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Tar B, Jenei C, Dezsi CA, Bakk S, Beres Z, Santa J, Svab M, Szentes V, Polgar P, Bujaky C, Czuriga D, Kőszegi Z. Less invasive fractional flow reserve measurement from 3-dimensional quantitative coronary angiography and classic fluid dynamic equations. EUROINTERVENTION 2018; 14:942-950. [DOI: 10.4244/eij-d-17-00859] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Pyxaras SA, Wijns W, Reiber JHC, Bax JJ. Invasive assessment of coronary artery disease. J Nucl Cardiol 2018; 25:860-871. [PMID: 28849416 DOI: 10.1007/s12350-017-1050-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 08/08/2017] [Indexed: 01/29/2023]
Abstract
Coronary artery disease is associated to high mortality and morbidity rates and an accurate diagnostic assessment during heart catheterization has a fundamental role in prognostic stratification and treatment choices. Coronary angiography has been integrated by intravascular imaging modalities, namely intravascular ultrasound and optical coherence tomography, which allow the precise quantification of the atherosclerotic burden of coronary arteries. The hemodynamic relevance of a given coronary stenosis can be assessed using stress or resting indexes: fractional flow reserve and instantaneous wave-free ratio are both coronary flow surrogates, used to guide percutaneous coronary interventions. This review summarizes the current state-of-the-art of invasive diagnostic methods during heart catheterization and highlights the potential role that an integration of anatomical and functional information enables.
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Affiliation(s)
- Stylianos A Pyxaras
- Cardiology Department, Coburg-Clinic, Ketschendorfer Str. 33, 96450, Coburg, Germany.
| | - William Wijns
- The Lambe Institute for Translational Medicine and Curam, National University of Ireland, Galway and Saolta University Healthcare Group, Galway, Ireland
| | - Johan H C Reiber
- Division of Image Processing, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
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Chu M, Dai N, Yang J, Westra J, Tu S. A systematic review of imaging anatomy in predicting functional significance of coronary stenoses determined by fractional flow reserve. Int J Cardiovasc Imaging 2017; 33:975-990. [PMID: 28265791 DOI: 10.1007/s10554-017-1085-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 01/28/2017] [Indexed: 01/06/2023]
Abstract
Fractional flow reserve (FFR) is the current gold standard to assess the physiological significance of coronary stenoses. With the development of coronary imaging techniques, several anatomic parameters have been investigated in vivo and their associations with FFR have been studied. The aim of this review is to summarize the accuracy of anatomic parameters derived by the present coronary imaging techniques including invasive coronary angiography, coronary computed tomography angiography, intravascular ultrasound and optical coherence tomography, in predicting a significant FFR. The impact of patient characteristics, lesion locations, variability of FFR and imaging resolution on the predictive ability are discussed.
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Affiliation(s)
- Miao Chu
- Biomedical Instrument Institute, School of Biomedical Engineering, Med-X Research Institute, Shanghai Jiao Tong University, No. 1954, Hua Shan Road, Shanghai, 200030, China
| | - Neng Dai
- Cardiovascular Department, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Junqing Yang
- The 3rd Division of Cardiology, Department of Cardiology, Guangdong General Hospital, Guangdong Provincial Cardiovascular Institute, Guangdong Academy of Medical Sciences, No.106, 2nd Zhongshan Road, Yuexiu district, Guangzhou, Guangdong, 510080, China.
| | - Jelmer Westra
- Department of Cardiology, Aarhus University Hospital, Skejby, Denmark
| | - Shengxian Tu
- Biomedical Instrument Institute, School of Biomedical Engineering, Med-X Research Institute, Shanghai Jiao Tong University, No. 1954, Hua Shan Road, Shanghai, 200030, China.
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Jaguszewski M, Zabalza Cerdeiriña M, Alushi B, Engel LC, Schwemmler C, Witt UE, König M, Olivecrona G, Roijer A, Witkowski A, Pręgowski J, Gutiérrez-Chico JL. How should I treat recurrent chest pain and systolic dysfunction after chemotherapy with anthracyclines? EUROINTERVENTION 2017; 12:1674-1677. [PMID: 28106002 DOI: 10.4244/eijv12i13a274] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Milosz Jaguszewski
- Department of Interventional Cardiology, Charité University Hospital, Campus Benjamin Franklin, Berlin, Germany
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Chung WY, Choi BJ, Lim SH, Matsuo Y, Lennon RJ, Gulati R, Sandhu GS, Holmes DR, Rihal CS, Lerman A. Three dimensional quantitative coronary angiography can detect reliably ischemic coronary lesions based on fractional flow reserve. J Korean Med Sci 2015; 30:716-24. [PMID: 26028923 PMCID: PMC4444471 DOI: 10.3346/jkms.2015.30.6.716] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2014] [Accepted: 01/28/2015] [Indexed: 12/25/2022] Open
Abstract
Conventional coronary angiography (CAG) has limitations in evaluating lesions producing ischemia. Three dimensional quantitative coronary angiography (3D-QCA) shows reconstructed images of CAG using computer based algorithm, the Cardio-op B system (Paieon Medical, Rosh Ha'ayin, Israel). The aim of this study was to evaluate whether 3D-QCA can reliably predict ischemia assessed by myocardial fractional flow reserve (FFR) < 0.80. 3D-QCA images were reconstructed from CAG which also were evaluated with FFR to assess ischemia. Minimal luminal diameter (MLD), percent diameter stenosis (%DS), minimal luminal area (MLA), and percent area stenosis (%AS) were obtained. The results of 3D-QCA and FFR were compared. A total of 266 patients was enrolled for the present study. FFR for all lesions ranged from 0.57 to 1.00 (0.85 ± 0.09). Measurement of MLD, %DS, MLA, and %AS all were significantly correlated with FFR (r = 0.569, 0609, 0.569, 0.670, respectively, all P < 0.001). In lesions with MLA < 4.0 mm(2), %AS of more than 65.5% had a 80% sensitivity and a 83% specificity to predict FFR < 0.80 (area under curve, AUC was 0.878). 3D-QCA can reliably predict coronary lesions producing ischemia and may be used to guide therapeutic approach for coronary artery disease.
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Affiliation(s)
- Woo-Young Chung
- Devision of Cardiology, Department of Internal Medicine, Boramae Medical Center, Seoul National University, College of Medicine, Seoul, Korea
| | - Byoung-Joo Choi
- Department of Cardiology, Ajou University School of Medicine, Suwon, Korea
| | - Seong-Hoon Lim
- Division of Cardiology, Department of Internal Medicine, School of Medicine, Dankook University, Cheonan, Korea
| | - Yoshiki Matsuo
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Ryan J Lennon
- Division of Cardiovascular Disease, Mayo Clinic, Rochester, MN, USA
| | - Rajiv Gulati
- Division of Cardiovascular Disease, Mayo Clinic, Rochester, MN, USA
| | | | - David R Holmes
- Division of Cardiovascular Disease, Mayo Clinic, Rochester, MN, USA
| | | | - Amir Lerman
- Division of Cardiovascular Disease, Mayo Clinic, Rochester, MN, USA
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Quantitative angiography and optical coherence tomography for the functional assessment of nonobstructive coronary stenoses: comparison with fractional flow reserve. Am Heart J 2013; 166:1010-1018.e1. [PMID: 24268215 DOI: 10.1016/j.ahj.2013.08.016] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Accepted: 08/13/2013] [Indexed: 11/22/2022]
Abstract
BACKGROUND The purpose was to compare 3-dimensional quantitative coronary angiography (3D-QCA) with optical coherence tomography (OCT) for the functional assessment of nonobstructive coronary stenoses, as evaluated by fractional flow reserve (FFR). METHODS Fifty-five nonobstructive coronary stenoses (30%-50% diameter stenosis by visual estimation) were assessed in 36 patients using FFR, 2-dimensional QCA (2D-QCA), 3D-QCA, and OCT. RESULTS Angiographic stenosis severity by 2D-QCA was 34% ± 13% diameter stenosis, and minimal lumen diameter (MLD) was 1.77 ± 0.58 mm. Fractional flow reserve values were 0.85 ± 0.10. Correlation coefficients between FFR and MLD or minimal lumen area (MLA) were highly significant for both 2D- and 3D-QCA (all P < .001), but higher R(2) values were observed for 3D-QCA measurements. Although significant, correlation coefficients between OCT and FFR data were weak (R(2) = 0.28, P = .001 for MLD and R(2) = 0.23, P = .003 for MLA). Correlation coefficients with FFR were significantly higher for 3D-QCA than for OCT (P values for MLD and MLA = .043 and .042, respectively). Nonobstructive stenoses with MLD >1.53 mm or MLA >2.43 mm(2) are unlikely to be hemodynamically significant. CONCLUSIONS In nonobstructive coronary stenoses, anatomical parameters derived from 3D-QCA can best identify lesions with preserved FFR values.
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Affiliation(s)
- Nils P. Johnson
- From the Division of Cardiology, Department of Medicine, Weatherhead PET Center For Preventing and Reversing Atherosclerosis, University of Texas Medical School and Memorial Hermann Hospital, Houston
| | - Richard L. Kirkeeide
- From the Division of Cardiology, Department of Medicine, Weatherhead PET Center For Preventing and Reversing Atherosclerosis, University of Texas Medical School and Memorial Hermann Hospital, Houston
| | - K. Lance Gould
- From the Division of Cardiology, Department of Medicine, Weatherhead PET Center For Preventing and Reversing Atherosclerosis, University of Texas Medical School and Memorial Hermann Hospital, Houston
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Kolozsvári R, Tar B, Lugosi P, Sánta J, Béres Z, Ungvári T, Polgár P, Kőszegi Z. Plaque volume derived from three-dimensional reconstruction of coronary angiography predicts the fractional flow reserve. Int J Cardiol 2011; 160:140-4. [PMID: 21543127 DOI: 10.1016/j.ijcard.2011.04.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2010] [Revised: 03/29/2011] [Accepted: 04/14/2011] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To compare the data calculated from the three dimensional (3D) reconstruction of a coronary stenosis with the fractional flow reserve (FFR) values measured on the same coronary segment. METHODS Multiple projections of 22 patients (7 female, 15 male, age: 61 ± 9.73 years) were evaluated by the IC30 software of the Axiom Artis X-ray machine. 3D reconstruction was successfully carried out on 23 coronary arteries (14 LAD, 4 CX and 5 RCA). RESULTS Regression analysis demonstrated significant relationship between the cross-sectional area percentage stenosis (AS) calculated based on the 3D measurement and the FFR (r: -0.566, p: 0.008), as well as between the 3D derived plaque volume (PV) and the FFR (r: -0.501, p: 0.018). On the other hand, the diameter stenosis (DS) and the minimal lumen diameter (MLD) did not correlate with the FFR values. According to the Receiver Operating Characteristic (ROC) analysis the rank of the areas under the ROC curves (AUC) was the following: 1. PV (0.76), 2. AS (0.74), 3. DS (0.62), 4. MLA (0.55), and 5. MLD (0.51). The difference between the AUC of the PV and MLA was found to be significant (p=0.02). The best agreement with the FFR was found when the PV was >44% (sensitivity 66.67%, specificity 82.35%) and the 3D AS was >60% (sensitivity 100%, specificity 47%). CONCLUSION Besides the 3D AS the calculated PV characterizing the entire lesion is also an important predictor of the flow consequence of the stenosis.
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Affiliation(s)
- R Kolozsvári
- Institute of Cardiology, University of Debrecen, Hungary
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Sarno G, Garg S, Onuma Y, Girasis C, Tonino P, Morel MA, van Es GA, Pijls N, Serruys PW. Bifurcation lesions: Functional assessment by fractional flow reserve vs. anatomical assessment using conventional and dedicated bifurcation quantitative coronary angiogram. Catheter Cardiovasc Interv 2010; 76:817-23. [DOI: 10.1002/ccd.22672] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Dvir D, Kornowski R. Real-time 3D imaging in the cardiac catheterization laboratory. Future Cardiol 2010; 6:463-71. [DOI: 10.2217/fca.10.68] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Worldwide experience in coronary catheterization and angiography for the detection and evaluation of lumen narrowing is extensive. Conventional coronary angiography analysis is complex since these arteries are of relatively small caliber and in constant movement, while being synchronized with the movement of the heart chambers and respiratory system. Moreover, atherosclerotic plaques in the coronary tree are themselves very intricate and frequently positioned in eccentric locations. The last decade has witnessed significant advances as novel data acquisition and processing techniques have been introduced. Researchers have developed novel processing systems that make it possible to construct 3D images in real-time during coronary intervention. The most common solutions are rotational imaging and reconstruction from multiple single-plane images. These techniques produce real-time 3D images of the coronary arteries in the catheterization laboratory. This article describes these state-of-the-art imaging methods and other specific novel applications in clinical practice, such as stent enhancement, guidance during transcatheter aortic valve implantation and advanced geometrical analysis with computational fluid dynamics.
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Affiliation(s)
- Danny Dvir
- Division of Interventional Cardiology, Rabin Medical Center, Petach Tikva 49100, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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