital, Cádiz, Spain.,Instituto de Investigación e Innovación en Ciencias Biomédicas de Cádiz (INiBICA), Cádiz, Spain
| | - Etelvino Silva
- Department of Cardiology, Juan Ramón Jiménez Hospital, Huelva, Spain
| | | | - Dolores Cañadas-Pruaño
- Department of Cardiology, Puerta del Mar University Hospital, Cádiz, Spain.,Instituto de Investigación e Innovación en Ciencias Biomédicas de Cádiz (INiBICA), Cádiz, Spain
| | | | - Germán Calle-Pérez
- Department of Cardiology, Puerta del Mar University Hospital, Cádiz, Spain.,Instituto de Investigación e Innovación en Ciencias Biomédicas de Cádiz (INiBICA), Cádiz, Spain
| | | | - Rafael Vázquez-García
- Department of Cardiology, Puerta del Mar University Hospital, Cádiz, Spain.,Instituto de Investigación e Innovación en Ciencias Biomédicas de Cádiz (INiBICA), Cádiz, Spain
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Kleczyński P, Dziewierz A, Rzeszutko Ł, Dudek D, Legutko J. Contrast medium Pd/Pa ratio in comparison to fractional flow reserve, quantitative flow ratio and instantaneous wave-free ratio for evaluation of intermediate coronary lesions. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2020; 16:384-390. [PMID: 33598010 PMCID: PMC7863821 DOI: 10.5114/aic.2020.101762] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 10/01/2020] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Contrast medium Pd/Pa ratio (cFFR) was introduced as an alternative to fractional flow reserve (FFR). AIM To assess the accuracy of cFFR in predicting of FFR, quantitative flow ratio (QFR) and instantaneous wave-free ratio (iFR). MATERIAL AND METHODS Resting Pd/Pa, cFFR, FFR, QFR, and iFR were measured in 110 intermediate coronary lesions. cFFR was obtained after intracoronary injection of contrast medium. FFR was measured after the intravenous administration of adenosine. QFR was derived from fixed empiric hyperemic flow velocity based on coronary angiography. iFR was calculated by measuring the resting pressure gradient across a coronary lesion during diastole. RESULTS Forty-four patients with 110 intermediate coronary lesions were enrolled. Mean baseline Pd/Pa was 0.93 ±0.05. Mean cFFR value was similar to FFR value (0.83 ±0.09 vs. 0.81 ±0.09; p = 0.13) and QFR (0.81 ±0.1; p = 0.69) and iFR (0.90 ±0.07; p = 0.1). A total of 46 vessels (41.8%) had FFR ≤ 0.80, 50 (45.5%) vessels had cFFR ≤ 0.83, 44 (40.0%) vessels had QFR ≤ 0.80, and 38 (34.5%) vessels had iFR ≤ 0.89. An excellent agreement between cFFR and resting Pd/Pa, FFR, QFR, and iFR was confirmed (intraclass correlation coefficients of 0.83, 0.99, 0.98, and 0.88, respectively). The optimal cutoff value of cFFR was 0.83 for prediction of FFR ≤ 0.80 with sensitivity, specificity, and accuracy of 96.9%, 97.8%, and 97.3%, respectively. 100% sensitivity was observed for a cutoff value of 0.82 and 100% specificity for a cutoff value of 0.84; AUC = 0.998 (0.995-1.00); p < 0.001. CONCLUSIONS Contrast medium Pd/Pa ratio seems to be accurate in predicting the functional significance of borderline coronary lesions assessed with FFR, iFR, and QFR.
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Affiliation(s)
- Paweł Kleczyński
- Department of Interventional Cardiology, John Paul II Hospital, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Artur Dziewierz
- 2 Department of Cardiology, University Hospital, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Łukasz Rzeszutko
- 2 Department of Cardiology, University Hospital, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Dariusz Dudek
- 2 Department of Cardiology, University Hospital, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Jacek Legutko
- Department of Interventional Cardiology, John Paul II Hospital, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
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Meta-Analysis of Diagnostic Performance of Contrast-Fractional Flow Reserve versus Quantitative Flow Ratio for Functional Assessment of Coronary Stenoses. J Interv Cardiol 2020. [DOI: 10.1155/2020/7352150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background. Use of the fractional flow reserve (FFR) technique is recommended to evaluate coronary stenosis severity and guide revascularization. However, its high cost, time to administer, and the side effects of adenosine reduce its clinical utility. Two novel adenosine-free indices, contrast-FFR (cFFR) and quantitative flow ratio (QFR), can simplify the functional evaluation of coronary stenosis. This study aimed to analyze the diagnostic performance of cFFR and QFR using FFR as a reference index. Methods. We conducted a systematic review and meta-analysis of observational studies in which cFFR or QFR was compared to FFR. A bivariate model was applied to pool diagnostic parameters. Cochran’s Q test and the I2 index were used to assess heterogeneity and identify the potential source of heterogeneity by metaregression and sensitivity analysis. Results. Overall, 2220 and 3000 coronary lesions from 20 studies were evaluated by cFFR and QFR, respectively. The pooled sensitivity and specificity were 0.87 (95% CI: 0.81, 0.91) and 0.92 (95% CI: 0.88, 0.94) for cFFR and 0.87 (95% CI: 0.82, 0.91) and 0.91 (95% CI: 0.87, 0.93) for QFR, respectively. No statistical significance of sensitivity and specificity for cFFR and QFR were observed in the bivariate analysis (P=0.8406 and 0.4397, resp.). The area under summary receiver-operating curve of cFFR and QFR was 0.95 (95% CI: 0.93, 0.97) for cFFR and 0.95 (95% CI: 0.93, 0.97). Conclusion. Both cFFR and QFR have good diagnostic performance in detecting functional severity of coronary arteries and showed similar diagnostic parameters.
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Fujimori Y, Baba T, Yamazaki K, Hashimoto S, Yamanaka Y, Ebisuda K, Kurihara K, Koike N, Takeuchi N, Nishiyama S, Terasawa Y, Wakabayashi T, Imai T. Saline-induced Pd/Pa ratio predicts functional significance of coronary stenosis assessed using fractional flow reserve. EUROINTERVENTION 2018; 14:898-906. [PMID: 29688181 DOI: 10.4244/eij-d-17-01010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS Fractional flow reserve (FFR), assessed using distal coronary pressure/aortic pressure (Pd)/(Pa) ratio, functionally evaluates coronary stenosis. An assessment method without vasodilators would be helpful. A single intracoronary bolus of saline decreases Pd because of the speculated low-viscosity effect. We hypothesised that saline-induced Pd/Pa ratio (SPR) could functionally evaluate coronary stenosis. This study aimed to test the accuracy and utility of SPR for predicting FFR ≤0.80. METHODS AND RESULTS In 137 coronary lesions with over 50% angiographic diameter stenosis, SPR was assessed using an intracoronary bolus of saline (2 mL/s) for five heartbeats (SPR-5) and three heartbeats (SPR-3). FFR was obtained after intravenous adenosine infusion (140 µg/kg/min). There was a strong correlation between FFR and SPR-5 or SPR-3 (R=0.941 and R=0.933, respectively). Receiver operating characteristic (ROC) curve analysis demonstrated good accuracy (86.3%) for SPR-5, with a cut-off of ≤0.84 for predicting FFR ≤0.80 (area under ROC curve 0.96, specificity 94.3, sensitivity 79.9). Thirty-three lesions (24%) were located in the "grey zone" (SPR 0.83-0.88). No complications were observed in 673 SPR measurements. CONCLUSIONS SPR may accurately predict FFR and can limit adenosine use to one in four lesions. Further studies are needed to confirm the validity of SPR.
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Nishi T, Johnson NP, De Bruyne B, Berry C, Gould KL, Jeremias A, Oldroyd KG, Kobayashi Y, Choi DH, Pijls NHJ, Fearon WF. Influence of Contrast Media Dose and Osmolality on the Diagnostic Performance of Contrast Fractional Flow Reserve. Circ Cardiovasc Interv 2018; 10:CIRCINTERVENTIONS.117.004985. [PMID: 29042397 DOI: 10.1161/circinterventions.117.004985] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 08/15/2017] [Indexed: 01/10/2023]
Abstract
BACKGROUND Contrast fractional flow reserve (cFFR) is a method for assessing functional significance of coronary stenoses, which is more accurate than resting indices and does not require adenosine. However, contrast media volume and osmolality may affect the degree of hyperemia and therefore diagnostic performance. METHODS AND RESULTS cFFR, instantaneous wave-free ratio, distal pressure/aortic pressure at rest, and FFR were measured in 763 patients from 12 centers. We compared the diagnostic performance of cFFR between patients receiving low or iso-osmolality contrast (n=574 versus 189) and low or high contrast volume (n=341 versus 422) using FFR≤0.80 as a reference standard. The sensitivity, specificity, and overall accuracy of cFFR for the low versus iso-osmolality groups were 73%, 93%, and 85% versus 87%, 90%, and 89%, and for the low versus high contrast volume groups were 69%, 99%, and 83% versus 82%, 93%, and 88%. By receiver operating characteristics (ROC) analysis, cFFR provided better diagnostic performance than resting indices regardless of contrast osmolality and volume (P<0.001 for all groups). There was no significant difference between the area under the curve of cFFR in the low- and iso-osmolality groups (0.938 versus 0.957; P=0.40) and in the low- and high-volume groups (0.939 versus 0.949; P=0.61). Multivariable logistic regression analysis showed that neither contrast osmolality nor volume affected the overall accuracy of cFFR; however, both affected the sensitivity and specificity. CONCLUSIONS The overall accuracy of cFFR is greater than instantaneous wave-free ratio and distal pressure/aortic pressure and not significantly affected by contrast volume and osmolality. However, contrast volume and osmolality do affect the sensitivity and specificity of cFFR. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov. Unique identifier: NCT02184117.
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Affiliation(s)
- Takeshi Nishi
- From the Stanford University Medical Center, CA (T.N., Y.K., D.-H.C., W.F.F.); Stanford Cardiovascular Institute, CA (T.N., Y.K., D.-H.C., W.F.F.); University of Texas Medical School and Memorial Hermann Hospital, Houston (N.P.J., K.L.G.); Cardiovascular Center Aalst, Belgium (B.D.B.); West of Scotland Heart and Lung Center, Golden Jubilee National Hospital, Clydebank, Scotland (C.B., K.G.O.); British Heart Foundation Glasgow Cardiovascular Research Center, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Scotland (C.B.); Division of Cardiovascular Medicine, Stony Brook University Medical Center, NY (A.J.); Cardiovascular Research Foundation (CFR), New York, NY (A.J.); Catharina Hospital, Eindhoven, the Netherlands (N.H.J.P.); and Eindhoven University of Technology, the Netherlands (N.H.J.P.)
| | - Nils P Johnson
- From the Stanford University Medical Center, CA (T.N., Y.K., D.-H.C., W.F.F.); Stanford Cardiovascular Institute, CA (T.N., Y.K., D.-H.C., W.F.F.); University of Texas Medical School and Memorial Hermann Hospital, Houston (N.P.J., K.L.G.); Cardiovascular Center Aalst, Belgium (B.D.B.); West of Scotland Heart and Lung Center, Golden Jubilee National Hospital, Clydebank, Scotland (C.B., K.G.O.); British Heart Foundation Glasgow Cardiovascular Research Center, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Scotland (C.B.); Division of Cardiovascular Medicine, Stony Brook University Medical Center, NY (A.J.); Cardiovascular Research Foundation (CFR), New York, NY (A.J.); Catharina Hospital, Eindhoven, the Netherlands (N.H.J.P.); and Eindhoven University of Technology, the Netherlands (N.H.J.P.)
| | - Bernard De Bruyne
- From the Stanford University Medical Center, CA (T.N., Y.K., D.-H.C., W.F.F.); Stanford Cardiovascular Institute, CA (T.N., Y.K., D.-H.C., W.F.F.); University of Texas Medical School and Memorial Hermann Hospital, Houston (N.P.J., K.L.G.); Cardiovascular Center Aalst, Belgium (B.D.B.); West of Scotland Heart and Lung Center, Golden Jubilee National Hospital, Clydebank, Scotland (C.B., K.G.O.); British Heart Foundation Glasgow Cardiovascular Research Center, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Scotland (C.B.); Division of Cardiovascular Medicine, Stony Brook University Medical Center, NY (A.J.); Cardiovascular Research Foundation (CFR), New York, NY (A.J.); Catharina Hospital, Eindhoven, the Netherlands (N.H.J.P.); and Eindhoven University of Technology, the Netherlands (N.H.J.P.)
| | - Colin Berry
- From the Stanford University Medical Center, CA (T.N., Y.K., D.-H.C., W.F.F.); Stanford Cardiovascular Institute, CA (T.N., Y.K., D.-H.C., W.F.F.); University of Texas Medical School and Memorial Hermann Hospital, Houston (N.P.J., K.L.G.); Cardiovascular Center Aalst, Belgium (B.D.B.); West of Scotland Heart and Lung Center, Golden Jubilee National Hospital, Clydebank, Scotland (C.B., K.G.O.); British Heart Foundation Glasgow Cardiovascular Research Center, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Scotland (C.B.); Division of Cardiovascular Medicine, Stony Brook University Medical Center, NY (A.J.); Cardiovascular Research Foundation (CFR), New York, NY (A.J.); Catharina Hospital, Eindhoven, the Netherlands (N.H.J.P.); and Eindhoven University of Technology, the Netherlands (N.H.J.P.)
| | - K Lance Gould
- From the Stanford University Medical Center, CA (T.N., Y.K., D.-H.C., W.F.F.); Stanford Cardiovascular Institute, CA (T.N., Y.K., D.-H.C., W.F.F.); University of Texas Medical School and Memorial Hermann Hospital, Houston (N.P.J., K.L.G.); Cardiovascular Center Aalst, Belgium (B.D.B.); West of Scotland Heart and Lung Center, Golden Jubilee National Hospital, Clydebank, Scotland (C.B., K.G.O.); British Heart Foundation Glasgow Cardiovascular Research Center, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Scotland (C.B.); Division of Cardiovascular Medicine, Stony Brook University Medical Center, NY (A.J.); Cardiovascular Research Foundation (CFR), New York, NY (A.J.); Catharina Hospital, Eindhoven, the Netherlands (N.H.J.P.); and Eindhoven University of Technology, the Netherlands (N.H.J.P.)
| | - Allen Jeremias
- From the Stanford University Medical Center, CA (T.N., Y.K., D.-H.C., W.F.F.); Stanford Cardiovascular Institute, CA (T.N., Y.K., D.-H.C., W.F.F.); University of Texas Medical School and Memorial Hermann Hospital, Houston (N.P.J., K.L.G.); Cardiovascular Center Aalst, Belgium (B.D.B.); West of Scotland Heart and Lung Center, Golden Jubilee National Hospital, Clydebank, Scotland (C.B., K.G.O.); British Heart Foundation Glasgow Cardiovascular Research Center, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Scotland (C.B.); Division of Cardiovascular Medicine, Stony Brook University Medical Center, NY (A.J.); Cardiovascular Research Foundation (CFR), New York, NY (A.J.); Catharina Hospital, Eindhoven, the Netherlands (N.H.J.P.); and Eindhoven University of Technology, the Netherlands (N.H.J.P.)
| | - Keith G Oldroyd
- From the Stanford University Medical Center, CA (T.N., Y.K., D.-H.C., W.F.F.); Stanford Cardiovascular Institute, CA (T.N., Y.K., D.-H.C., W.F.F.); University of Texas Medical School and Memorial Hermann Hospital, Houston (N.P.J., K.L.G.); Cardiovascular Center Aalst, Belgium (B.D.B.); West of Scotland Heart and Lung Center, Golden Jubilee National Hospital, Clydebank, Scotland (C.B., K.G.O.); British Heart Foundation Glasgow Cardiovascular Research Center, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Scotland (C.B.); Division of Cardiovascular Medicine, Stony Brook University Medical Center, NY (A.J.); Cardiovascular Research Foundation (CFR), New York, NY (A.J.); Catharina Hospital, Eindhoven, the Netherlands (N.H.J.P.); and Eindhoven University of Technology, the Netherlands (N.H.J.P.)
| | - Yuhei Kobayashi
- From the Stanford University Medical Center, CA (T.N., Y.K., D.-H.C., W.F.F.); Stanford Cardiovascular Institute, CA (T.N., Y.K., D.-H.C., W.F.F.); University of Texas Medical School and Memorial Hermann Hospital, Houston (N.P.J., K.L.G.); Cardiovascular Center Aalst, Belgium (B.D.B.); West of Scotland Heart and Lung Center, Golden Jubilee National Hospital, Clydebank, Scotland (C.B., K.G.O.); British Heart Foundation Glasgow Cardiovascular Research Center, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Scotland (C.B.); Division of Cardiovascular Medicine, Stony Brook University Medical Center, NY (A.J.); Cardiovascular Research Foundation (CFR), New York, NY (A.J.); Catharina Hospital, Eindhoven, the Netherlands (N.H.J.P.); and Eindhoven University of Technology, the Netherlands (N.H.J.P.)
| | - Dong-Hyun Choi
- From the Stanford University Medical Center, CA (T.N., Y.K., D.-H.C., W.F.F.); Stanford Cardiovascular Institute, CA (T.N., Y.K., D.-H.C., W.F.F.); University of Texas Medical School and Memorial Hermann Hospital, Houston (N.P.J., K.L.G.); Cardiovascular Center Aalst, Belgium (B.D.B.); West of Scotland Heart and Lung Center, Golden Jubilee National Hospital, Clydebank, Scotland (C.B., K.G.O.); British Heart Foundation Glasgow Cardiovascular Research Center, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Scotland (C.B.); Division of Cardiovascular Medicine, Stony Brook University Medical Center, NY (A.J.); Cardiovascular Research Foundation (CFR), New York, NY (A.J.); Catharina Hospital, Eindhoven, the Netherlands (N.H.J.P.); and Eindhoven University of Technology, the Netherlands (N.H.J.P.)
| | - Nico H J Pijls
- From the Stanford University Medical Center, CA (T.N., Y.K., D.-H.C., W.F.F.); Stanford Cardiovascular Institute, CA (T.N., Y.K., D.-H.C., W.F.F.); University of Texas Medical School and Memorial Hermann Hospital, Houston (N.P.J., K.L.G.); Cardiovascular Center Aalst, Belgium (B.D.B.); West of Scotland Heart and Lung Center, Golden Jubilee National Hospital, Clydebank, Scotland (C.B., K.G.O.); British Heart Foundation Glasgow Cardiovascular Research Center, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Scotland (C.B.); Division of Cardiovascular Medicine, Stony Brook University Medical Center, NY (A.J.); Cardiovascular Research Foundation (CFR), New York, NY (A.J.); Catharina Hospital, Eindhoven, the Netherlands (N.H.J.P.); and Eindhoven University of Technology, the Netherlands (N.H.J.P.)
| | - William F Fearon
- From the Stanford University Medical Center, CA (T.N., Y.K., D.-H.C., W.F.F.); Stanford Cardiovascular Institute, CA (T.N., Y.K., D.-H.C., W.F.F.); University of Texas Medical School and Memorial Hermann Hospital, Houston (N.P.J., K.L.G.); Cardiovascular Center Aalst, Belgium (B.D.B.); West of Scotland Heart and Lung Center, Golden Jubilee National Hospital, Clydebank, Scotland (C.B., K.G.O.); British Heart Foundation Glasgow Cardiovascular Research Center, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Scotland (C.B.); Division of Cardiovascular Medicine, Stony Brook University Medical Center, NY (A.J.); Cardiovascular Research Foundation (CFR), New York, NY (A.J.); Catharina Hospital, Eindhoven, the Netherlands (N.H.J.P.); and Eindhoven University of Technology, the Netherlands (N.H.J.P.).
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An augmented Pd/Pa response after contrast injection during intravenous adenosine-induced hyperemia. Coron Artery Dis 2018; 29:609-610. [PMID: 29762146 DOI: 10.1097/mca.0000000000000631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Spagnoli V, Picard F, Tadros VX, Cournoyer D, Doucet S, Tanguay JF, Gosselin G, de Guise P, Gallo R. Simplifying the assessment of coronary artery stenosis by enhancing instantaneous wave free ratio. Cardiovasc Diagn Ther 2018; 8:156-163. [PMID: 29850406 DOI: 10.21037/cdt.2017.12.04] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Background Instantaneous wave free ratio (iFR) does not require adenosine, but has a relatively wide intermediate range where functional assessment remains inconclusive. In this pilot study, we sought to enhance iFR through with the use of intracoronary (IC) saline (iFRs) and contrast media (iFRc) and determine whether these techniques correlated well with fractional flow reserve (FFR). Methods Patients with coronary artery stenosis (CAS) associated with an iFR in the intermediate zone (≥0.86 and ≤0.93) were prospectively assessed with resting distal coronary pressure/aorta pressure (Pd/Pa), iFR, iFRs, iFRc and FFR. Results A total of 40 coronary lesions were studied (40 patients). Pearson correlation coefficients for FFR and iFR, FFR and iFRs, FFR and iFRc were respectively: 0.57 (P=0.0002), 0.80 (P<0.0001) and 0.77 (P<0.0001). Receiver-operating characteristic (ROC) curve analysis showed similar area under the curve (AUC) of iFRs and iFR [0.90 (95% CI: 0.76-1) vs. 0.89 (95% CI: 0.79-0.99), P=0.89]. Youden's index established cut-off values of ≤0.90 for iFR (sensitivity =91%, specificity =74%) and ≤0.78 for iFRs (sensitivity =73%, specificity =100%). In contrast, the AUC of iFRc was superior to the AUC of iFR [0.99 (95% CI: 0.98-1), P=0.049]. iFRc showed excellent accuracy and established cut-off values of ≤0.81 in predicting an FFR value of ≤0.80 (sensitivity =100%, specificity =93%). Conclusions When iFR is in the intermediate zone, functional assessment of CAS by iFR is enhanced with the use of contrast media but not saline. This pilot study could be hypothesis generating for further study to enhance iFR specificity and sensibility.
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Affiliation(s)
- Vincent Spagnoli
- Department of Cardiology, Montréal Heart Institute, Université de Montréal, Montréal, Canada
| | - Fabien Picard
- Department of Cardiology, Montréal Heart Institute, Université de Montréal, Montréal, Canada
| | - Victor-Xavier Tadros
- Department of Cardiology, Montréal Heart Institute, Université de Montréal, Montréal, Canada
| | | | - Serge Doucet
- Department of Cardiology, Montréal Heart Institute, Université de Montréal, Montréal, Canada
| | - Jean François Tanguay
- Department of Cardiology, Montréal Heart Institute, Université de Montréal, Montréal, Canada
| | - Gilbert Gosselin
- Department of Cardiology, Montréal Heart Institute, Université de Montréal, Montréal, Canada
| | - Pierre de Guise
- Department of Cardiology, Montréal Heart Institute, Université de Montréal, Montréal, Canada
| | - Richard Gallo
- Department of Cardiology, Montréal Heart Institute, Université de Montréal, Montréal, Canada
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AL-Obaidi FR, Fearon WF, Yong AS. Invasive physiological indices to determine the functional significance of coronary stenosis. IJC HEART & VASCULATURE 2018; 18:39-45. [PMID: 29876502 PMCID: PMC5988484 DOI: 10.1016/j.ijcha.2018.02.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 02/13/2018] [Indexed: 01/10/2023]
Abstract
Physiological measurements are now commonly used to assess coronary lesions in the cardiac catheterisation laboratory, and this practice is evidence-based and supported by clinical guidelines. Fractional flow reserve is currently the gold standard method to determine whether coronary lesions are functionally significant, and is used to guide revascularization. There are however several other physiological measurements that have been proposed as alternatives to the fractional flow reserve. This review aims to comprehensively discuss physiological indices that can be used in the cardiac catheterisation laboratory to determine the functional significance of coronary lesions. We will focus on their advantages and disadvantages, and the current evidence supporting their use.
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Affiliation(s)
- Firas R. AL-Obaidi
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
- College of Medicine, University of Thi Qar, Iraq
| | - William F. Fearon
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Andy S.C. Yong
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
- ANZAC Research Institute, Concord Hospital, Sydney, Australia
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Van Wyk P, Puri A, Blake J, Elliott JM, McClean D, Arshad M, Sutherland J, Thacker O, Bailey T, Yi M, Smyth D. The Utility of Contrast Medium Fractional Flow Reserve in Functional Assessment Of Coronary Disease in Daily Practice. Heart Lung Circ 2018; 27:212-218. [DOI: 10.1016/j.hlc.2017.03.158] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 03/08/2017] [Accepted: 03/15/2017] [Indexed: 01/10/2023]
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Han D, Lee JH, Rizvi A, Gransar H, Baskaran L, Schulman-Marcus J, Ó Hartaigh B, Lin FY, Min JK. Incremental role of resting myocardial computed tomography perfusion for predicting physiologically significant coronary artery disease: A machine learning approach. J Nucl Cardiol 2018; 25:223-233. [PMID: 28303473 DOI: 10.1007/s12350-017-0834-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 01/31/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND Evaluation of resting myocardial computed tomography perfusion (CTP) by coronary CT angiography (CCTA) might serve as a useful addition for determining coronary artery disease. We aimed to evaluate the incremental benefit of resting CTP over coronary stenosis for predicting ischemia using a computational algorithm trained by machine learning methods. METHODS 252 patients underwent CCTA and invasive fractional flow reserve (FFR). CT stenosis was classified as 0%, 1-30%, 31-49%, 50-70%, and >70% maximal stenosis. Significant ischemia was defined as invasive FFR < 0.80. Resting CTP analysis was performed using a gradient boosting classifier for supervised machine learning. RESULTS On a per-patient basis, accuracy, sensitivity, specificity, positive predictive, and negative predictive values according to resting CTP when added to CT stenosis (>70%) for predicting ischemia were 68.3%, 52.7%, 84.6%, 78.2%, and 63.0%, respectively. Compared with CT stenosis [area under the receiver operating characteristic curve (AUC): 0.68, 95% confidence interval (CI) 0.62-0.74], the addition of resting CTP appeared to improve discrimination (AUC: 0.75, 95% CI 0.69-0.81, P value .001) and reclassification (net reclassification improvement: 0.52, P value < .001) of ischemia. CONCLUSIONS The addition of resting CTP analysis acquired from machine learning techniques may improve the predictive utility of significant ischemia over coronary stenosis.
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Affiliation(s)
- Donghee Han
- Dalio Institute of Cardiovascular Imaging, Department of Radiology, NewYork-Presbyterian Hospital and the Weill Cornell Medicine, New York, NY, USA
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Ji Hyun Lee
- Dalio Institute of Cardiovascular Imaging, Department of Radiology, NewYork-Presbyterian Hospital and the Weill Cornell Medicine, New York, NY, USA
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Asim Rizvi
- Dalio Institute of Cardiovascular Imaging, Department of Radiology, NewYork-Presbyterian Hospital and the Weill Cornell Medicine, New York, NY, USA
| | - Heidi Gransar
- Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Lohendran Baskaran
- Dalio Institute of Cardiovascular Imaging, Department of Radiology, NewYork-Presbyterian Hospital and the Weill Cornell Medicine, New York, NY, USA
| | - Joshua Schulman-Marcus
- Dalio Institute of Cardiovascular Imaging, Department of Radiology, NewYork-Presbyterian Hospital and the Weill Cornell Medicine, New York, NY, USA
- Division of Cardiology, Albany Medical College, Albany, NY, USA
| | - Bríain Ó Hartaigh
- Dalio Institute of Cardiovascular Imaging, Department of Radiology, NewYork-Presbyterian Hospital and the Weill Cornell Medicine, New York, NY, USA
| | - Fay Y Lin
- Dalio Institute of Cardiovascular Imaging, Department of Radiology, NewYork-Presbyterian Hospital and the Weill Cornell Medicine, New York, NY, USA
| | - James K Min
- Dalio Institute of Cardiovascular Imaging, Department of Radiology, NewYork-Presbyterian Hospital and the Weill Cornell Medicine, New York, NY, USA.
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Hubbard L, Lipinski J, Ziemer B, Malkasian S, Sadeghi B, Javan H, Groves EM, Dertli B, Molloi S. Comprehensive Assessment of Coronary Artery Disease by Using First-Pass Analysis Dynamic CT Perfusion: Validation in a Swine Model. Radiology 2017; 286:93-102. [PMID: 29059038 DOI: 10.1148/radiol.2017162821] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Purpose To retrospectively validate a first-pass analysis (FPA) technique that combines computed tomographic (CT) angiography and dynamic CT perfusion measurement into one low-dose examination. Materials and Methods The study was approved by the animal care committee. The FPA technique was retrospectively validated in six swine (mean weight, 37.3 kg ± 7.5 [standard deviation]) between April 2015 and October 2016. Four to five intermediate-severity stenoses were generated in the left anterior descending artery (LAD), and 20 contrast material-enhanced volume scans were acquired per stenosis. All volume scans were used for maximum slope model (MSM) perfusion measurement, but only two volume scans were used for FPA perfusion measurement. Perfusion measurements in the LAD, left circumflex artery (LCx), right coronary artery, and all three coronary arteries combined were compared with microsphere perfusion measurements by using regression, root-mean-square error, root-mean-square deviation, Lin concordance correlation, and diagnostic outcomes analysis. The CT dose index and size-specific dose estimate per two-volume FPA perfusion measurement were also determined. Results FPA and MSM perfusion measurements (PFPA and PMSM) in all three coronary arteries combined were related to reference standard microsphere perfusion measurements (PMICRO), as follows: PFPA_COMBINED = 1.02 PMICRO_COMBINED + 0.11 (r = 0.96) and PMSM_COMBINED = 0.28 PMICRO_COMBINED + 0.23 (r = 0.89). The CT dose index and size-specific dose estimate per two-volume FPA perfusion measurement were 10.8 and 17.8 mGy, respectively. Conclusion The FPA technique was retrospectively validated in a swine model and has the potential to be used for accurate, low-dose vessel-specific morphologic and physiologic assessment of coronary artery disease. © RSNA, 2017.
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Affiliation(s)
- Logan Hubbard
- From the Department of Radiological Sciences (L.H., J.L., B.Z., S. Malkasian, B.S., H.J., B.D., S. Molloi) and Division of Cardiology (E.M.G.), University of California, Irvine, Medical Sciences I, B-140, Irvine, CA 92697
| | - Jerry Lipinski
- From the Department of Radiological Sciences (L.H., J.L., B.Z., S. Malkasian, B.S., H.J., B.D., S. Molloi) and Division of Cardiology (E.M.G.), University of California, Irvine, Medical Sciences I, B-140, Irvine, CA 92697
| | - Benjamin Ziemer
- From the Department of Radiological Sciences (L.H., J.L., B.Z., S. Malkasian, B.S., H.J., B.D., S. Molloi) and Division of Cardiology (E.M.G.), University of California, Irvine, Medical Sciences I, B-140, Irvine, CA 92697
| | - Shant Malkasian
- From the Department of Radiological Sciences (L.H., J.L., B.Z., S. Malkasian, B.S., H.J., B.D., S. Molloi) and Division of Cardiology (E.M.G.), University of California, Irvine, Medical Sciences I, B-140, Irvine, CA 92697
| | - Bahman Sadeghi
- From the Department of Radiological Sciences (L.H., J.L., B.Z., S. Malkasian, B.S., H.J., B.D., S. Molloi) and Division of Cardiology (E.M.G.), University of California, Irvine, Medical Sciences I, B-140, Irvine, CA 92697
| | - Hanna Javan
- From the Department of Radiological Sciences (L.H., J.L., B.Z., S. Malkasian, B.S., H.J., B.D., S. Molloi) and Division of Cardiology (E.M.G.), University of California, Irvine, Medical Sciences I, B-140, Irvine, CA 92697
| | - Elliott M Groves
- From the Department of Radiological Sciences (L.H., J.L., B.Z., S. Malkasian, B.S., H.J., B.D., S. Molloi) and Division of Cardiology (E.M.G.), University of California, Irvine, Medical Sciences I, B-140, Irvine, CA 92697
| | - Brian Dertli
- From the Department of Radiological Sciences (L.H., J.L., B.Z., S. Malkasian, B.S., H.J., B.D., S. Molloi) and Division of Cardiology (E.M.G.), University of California, Irvine, Medical Sciences I, B-140, Irvine, CA 92697
| | - Sabee Molloi
- From the Department of Radiological Sciences (L.H., J.L., B.Z., S. Malkasian, B.S., H.J., B.D., S. Molloi) and Division of Cardiology (E.M.G.), University of California, Irvine, Medical Sciences I, B-140, Irvine, CA 92697
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Hubbard L, Ziemer B, Lipinski J, Sadeghi B, Javan H, Groves EM, Malkasian S, Molloi S. Functional Assessment of Coronary Artery Disease Using Whole-Heart Dynamic Computed Tomographic Perfusion. Circ Cardiovasc Imaging 2017; 9:CIRCIMAGING.116.005325. [PMID: 27956409 DOI: 10.1161/circimaging.116.005325] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 10/13/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Computed tomographic (CT) angiography is an important tool for the evaluation of coronary artery disease but often correlates poorly with myocardial ischemia. Current dynamic CT perfusion techniques can assess ischemia but have limited accuracy and deliver high radiation dose. Therefore, an accurate, low-dose, dynamic CT perfusion technique is needed. METHODS AND RESULTS A total of 20 contrast-enhanced CT volume scans were acquired in 5 swine (40±10 kg) to generate CT angiography and perfusion images. Varying degrees of stenosis were induced using a balloon catheter in the proximal left anterior descending coronary artery, and a pressure wire was used for reference fractional flow reserve (FFR) measurement. Perfusion measurements were made with only 2 volume scans using a new first-pass analysis (FPA) technique and with 20 volume scans using an existing maximum slope model (MSM) technique. Perfusion (P) and FFR measurements were related by PFPA=1.01 FFR-0.03 (R2=0.85) and PMSM=1.03 FFR-0.03 (R2=0.80) for FPA and MSM techniques, respectively. Additionally, the effective radiation doses were calculated to be 2.64 and 26.4 mSv for FPA and MSM techniques, respectively. CONCLUSIONS A new FPA-based dynamic CT perfusion technique was validated in a swine animal model. The results indicate that the FPA technique can potentially be used for improved anatomical and functional assessment of coronary artery disease at a relatively low radiation dose.
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Affiliation(s)
- Logan Hubbard
- From the Department of Radiological Sciences (L.H., B.Z., J.L., B.S., H.J., S. Malkasian, S. Molloi) and Division of Cardiology (E.M.G.), University of California, Irvine
| | - Benjamin Ziemer
- From the Department of Radiological Sciences (L.H., B.Z., J.L., B.S., H.J., S. Malkasian, S. Molloi) and Division of Cardiology (E.M.G.), University of California, Irvine
| | - Jerry Lipinski
- From the Department of Radiological Sciences (L.H., B.Z., J.L., B.S., H.J., S. Malkasian, S. Molloi) and Division of Cardiology (E.M.G.), University of California, Irvine
| | - Bahman Sadeghi
- From the Department of Radiological Sciences (L.H., B.Z., J.L., B.S., H.J., S. Malkasian, S. Molloi) and Division of Cardiology (E.M.G.), University of California, Irvine
| | - Hanna Javan
- From the Department of Radiological Sciences (L.H., B.Z., J.L., B.S., H.J., S. Malkasian, S. Molloi) and Division of Cardiology (E.M.G.), University of California, Irvine
| | - Elliott M Groves
- From the Department of Radiological Sciences (L.H., B.Z., J.L., B.S., H.J., S. Malkasian, S. Molloi) and Division of Cardiology (E.M.G.), University of California, Irvine
| | - Shant Malkasian
- From the Department of Radiological Sciences (L.H., B.Z., J.L., B.S., H.J., S. Malkasian, S. Molloi) and Division of Cardiology (E.M.G.), University of California, Irvine
| | - Sabee Molloi
- From the Department of Radiological Sciences (L.H., B.Z., J.L., B.S., H.J., S. Malkasian, S. Molloi) and Division of Cardiology (E.M.G.), University of California, Irvine.
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La Grutta L, Toia P, Maffei E, Cademartiri F, Lagalla R, Midiri M. Infarct characterization using CT. Cardiovasc Diagn Ther 2017; 7:171-188. [PMID: 28540212 DOI: 10.21037/cdt.2017.03.18] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Myocardial infarction (MI) is a major cause of death and disability worldwide. The incidence is not expected to diminish, despite better prevention, diagnosis and treatment, because of the ageing population in industrialized countries and unhealthy lifestyles in developing countries. Nowadays it is highly requested an imaging tool able to evaluate MI and viability. Technology improvements determined an expansion of clinical indications from coronary plaque evaluation to functional applications (perfusion, ischemia and viability after MI) integrating additional phases and information in the mainstream examination. Cardiac computed tomography (CCT) and cardiac MR (CMR) employ different contrast media, but may characterize MI with overlapping imaging findings due to the similar kinetics and tissue distribution of gadolinium and iodinated contrast media. CCT may detect first-pass perfusion defects, dynamic perfusion after pharmacological stress, and delayed enhancement (DE) of non-viable territories.
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Affiliation(s)
| | - Patrizia Toia
- Department of Radiology, DIBIMED, University of Palermo, Palermo, Italy
| | - Erica Maffei
- Department of Radiology, Montreal Heart Institute/Universitè de Montreal, Montreal, Canada
| | - Filippo Cademartiri
- Department of Radiology, Montreal Heart Institute/Universitè de Montreal, Montreal, Canada.,Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Roberto Lagalla
- Department of Radiology, DIBIMED, University of Palermo, Palermo, Italy
| | - Massimo Midiri
- Department of Radiology, DIBIMED, University of Palermo, Palermo, Italy
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Gerk U, Mrowietz C, Sternitzky R, Franke RP, Spitzer SG, Jung F. Effect of Ioxaglate on the cutaneous microcirculation in patients with coronary artery disease: Randomized, double blind, placebo-controlled study. Clin Hemorheol Microcirc 2017; 64:297-304. [PMID: 28128751 DOI: 10.3233/ch-168101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Radiographic contrast media (RCM) can initiate microcirculatory disorders. This study was performed to investigate effects of Ioxaglate on the cutaneous microcirculation. The investigation was carried out as prospective randomized double-blind comparison in parallel-group design on two groups of n = 10 patients each who had to undergo a diagnostic coronary angiography.The confirmatory parameter of the study was mean erythrocyte capillary velocity [vRBC in mm/sec]. VRBC in the ipsilateral nail-fold capillaries was recorded continuously for 3 min before and 6 min after injection of RCM or isotonic saline solution in the A. axillaris respectively, and was evaluated off-line.VRBC in nailfold capillaries was found to be decreased by Ioxaglate by 34% 150 seconds after injection, while isotonic NaCl solution immediately induced a slight increase of 14%.
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Affiliation(s)
- U Gerk
- Krankenhaus Dresden-Friedrichstadt, II. Medizinische Klinik, Dresden, Germany
| | - C Mrowietz
- Institute for Heart and Circulation Research, Eißendorfer Pferdeweg, Hamburg-Harburg, Germany
| | - R Sternitzky
- Praxisklinik Herz und Gefäße, Dresden, and Brandenburgische Technische Universität (BTU), Cottbus-Senftenberg, Germany
| | - R P Franke
- Department of Biomaterials, Central Institute for Biomedical Engineering, University of Ulm, Ulm, Germany
| | - S G Spitzer
- Praxisklinik Herz und Gefäße, Dresden, and Brandenburgische Technische Universität (BTU), Cottbus-Senftenberg, Germany
| | - F Jung
- Institute of Biomaterial Science and Berlin-Brandenburg Centre for Regenerative Therapies, Helmholtz-Zentrum Geesthacht, Teltow, Germany
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Use of fractional flow reserve in patients with coronary artery disease: The right choice for the right outcome. Trends Cardiovasc Med 2017; 27:106-120. [DOI: 10.1016/j.tcm.2016.06.011] [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: 05/12/2016] [Revised: 06/21/2016] [Accepted: 06/23/2016] [Indexed: 01/15/2023]
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Leone AM, Martin-Reyes R, Baptista SB, Amabile N, Raposo L, Franco Pelaez JA, Trani C, Cialdella P, Basile E, Zimbardo G, Burzotta F, Porto I, Aurigemma C, Rebuzzi AG, Faustino M, Niccoli G, Abreu PF, Slama MS, Spagnoli V, Telleria Arrieta M, Amat Santos IJ, de la Torre Hernandez JM, Lopez Palop R, Crea F. The Multi-center Evaluation of the Accuracy of the Contrast MEdium INduced Pd/Pa RaTiO in Predicting FFR (MEMENTO-FFR) Study. EUROINTERVENTION 2016; 12:708-15. [DOI: 10.4244/eijv12i6a115] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Myocardial Fractional Flow Reserve Measurement Using Contrast Media as a First-Line Assessment of Coronary Lesions in Current Practice. Can J Cardiol 2015; 32:739-46. [PMID: 26774229 DOI: 10.1016/j.cjca.2015.09.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 09/14/2015] [Accepted: 09/14/2015] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Fractional flow reserve (FFR) measurement requires adenosine injection. However, adenosine can induce conductive and rhythmic complications, or be contraindicated in some patients. Contrast-induced hyperemia could provide a simple first-line method (contrast-enhanced FFR; cFFR) to assess coronary lesions. In this study we evaluated the accuracy of cFFR to predict lesion significance. METHODS This prospective study included 104 patients with 138 coronary lesions. Each stenosis was evaluated using resting distal coronary pressure to aortic pressure ratio (Pd/Pa) measurements using intracoronary iodixanol (cFFR) and adenosine (FFR) injection. An FFR value ≤ 0.8 defined a significant lesion. RESULTS Dose-ranging analysis (n = 12 lesions) showed that 10 mL iodixanol was required to obtain the lowest cFFR value. Intermeasurement reproducibility of cFFR (n = 18 lesions) showed limited variability and small mean estimated bias (0.001 ± 0.014). Values of cFFR and FFR were highly correlated in a first series of n = 36 lesions (r = 0.9; P < 0.001). Receiver-operating characteristic curve analysis showed an excellent accuracy of cFFR cutoff value of ≤ 0.85 in predicting FFR value ≤ 0.80 (area under the curve, 0.94; 95% confidence interval, 0.90-0.98; sensitivity, 95%; specificity, 73%). This threshold was then tested prospectively in an independent cohort of n = 72 lesions. A cFFR value ≤ 0.85 correctly identified hemodynamically significant lesions with a sensitivity of 100%, specificity of 78%, positive predictive value of 78%, and negative predictive value of 100%. CONCLUSIONS cFFR is reproducible and can be achieved with usual volumes of contrast. A cFFR threshold value of 0.85 provides excellent sensitivity and negative predictive value in coronary artery stenosis.
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Takaoka H, Funabashi N, Fujimoto Y, Kobayashi Y. Detection of significant stenosis in the Left Anterior Descending Artery by ‘Virtual Myocardial Perfusion’ Bolus Tracking, 320 Slice Computed Tomography. Int J Cardiol 2014; 177:1001-7. [DOI: 10.1016/j.ijcard.2014.09.141] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2014] [Revised: 09/10/2014] [Accepted: 09/27/2014] [Indexed: 10/24/2022]
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Bucher AM, De Cecco CN, Schoepf UJ, Wang R, Meinel FG, Binukrishnan SR, Spearman JV, Vogl TJ, Ruzsics B. Cardiac CT for myocardial ischaemia detection and characterization--comparative analysis. Br J Radiol 2014; 87:20140159. [PMID: 25135617 DOI: 10.1259/bjr.20140159] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
The assessment of patients presenting with symptoms of myocardial ischaemia remains one of the most common and challenging clinical scenarios faced by physicians. Current imaging modalities are capable of three-dimensional, functional and anatomical views of the heart and as such offer a unique contribution to understanding and managing the pathology involved. Evidence has accumulated that visual anatomical coronary evaluation does not adequately predict haemodynamic relevance and should be complemented by physiological evaluation, highlighting the importance of functional assessment. Technical advances in CT technology over the past decade have progressively moved cardiac CT imaging into the clinical workflow. In addition to anatomical evaluation, cardiac CT is capable of providing myocardial perfusion parameters. A variety of CT techniques can be used to assess the myocardial perfusion. The single energy first-pass CT and dual energy first-pass CT allow static assessment of myocardial blood pool. Dynamic cardiac CT imaging allows quantification of myocardial perfusion through time-resolved attenuation data. CT-based myocardial perfusion imaging (MPI) is showing promising diagnostic accuracy compared with the current reference modalities. The aim of this review is to present currently available myocardial perfusion techniques with a focus on CT imaging in light of recent clinical investigations. This article provides a comprehensive overview of currently available CT approaches of static and dynamic MPI and presents the results of corresponding clinical trials.
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Affiliation(s)
- A M Bucher
- 1 Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
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Nolte F, van de Hoef TP, de Klerk W, Baan J, Lockie TP, Spaan JA, Piek JJ, Siebes M. Functional coronary stenosis severity assessed from the mean pressure gradient-velocity relationship obtained by contrast medium-induced submaximal hyperaemia. EUROINTERVENTION 2014; 10:320-8. [DOI: 10.4244/eijv10i3a55] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Clayton B, Roobottom C, Morgan-Hughes G. Assessment of the myocardium with cardiac computed tomography. Eur Heart J Cardiovasc Imaging 2014; 15:603-9. [PMID: 24578413 DOI: 10.1093/ehjci/jeu028] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
The imaging of myocardial disease is of increasing importance for cardiologists from all subspecialties, for diagnosis, risk stratification, or to facilitate therapy. While the gold standard modalities for such assessment are cardiac magnetic resonance and echocardiography, these are not universally suitable. Cardiac computed tomography (CT), well-established for the assessment of coronary artery disease (CAD), can be of value in the assessment of myocardial pathology, due to excellent patient compatibility and tolerability, high spatial resolution, and acceptable tissue characterization. This review considers the value and limitations of CT in the assessment of the myocardial sequelae of CAD, and for patients with a variety of other cardiomyopathic diseases, depicts some of the common findings, and considers current developments in this area.
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Affiliation(s)
- Benjamin Clayton
- Cardiology Department, X-Ray East, Derriford Hospital, Plymouth PL6 8DH, UK
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Resting cardiac 64-MDCT does not reliably detect myocardial ischemia identified by radionuclide imaging. AJR Am J Roentgenol 2013; 200:337-42. [PMID: 23345355 DOI: 10.2214/ajr.11.8171] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE CT myocardial perfusion imaging is an emerging diagnostic modality that is under intensive study but not yet widely used in clinical practice. The purpose of this study is to evaluate the performance of resting 64-MDCT in revealing ischemia identified on radionuclide myocardial perfusion imaging (MPI). MATERIALS AND METHODS We retrospectively identified 35 patients (20 women and 15 men; mean age, 52 years) with myocardial ischemia found on MPI who underwent retrospectively gated CT within 90 days of MPI. Myocardial perfusion on CT was evaluated using both a visual (n = 35) and an automated (n = 34) method. For the visual method, myocardial segments were evaluated qualitatively in systole and diastole. For the automated method, subendocardial perfusion of the standard 17 American Heart Association segments was measured using a commercially available tool in both systole and diastole. Differences between systolic and diastolic perfusion were computed. RESULTS Five hundred eighty myocardial segments were evaluated, 152 of which were ischemic on MPI. Visual analysis had a sensitivity of 16% (24/152), specificity of 92% (393/428), positive predictive value of 40% (24/60), and negative predictive value of 75% (392/520) in systole, and a sensitivity of 18% (27/152), specificity of 89% (382/428), positive predictive value of 37% (27/73), and negative predictive value of 75% (382/507) in diastole, as compared with MPI. There was no significant difference in subendocardial perfusion between ischemic and nonischemic segments by the automated method. There was no significant difference in CT perfusion between patients with and without obstructive coronary artery disease on CT angiography using the visual or automated methods. CONCLUSION Resting 64-MDCT is unsuitable for clinical use in revealing ischemia seen on MPI.
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Dual Energy CT of the Heart: Current Status and Future Applications. CURRENT CARDIOVASCULAR IMAGING REPORTS 2013. [DOI: 10.1007/s12410-013-9197-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Abstract
OBJECTIVE Interest in dual-energy CT (DECT) for evaluating the myocardial blood supply, as an addition to coronary artery assessment, is increasing. Although it is still in the early clinical phase, assessment of myocardial ischemia and infarction by DECT constitutes a promising step toward comprehensive evaluation of coronary artery disease with a single noninvasive modality. CONCLUSION Compared with dynamic CT approaches, DECT has advantages regarding radiation dose and clinical applicability. In this review, the literature on DECT of the heart is discussed.
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CT of coronary heart disease: Part 1, CT of myocardial infarction, ischemia, and viability. AJR Am J Roentgenol 2012; 198:531-47. [PMID: 22357992 DOI: 10.2214/ajr.11.7082] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE This article reviews the CT-based approaches aimed at the assessment of myocardial infarction, ischemia, and viability described in the recent literature. CONCLUSION Rapid advances in CT technology not only have improved visualization of coronary arteries but also increasingly enable noncoronary myocardial applications, including analysis of wall motion and the state of the myocardial blood supply. These advancements hold promise for eventually accomplishing the goal of comprehensively evaluating coronary heart disease with a single noninvasive modality.
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Impact of iso-osmolar versus low-osmolar contrast agents on contrast-induced nephropathy and tissue reperfusion in unselected patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention (from the Contrast Media and Nephrotoxicity Following Primary Angioplasty for Acute Myocardial Infarction [CONTRAST-AMI] Trial). Am J Cardiol 2012; 109:67-74. [PMID: 21943940 DOI: 10.1016/j.amjcard.2011.08.006] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2011] [Revised: 08/04/2011] [Accepted: 08/04/2011] [Indexed: 10/17/2022]
Abstract
Conflicting data have been reported on the effects of low-osmolar and iso-osmolar contrast media on contrast-induced acute kidney injury (CI-AKI). In particular, no clinical trial has yet focused on the effect of contemporary contrast media on CI-AKI, epicardial flow, and microcirculatory function in patients with ST-segment elevation acute myocardial infarction who undergo primary percutaneous coronary intervention. The Contrast Media and Nephrotoxicity Following Coronary Revascularization by Angioplasty for Acute Myocardial Infarction (CONTRAST-AMI) trial is a prospective, randomized, single-blind, parallel-group, noninferiority study aiming to evaluate the effects of the low-osmolar contrast medium iopromide compared to the iso-osmolar agent iodixanol on CI-AKI and tissue-level perfusion in patients with ST-segment elevation acute myocardial infarction. Four hundred seventy-five consecutive, unselected patients who underwent primary percutaneous coronary intervention were randomized to iopromide (n = 239) or iodixanol (n = 236). All patients received high-dose N-acetylcysteine and hydration. The primary end point was the proportion of patients with serum creatinine (sCr) increases ≥25% from baseline to 72 hours. Secondary end points were Thrombolysis In Myocardial Infarction (TIMI) myocardial perfusion grade, increase in sCr ≥50%, increase in sCr ≥0.5 or ≥1 mg/dl, and 1-month major adverse cardiac events. The primary end point occurred in 10% of the iopromide group and in 13% of the iodixanol group (95% confidence interval -9% to 3%, p for noninferiority = 0.0002). A TIMI myocardial perfusion grade of 0 or 1 was present in 14% of patients in the 2 groups. No differences between the 2 groups were found in any of the secondary analyses of sCr increase. No significant difference in 1-month major adverse cardiac events was found (8% vs 6%, p = 0.37). In conclusion, in a population of unselected patients with ST-segment elevation acute myocardial infarction who underwent primary percutaneous coronary intervention, iopromide was not inferior to iodixanol in the occurrence of CI-AKI; no significant differences were found in terms of tissue-level reperfusion and major adverse cardiac events between the 2 contrast agents.
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Iwasaki K, Matsumoto T. Myocardial perfusion defect in patients with coronary artery disease demonstrated by 64-multidetector computed tomography at rest. Clin Cardiol 2011; 34:454-60. [PMID: 21660991 DOI: 10.1002/clc.20908] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2010] [Revised: 02/11/2011] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND The first-pass imaging of 64-multidetector computed tomography (MDCT) using pharmacological stress has been used to assess myocardial perfusion. However, detection of myocardial ischemia at rest using MDCT has yet to be elucidated. We studied the incidence of myocardial perfusion defect (MPD) by 64-MDCT at rest and the effect of coronary revascularization therapy on MPD in patients with coronary artery disease. HYPOTHESIS MPD by 64-MDCT at rest indicates myocardial ischemia. METHODS We studied 76 patients with coronary artery disease who underwent 64-MDCT before and after revascularization therapy and 55 patients who did not undergo revascularization therapy. According to percent diameter stenosis, we defined group A, B, C, and D to have stenosis between 70% and 90%, 50% and 69%, 30% and 49%, and 10% and 29%, respectively. We evaluated regional myocardial contrast enhancement by long and short axis planes. MPD was defined as hypoenhancement area of some extent with CT value <50 HU during diastole. RESULTS MPD was found in 60.0% and 32.4% of group A and B patients, respectively (P = 0.0176). The incidence was 4.8% and 0% in group C and D patients, respectively (P<0.0001 compared with group A and B). All patients in group A and B and 2 patients with MPD in group C underwent coronary revascularization therapy. MPD disappeared after revascularization therapy in all but 3 group A patients. No patients showed new MPD after revascularization therapy. CONCLUSIONS Our results demonstrate that a significant percentage of patients with significant coronary artery stenosis show MPD by 64-MDCT at rest, and these MPDs may represent myocardial ischemia.
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Affiliation(s)
- Kohichiro Iwasaki
- Department of Cardiology, Okayama Kyokuto Hospital, 567-1 Kurata, Nakaku, Okayama, Japan.
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Une D, Shimizu S, Kamiya A, Kawada T, Shishido T, Sugimachi M. Both skeletonized and pedicled internal thoracic arteries supply adequate graft flow after coronary artery bypass grafting even during intense sympathoexcitation. J Physiol Sci 2010; 60:407-13. [PMID: 20839081 PMCID: PMC10717421 DOI: 10.1007/s12576-010-0109-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2010] [Accepted: 08/15/2010] [Indexed: 10/19/2022]
Abstract
The internal thoracic artery (ITA) is harvested by either the pedicled or the skeletonized technique in coronary artery bypass grafting (CABG), with no clear advantage of one technique over the other. We compared graft flow between the pedicled and skeletonized ITA grafts while varying myocardial oxygen demand. CABG was performed to the left anterior descending artery in five anesthetized dogs using a pedicled ITA graft and the graft was subsequently skeletonized. Graft flow was measured during stepwise electrical stimulation of the stellate ganglion. The baseline graft flow before sympathetic stimulation was higher in skeletonized (27.8 ± 1.9 ml/min) than that in pedicled ITA grafts (22.6 ± 2.7 ml/min) (P < 0.05). In both ITA grafts, however, graft flow increased to a similar level during sympathetic stimulation that doubled the double product, correlating with the double product. Based on these results, we conclude that metabolic demand can override the potential difference in sympathetic vasoconstriction in both pedicled and skeletonized ITA grafts.
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Affiliation(s)
- Dai Une
- Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center Research Institute, 5-7-1 Fujishiro-dai, Suita, Osaka 565-8565 Japan
| | - Shuji Shimizu
- Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center Research Institute, 5-7-1 Fujishiro-dai, Suita, Osaka 565-8565 Japan
- Japan Association for the Advancement of Medical Equipment, Tokyo, Japan
| | - Atsunori Kamiya
- Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center Research Institute, 5-7-1 Fujishiro-dai, Suita, Osaka 565-8565 Japan
| | - Toru Kawada
- Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center Research Institute, 5-7-1 Fujishiro-dai, Suita, Osaka 565-8565 Japan
| | - Toshiaki Shishido
- Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center Research Institute, 5-7-1 Fujishiro-dai, Suita, Osaka 565-8565 Japan
| | - Masaru Sugimachi
- Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center Research Institute, 5-7-1 Fujishiro-dai, Suita, Osaka 565-8565 Japan
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Halpern EJ. Clinical applications of cardiac CT angiography. Insights Imaging 2010; 1:205-222. [PMID: 22347917 PMCID: PMC3259381 DOI: 10.1007/s13244-010-0038-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2010] [Revised: 07/22/2010] [Accepted: 07/29/2010] [Indexed: 01/07/2023] Open
Abstract
ECG-gated multislice CT provides a cost-effective, non-invasive technology for evaluation of the coronary arteries, as well as for additional clinical applications, which require morphological assessment of the heart and adjacent structures with simultaneous evaluation of the coronary circulation.The excellent negative predictive value of a normal coronary CTA (cCTA) examination excludes the presence of significant coronary disease in the symptomatic patient. Triple rule-out studies provide evaluation of the aorta and pulmonary arteries without loss of image quality in the coronary circulation. The ability to visualize surrounding vascular structures along with the coronary arteries is essential in the evaluation of coronary anomalies.Cardiac CTA is useful in non-coronary applications, including evaluation of the thoracic aorta, cardiac valves and other aspects of cardiac morphology that may require surgical or percutaneous repair. Although radiation exposure is a limitation of cCTA relative to echocardiography and MRI, recent technological advances allow coronary imaging with effective doses as low as 1 mSv.Recent advances in evaluation of coronary plaque morphology as well as myocardial perfusion will allow a more complete noninvasive cardiac assessment in the future and may provide a highly effective method of cardiac risk stratification to facilitate preventive cardiac care.
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Affiliation(s)
- Ethan J. Halpern
- Department of Radiology, Thomas Jefferson University, 132 South 10th Street, Philadelphia, PA 19107-5244 USA
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Bolognese L, Falsini G, Grotti S, Limbruno U, Liistro F, Carrera A, Angioli P, Picchi A, Ducci K, Pierli C. The contrast media and nephrotoxicity following coronary revascularization by primary angioplasty for acute myocardial infarction study: design and rationale of the CONTRAST-AMI study. J Cardiovasc Med (Hagerstown) 2010; 11:199-206. [PMID: 19829124 DOI: 10.2459/jcm.0b013e32833186a4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Contrast-induced acute kidney injury (CI-AKI) is a complex syndrome of acute renal failure occurring after the administration of contrast media and contributing to prolonged hospital stay and mortality. The risk of CI-AKI is higher among patients undergoing primary percutaneous coronary interventions for acute myocardial infarction (AMI), but its clinical relevance in such setting has only been evaluated by small sample size single-center studies and retrospective or observational analyses. Furthermore, whereas high-osmolar contrast media was shown to have direct nephrotoxicity, the role of low-osmolar and iso-osmolar agents is still debated. STUDY DESIGN The CONTRAST-AMI study is a prospective, multicenter, controlled, randomized, single-blind, parallel-group trial, designed to show the noninferiority of the effects of iopromide (low-osmolar) compared with iodixanol (iso-osmolar) contrast media on the incidence of CI-AKI and tissue-level perfusion in patients with AMI. All consecutive patients admitted to participating centers for ST-segment elevation AMI undergoing primary percutaneous coronary intervention will be enrolled. All patients will be treated with high-dose N-acetylcysteine (1200 mg intravenously during the procedure and 1200 mg orally two times daily for the next 48 h after percutaneous coronary intervention) and hydration according to a standardized protocol. The primary endpoint is the proportion of patients with a relative increase in serum creatinine (sCr) of at least 25% from baseline to 72 h after agent administration. The secondary endpoints are absolute and relative increases in sCr of at least 50%, thrombolysis in myocardial infarction (TIMI) perfusion grade, and major adverse cardiac events at 1, 6, and 12 months. CONCLUSION The CONTRAST-AMI study will provide information on the effects of iodixanol and iopromide on the incidence of CI-AKI and tissue-level perfusion in patients with AMI.
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Ruzsics B, Schwarz F, Schoepf UJ, Lee YS, Bastarrika G, Chiaramida SA, Costello P, Zwerner PL. Comparison of dual-energy computed tomography of the heart with single photon emission computed tomography for assessment of coronary artery stenosis and of the myocardial blood supply. Am J Cardiol 2009; 104:318-26. [PMID: 19616661 DOI: 10.1016/j.amjcard.2009.03.051] [Citation(s) in RCA: 117] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2009] [Revised: 03/15/2009] [Accepted: 03/17/2009] [Indexed: 01/03/2023]
Abstract
To evaluate the performance of dual-energy computed tomography (CT) for integrative imaging of the coronary artery morphology and the myocardial blood supply, 36 patients (15 women, mean age 57 +/- 11 years) with equivocal or incongruous single photon emission CT (SPECT) results were investigated by a single-contrast medium-enhanced, retrospectively electrocardiographic-gated dual-energy CT (DECT) scan with simultaneous acquisition of high and low x-ray spectra. Thirteen patients subsequently underwent invasive coronary angiography (ICA). The DECT data were used to reconstruct anatomic coronary CT angiographic images and to map the myocardial iodine distribution within the left ventricular myocardium. Two independent observers analyzed all DECT studies for stenosis and myocardial iodine defects. A segmental comparison was performed between the stress/rest SPECT perfusion defects and DECT iodine defects and between the ICA and coronary CT angiographic findings for stenosis. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were estimated, along with the kappa statistics. Overall, DECT had 92% sensitivity and 93% specificity, with 93% accuracy for detecting any type of myocardial perfusion defect seen on SPECT. Contrast defects at DECT correctly identified 85 (96%) of 89 fixed and 60 (88%) of 68 reversible myocardial perfusion defects. The interobserver agreement was very good (weighted kappa = 0.87). Compared with ICA, coronary CT angiography had 90% sensitivity, 94% specificity, and 93% accuracy for the detection of >50% stenosis. In conclusion, our initial experience suggests that DECT, as a single examination, might be promising for the integrative analysis of the coronary artery morphology and the myocardial blood supply and is in good agreement with ICA and SPECT.
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Reliability of ultrasonography in detecting flow mediated dilation. Int J Cardiovasc Imaging 2009; 25:705-11. [DOI: 10.1007/s10554-009-9475-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2008] [Accepted: 07/06/2009] [Indexed: 10/20/2022]
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Bozlar U, Ugurel MS, Ozcan O, Cakir E, Ustunsoz B, Ucoz T, Bilgi C, Somuncu I. Impact of Catheter Arteriography on the Serum Level of Asymmetric Dimethylarginine, an Endogenous Inhibitor of Nitric Oxide Synthase. Cardiovasc Intervent Radiol 2008; 31:490-5. [DOI: 10.1007/s00270-008-9312-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2007] [Revised: 01/24/2008] [Accepted: 02/05/2008] [Indexed: 10/22/2022]
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Irace C, Tamburrini S, Tamburini S, Bertucci B, De Franceschi MS, Gnasso A. Effects of iodinated contrast media on common carotid and brachial artery blood flow and wall shear stress. Eur Radiol 2006; 16:2721-7. [PMID: 16733684 DOI: 10.1007/s00330-006-0280-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2005] [Revised: 03/07/2006] [Accepted: 04/03/2006] [Indexed: 10/24/2022]
Abstract
The aim of our study was to evaluate the effect of the intravenous contrast media iomeprol on wall shear stress, blood flow and vascular parameters in the common carotid and brachial artery. Thirty outpatients undergoing thoracic or abdominal spiral CT scans were studied. The internal diameter and flow velocity of the common carotid and brachial artery were evaluated by ultrasound, and blood viscosity was measured before and after low osmolality iomeprol (Iomeron 350) injection. The wall shear stress, blood flow and pulsatility index were calculated. To test the differences between groups, the Wilcoxon rank test and Mann Whitney U test were applied. Blood viscosity decreased slightly, but significantly after contrast media (4.6+/-0.7 vs. 4.5+/-0.7 mPa.s, P = 0.02). Contrarily, blood flow and wall shear stress did not change in the common carotid artery, but significantly decreased in the brachial artery (0.9+/-0.4 vs. 0.6+/-0.3 ml/s, P < 0.0001, and 41.5+/-13.9 vs. 35.3+/-11.0 dynes/cm2, P < 0.002, respectively), whereas the pulsatility index significantly increased in the brachial artery (5.0+/-3.3 vs. 7.5+/-5.3, P < 0.001). Iomeprol injection causes blood flow and wall shear stress reduction of the brachial artery; the rise in the pulsatility index suggests an increase in peripheral vascular resistance. Further investigation is needed to evaluate whether these modifications can be clinically relevant.
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Affiliation(s)
- C Irace
- Dipartimento di Medicina Sperimentale e Clinica G. Salvatore, Magna Graecia University, Catanzaro, Italy.
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Arias MA, Peinado R, Sánchez AM, Merino JL. Incessant ventricular tachycardia acutely controlled with intracoronary injection of radiographic contrast media. Am J Emerg Med 2006; 24:290-2. [PMID: 16635699 DOI: 10.1016/j.ajem.2005.09.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2005] [Accepted: 09/30/2005] [Indexed: 11/27/2022] Open
Abstract
Management of patients with incessant monomorphic ventricular tachycardia is challenging. We report on 2 patients who had incessant ventricular tachycardia despite emergency treatment with antiarrhythmic drugs and repeated electrical cardioversions. In both cases, the arrhythmia was acutely terminated with intracoronary administration of radiographic contrast media, allowing hemodynamic stabilization. No tachycardia recurrences occurred.
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Affiliation(s)
- Miguel A Arias
- Arrhythmia Unit, Complejo Hospitalario de Jaén, 23007 Jaén, Spain.
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Discigil B, Evora PRB, Pearson PJ, Viaro F, Rodrigues AJ, Schaff HV. Ionic radiocontrast inhibits endothelium-dependent vasodilation of the canine renal artery in vitro: possible mechanism of renal failure following contrast medium infusion. Braz J Med Biol Res 2004; 37:259-65. [PMID: 14762582 DOI: 10.1590/s0100-879x2004000200014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
To determine if radiocontrast impairs vascular relaxation of the renal artery, segments (4-5 mm in length) of canine renal artery were suspended in vitro in organ chambers to measure isometric force (95% O2/5% CO2, at 37 C). Arterial segments with and without endothelium were placed at the optimal point of their length-tension relation and incubated with 10 microM indomethacin to prevent synthesis of endogenous prostanoids. The presence of nonionic radiocontrast (iohexol, Omnipaque 350, 1 ml in 25 ml control solution, 4% (v/v)) did not alter endothelium-dependent relaxation to acetylcholine in rings precontracted with both norepinephrine and prostaglandin F2alpha (N = 6). When the rings were precontracted with prostaglandin F2alpha, the presence of ionic contrast did not inhibit the relaxation of the arteries. However, in canine renal arteries contracted with norepinephrine, the presence of ionic radiocontrast (diatrizoate meglumine and diatrizoate sodium, MD-76, 1 ml in 25 ml control solution, 4% (v/v)) inhibited relaxation in response to acetylcholine, sodium nitroprusside (N = 6 in each group), and isoproterenol (N = 5; P < 0.05). Rings were relaxed less than 50% of norepinephrine contraction. Following removal of the contrast, vascular relaxation in response to the agonists returned to normal. These results indicate that ionic radiocontrast nonspecifically inhibits vasodilation (both cAMP-mediated and cGMP-mediated) of canine renal arteries contracted with norepinephrine. This reversible impairment of vasodilation could inhibit normal renal perfusion and act as a mechanism of renal failure following radiocontrast infusion. In the adopted experimental protocol the isoproterenol-induced relaxation of renal arteries precontracted with norepinephrine was more affected, suggesting a pivotal role of the cAMP system.
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Affiliation(s)
- B Discigil
- Department of Cardiovascular Surgery, Adnan Menderes, University Medical Faculty, Aydin, Turkey
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Carvalho P, Thompson WH, Whale M, Charan NB. Bronchovascular responses to intravenous contrast media for helical CT pulmonary angiography. Arch Physiol Biochem 2003; 111:323-5. [PMID: 15764065 DOI: 10.3109/13813450312331337504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CT angiography is now commonly used for the diagnosis of pulmonary embolism, but the contrast media used for imaging produces various hemodynamic changes. In this study, we investigated the bronchovascular and hemodynamic responses to intravenous iopromide, a non-ionic contrast agent used for pulmonary CT angiograms, in anesthetized, mechanically ventilated sheep (n = 6). Bronchial blood flow and cardiac output were measured with ultrasonic flow probes. Systemic and pulmonary arterial pressures were continuously monitored. Injections of 0.9% NaCl (120 ml over 30 s) or iopromide (300 mg/ml, 120 ml over 30 s) were given in random order in a peripheral vein with an angiogram infuser and hemodynamic changes were determined. After these parameters returned to baseline, the left pulmonary artery (LPA) was occluded with a snare and the animals were allowed to stabilize. Injections of NaCl and iopromide were repeated in random order as before. There were no significant hemodynamic effects with infusion of NaCl. With intact pulmonary vasculature, NaCl and iopromide did not cause significant changes in arterial blood gases, however, cardiac output (QT, L/min), mean systemic and pulmonary arterial pressures (PSA and PPA, Torr) increased and bronchovascular resistance (BVR, Torr x min/ml), decreased. Following LPA ligation, pH and PO2 significantly decreased over baseline, whereas PCO2 increased. After LPA ligation, iopromide produced a greater decrease in BVR as compared with preligation intact pulmonary vasculature. In conclusion, iopromide caused rapid hemodynamic changes and decreased BVR, likely secondary to osmolar stress. Bronchovascular effects were more pronounced after pulmonary arterial occlusion.
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Rosengarten B, Steen-Müller MK, Müller A, Traupe H, Voss RK, Kaps M. Contrast media effect on cerebral blood flow regulation after performance of cerebral or coronary angiography. Cerebrovasc Dis 2003; 16:42-6. [PMID: 12766361 DOI: 10.1159/000070114] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2002] [Accepted: 08/21/2002] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The immediate hemodynamic effects of contrast agents are well documented. Less is known about their longer-lasting effects. We investigated the later effect of iopromide on the neurovascular coupling mechanism after the performance of cerebral or coronary angiography. Neurovascular coupling is a fine-tuned and reliable mechanism adapting cerebral blood flow to cortical activity. When performing a visual stimulation and measuring the resultant flow velocity change in the posterior cerebral artery transcranial Doppler has been used to determine vascular integrity. METHODS The visually evoked blood flow velocity response in the posterior cerebral artery was measured with transcranial Doppler before, 1-2 h after and the day after angiography. The overshoot of the flow velocity response and the stable flow velocity level at the end of the stimulation phase were used to compare the different conditions. RESULTS A significantly diminished overshoot was found 1-2 h after angiography only in patients undergoing cerebral angiography. The stable blood flow velocity levels at the end of the stimulation phase remained unchanged in all cases. CONCLUSIONS Our finding demonstrates effects of contrast media on dynamic blood flow regulation of the cerebral vasculature 1-2 h after application of direct contrast agent suggesting a possible concentration effect of the contrast agent. However, since the relative blood flow velocity increase under stable blood flow conditions remained constant, this dynamic alteration does not cause a reduction in cerebral blood flow.
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Affiliation(s)
- B Rosengarten
- Department of Neurology, Justus Liebig University of Giessen, Germany
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