1
|
Wolf EV, Halfmann MC, Varga-Szemes A, Fink N, Kloeckner R, Bockius S, Allmendinger T, Hagenauer J, Koehler T, Kreitner KF, Schoepf UJ, Münzel T, Düber C, Gori T, Yang Y, Hell MM, Emrich T. Photon-Counting Detector CT Virtual Monoenergetic Images for Coronary Artery Stenosis Quantification: Phantom and In Vivo Evaluation. AJR Am J Roentgenol 2024; 222:e2330481. [PMID: 38197760 DOI: 10.2214/ajr.23.30481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
BACKGROUND. Calcium blooming causes stenosis overestimation on coronary CTA. OBJECTIVE. The purpose of this article was to evaluate the impact of virtual monoenergetic imaging (VMI) reconstruction level on coronary artery stenosis quantification using photon-counting detector (PCD) CT. METHODS. A phantom containing two custom-made vessels (representing 25% and 50% stenosis) underwent PCD CT acquisitions without and with simulated cardiac motion. A retrospective analysis was performed of 33 patients (seven women, 26 men; mean age, 71.3 ± 9.0 [SD] years; 64 coronary artery stenoses) who underwent coronary CTA by PCD CT followed by invasive coronary angiography (ICA). Scans were reconstructed at nine VMI energy levels (40-140 keV). Percentage diameter stenosis (PDS) was measured, and bias was determined from the ground-truth stenosis percentage in the phantom and ICA-derived quantitative coronary angiography measurements in patients. Extent of blooming artifact was measured in the phantom and in calcified and mixed plaques in patients. RESULTS. In the phantom, PDS decreased for 25% stenosis from 59.9% (40 keV) to 13.4% (140 keV) and for 50% stenosis from 81.6% (40 keV) to 42.3% (140 keV). PDS showed lowest bias for 25% stenosis at 90 keV (bias, 1.4%) and for 50% stenosis at 100 keV (bias, -0.4%). Blooming artifacts decreased for 25% stenosis from 61.5% (40 keV) to 35.4% (140 keV) and for 50% stenosis from 82.7% (40 keV) to 52.1% (140 keV). In patients, PDS for calcified plaque decreased from 70.8% (40 keV) to 57.3% (140 keV), for mixed plaque decreased from 69.8% (40 keV) to 56.3% (140 keV), and for noncalcified plaque was 46.6% at 40 keV and 54.6% at 140 keV. PDS showed lowest bias for calcified plaque at 100 keV (bias, 17.2%), for mixed plaque at 140 keV (bias, 5.0%), and for noncalcified plaque at 40 keV (bias, -0.5%). Blooming artifacts decreased for calcified plaque from 78.4% (40 keV) to 48.6% (140 keV) and for mixed plaque from 73.1% (40 keV) to 44.7% (140 keV). CONCLUSION. For calcified and mixed plaque, stenosis severity measurements and blooming artifacts decreased at increasing VMI reconstruction levels. CLINICAL IMPACT. PCD CT with VMI reconstruction helps overcome current limitations in stenosis quantification on coronary CTA.
Collapse
Affiliation(s)
- Elias V Wolf
- Department of Diagnostic and Interventional Radiology, University Medical Center Mainz, Langenbeckstraβe 1, 55131 Mainz, Germany
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Medical University of South Carolina, Charleston, SC
| | - Moritz C Halfmann
- Department of Diagnostic and Interventional Radiology, University Medical Center Mainz, Langenbeckstraβe 1, 55131 Mainz, Germany
- German Centre for Cardiovascular Research, Partner site Rhine-Main, Mainz, Germany
| | - Akos Varga-Szemes
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Medical University of South Carolina, Charleston, SC
| | - Nicola Fink
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Medical University of South Carolina, Charleston, SC
- Department of Radiology, University Hospital, LMU Munich, München, Germany
| | - Roman Kloeckner
- Department of Diagnostic and Interventional Radiology, University Medical Center Mainz, Langenbeckstraβe 1, 55131 Mainz, Germany
- Department for Interventional Radiology, University Hospital of Lübeck, Lübeck, Germany
| | - Stefanie Bockius
- Department of Diagnostic and Interventional Radiology, University Medical Center Mainz, Langenbeckstraβe 1, 55131 Mainz, Germany
| | | | | | | | - Karl-Friedrich Kreitner
- Department of Diagnostic and Interventional Radiology, University Medical Center Mainz, Langenbeckstraβe 1, 55131 Mainz, Germany
| | - U Joseph Schoepf
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Medical University of South Carolina, Charleston, SC
| | - Thomas Münzel
- German Centre for Cardiovascular Research, Partner site Rhine-Main, Mainz, Germany
- Department of Cardiology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Christoph Düber
- Department of Diagnostic and Interventional Radiology, University Medical Center Mainz, Langenbeckstraβe 1, 55131 Mainz, Germany
| | - Tommaso Gori
- German Centre for Cardiovascular Research, Partner site Rhine-Main, Mainz, Germany
- Department of Cardiology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Yang Yang
- Department of Diagnostic and Interventional Radiology, University Medical Center Mainz, Langenbeckstraβe 1, 55131 Mainz, Germany
| | - Michaela M Hell
- Department of Cardiology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Tilman Emrich
- Department of Diagnostic and Interventional Radiology, University Medical Center Mainz, Langenbeckstraβe 1, 55131 Mainz, Germany
- Department of Radiology and Radiological Science, Division of Cardiovascular Imaging, Medical University of South Carolina, Charleston, SC
- German Centre for Cardiovascular Research, Partner site Rhine-Main, Mainz, Germany
| |
Collapse
|
2
|
Liu J, Jin J, Yu B, Zhang S, Lu X, Chen G, Yang Y, Dong H. Determinants and Prognoses of Visual-Functional Mismatches After Mechanical Reperfusion in ST-Elevation Myocardial Infarction. Int J Gen Med 2024; 17:693-704. [PMID: 38435112 PMCID: PMC10908277 DOI: 10.2147/ijgm.s444933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 02/09/2024] [Indexed: 03/05/2024] Open
Abstract
Background Discordance between the anatomy and physiology of the coronary has important implications for managing patients with stable coronary disease, but its significance in ST-elevation myocardial infarction has not been fully elucidated. Methods The retrospective study involved patients diagnosed with ST-elevation myocardial infarction (STEMI) who underwent percutaneous coronary intervention (PCI), along with quantitative coronary angiography (QCA) and quantitative flow ratio (QFR) assessments. Patients were stratified into four groups regarding the severity of the culprit vessel, both visually and functionally: concordantly negative (QCA-diameter stenosis [DS] ≤ 50% and QFR > 0.80), mismatch (QCA-DS > 50% and QFR > 0.80), reverse mismatch (QCA-DS ≤ 50% and QFR ≤ 0.80), and concordantly positive (QCA-DS > 50% and QFR ≤ 0.80). Multivariable logistic regression analyses were conducted to identify the clinical factors linked to visual-functional mismatches. Kaplan‒Meier analysis was conducted to estimate the 18-month adverse cardiovascular events (MACE)-free survival between the four groups. Results The study involved 310 patients, with 68 presenting visual-functional mismatch, and 51 exhibiting reverse mismatch. The mismatch was associated with higher angiography-derived microcirculatory resistance (AMR) (adjusted odds ratio [aOR]=1.016, 95% CI: 1.010-1.022, P<0.001). Reverse mismatch was associated with larger area stenosis (aOR=1.044, 95% CI: 1.004-1.086, P=0.032), lower coronary flow velocity (aOR=0.690, 95% CI: 0.567-0.970, P<0.001) and lower AMR (aOR=0.947, 95% CI: 0.924-0.970, P<0.001). Additionally, the mismatch group showed the worst 18-month MACE-free survival among the four groups (Log rank test p = 0.013). Conclusion AMR plays a significant role in the occurrence of visual-functional mismatches between QCA-DS and QFR, and the mismatch group showed the worst prognosis.
Collapse
Affiliation(s)
- Jieliang Liu
- Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, 510080, People’s Republic of China
| | - Junguo Jin
- Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, 510080, People’s Republic of China
| | - Bingyan Yu
- Department of Cardiology, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, 510080, People’s Republic of China
| | - Shanghong Zhang
- Department of Cardiology, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, 510080, People’s Republic of China
| | - Xiaoqi Lu
- Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, 510080, People’s Republic of China
| | - Guoqiang Chen
- Department of Cardiology, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, 510080, People’s Republic of China
| | - Yi Yang
- Department of Cardiology, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, 510080, People’s Republic of China
| | - Haojian Dong
- Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, 510080, People’s Republic of China
- Nyingchi People’s Hospital, Nyingchi, Tibet, 860000, People’s Republic of China
| |
Collapse
|
3
|
Westra J, Rasmussen LD, Eftekhari A, Winther S, Karim SR, Johansen JK, Hammid O, Søndergaard HM, Ejlersen JA, Gormsen LC, Mogensen LJH, Bøttcher M, Holm NR, Christiansen EH. Coronary Artery Stenosis Evaluation by Angiography-Derived FFR: Validation by Positron Emission Tomography and Invasive Thermodilution. JACC Cardiovasc Imaging 2023; 16:1321-1331. [PMID: 37052562 DOI: 10.1016/j.jcmg.2023.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 02/06/2023] [Accepted: 02/08/2023] [Indexed: 04/14/2023]
Abstract
BACKGROUND Fractional flow reserve (FFR) derived from invasive coronary angiography (QFR) is promising for evaluation of intermediate coronary artery stenosis. OBJECTIVES The authors aimed to compare the diagnostic performance of QFR and the guideline-recommended invasive FFR using 82Rubidium positron emission tomography (82Rb-PET) myocardial perfusion imaging as reference standard. METHODS This is a prospective, observational study of symptomatic patients with suspected obstructive coronary artery disease on coronary computed tomography angiography (≥50% diameter stenosis in ≥1 vessel). All patients were referred to 82Rb-PET and invasive coronary angiography with FFR and QFR assessment of all intermediate (30%-90% diameter stenosis) stenoses. Main analyses included a comparison of the ability of QFR and FFR to identify reduced myocardial blood flow (<2 mL/g/min) during vasodilation and/or relative perfusion abnormalities (summed stress score ≥4 in ≥2 adjacent segments). RESULTS A total of 250 patients (320 vessels) with indication for invasive physiological assessment were included. The continuous relationship of 82Rb-PET stress myocardial blood flow per 0.10 increase in FFR was +0.14 mL/g/min (95% CI: 0.07-0.21 mL/g/min) and +0.08 mL/g/min (95% CI: 0.02-0.14 mL/g/min) per 0.10 QFR increase. Using 82Rb-PET as reference, QFR and FFR had similar diagnostic performance on both a per-patient level (accuracy: 73%; 95% CI: 67%-79%; vs accuracy: 71%; 95% CI: 64%-78%) and per-vessel level (accuracy: 70%; 95% CI: 64%-75%; vs accuracy: 68%; 95% CI: 62%-73%). The per-vessel feasibility was 84% (95% CI: 80%-88%) for QFR and 88% (95% CI: 85%-92%) for FFR by intention-to-diagnose analysis. CONCLUSIONS With 82Rb-PET as reference modality, the wire-free QFR solution showed similar diagnostic accuracy as invasive FFR in evaluation of intermediate coronary stenosis. (DAN-NICAD - Danish Study of Non-Invasive Diagnostic Testing in Coronary Artery Disease; NCT02264717).
Collapse
Affiliation(s)
- Jelmer Westra
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; Department of Cardiology, Linköping University Hospital, Linköping, Sweden.
| | | | - Ashkan Eftekhari
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Simon Winther
- Department of Cardiology, Gødstrup Hospital, Herning, Denmark
| | | | - Jane Kirk Johansen
- Department of Cardiology, Regional Hospital Central Jutland, Silkeborg, Denmark
| | - Osama Hammid
- Department of Cardiology, Regional Hospital East Jutland, Randers, Denmark
| | | | - June Anita Ejlersen
- Department of Clinical Physiology, Regional Hospital Central Jutland, Viborg, Denmark; Department of Nuclear Medicine, Hospital Unit West, Herning, Denmark
| | - Lars C Gormsen
- Department of Nuclear Medicine, Aarhus University Hospital, Aarhus, Denmark
| | | | - Morten Bøttcher
- Department of Cardiology, Gødstrup Hospital, Herning, Denmark
| | | | | |
Collapse
|
4
|
Stader J, Antoniadis M, Ussat M, Wachter R, Lavall D, Metze M, Neef M, Spies C, Laufs U, Lenk K. Comparison of quantitative flow ratio with instantaneous wave-free ratio and resting full-cycle ratio during daily routine in the catheterization laboratory. Catheter Cardiovasc Interv 2023. [PMID: 37194726 DOI: 10.1002/ccd.30690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 04/09/2023] [Accepted: 04/28/2023] [Indexed: 05/18/2023]
Abstract
BACKGROUND Quantitative flow ratio (QFR) is a novel, software-based method to evaluate the physiology of coronary lesions. The aim of this study was to compare QFR with the established invasive measurements of coronary blood flow using instantaneous wave-free ratio (iFR) or resting full-cycle ratio (RFR) in daily cathlab routine. METHODS 102 patients with stable coronary artery disease and a coronary stenosis of 40%-90% were simultaneously assessed with QFR and iFR or RFR. QFR-computation was performed by two certified experts using the appropriate software (QAngio XA 3D 3.2). RESULTS QFR showed a significant correlation (r = 0.75, p < 0.001) to iFR and RFR. The area under the receiver curve for all measurements was 0.93 (95% confidence interval, 0.87-0.98) for QFR compared to iFR or RFR. QFR based assessment required less time with a median of 501 s (IQR 421-659 s) compared to iFR or RFR which required a median of 734 s to obtain the result (IQR 512-967 s; p < 0.001). The median use of contrast medium was similar with 21 mL (IQR 16-30 mL) for the QFR-based and 22 mL (IQR 15-35 mL) for the iFR- or RFR-based diagnostic. QFR diagnostic required less radiation. The median dose area product for QFR was 307cGycm2 (IQR 151-429 cGycm2 ) compared to 599 cGycm2 (IQR 345-1082 cGycm2 ) for iFR or RFR, p < 0.001. CONCLUSION QFR measurements of coronary artery blood flow correlate with iFR or RFR measurements and are associated with shorter procedure times and reduced radiation dose.
Collapse
Affiliation(s)
- Jannis Stader
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Marios Antoniadis
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Matti Ussat
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Rolf Wachter
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Daniel Lavall
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Michael Metze
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Martin Neef
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Christian Spies
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Ulrich Laufs
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Karsten Lenk
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Leipzig, Germany
| |
Collapse
|
5
|
Kim Y, Choi AD, Telluri A, Lipkin I, Bradley AJ, Sidahmed A, Jonas R, Andreini D, Bathina R, Baggiano A, Cerci R, Choi EY, Choi JH, Choi SY, Chung N, Cole J, Doh JH, Ha SJ, Her AY, Kepka C, Kim JY, Kim JW, Kim SW, Kim W, Pontone G, Villines TC, Cho I, Danad I, Heo R, Lee SE, Lee JH, Park HB, Sung JM, Crabtree T, Earls JP, Min JK, Chang HJ. Atherosclerosis Imaging Quantitative Computed Tomography (AI-QCT) to guide referral to invasive coronary angiography in the randomized controlled CONSERVE trial. Clin Cardiol 2023; 46:477-483. [PMID: 36847047 PMCID: PMC10189079 DOI: 10.1002/clc.23995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 01/25/2023] [Indexed: 03/01/2023] Open
Abstract
AIMS We compared diagnostic performance, costs, and association with major adverse cardiovascular events (MACE) of clinical coronary computed tomography angiography (CCTA) interpretation versus semiautomated approach that use artificial intelligence and machine learning for atherosclerosis imaging-quantitative computed tomography (AI-QCT) for patients being referred for nonemergent invasive coronary angiography (ICA). METHODS CCTA data from individuals enrolled into the randomized controlled Computed Tomographic Angiography for Selective Cardiac Catheterization trial for an American College of Cardiology (ACC)/American Heart Association (AHA) guideline indication for ICA were analyzed. Site interpretation of CCTAs were compared to those analyzed by a cloud-based software (Cleerly, Inc.) that performs AI-QCT for stenosis determination, coronary vascular measurements and quantification and characterization of atherosclerotic plaque. CCTA interpretation and AI-QCT guided findings were related to MACE at 1-year follow-up. RESULTS Seven hundred forty-seven stable patients (60 ± 12.2 years, 49% women) were included. Using AI-QCT, 9% of patients had no CAD compared with 34% for clinical CCTA interpretation. Application of AI-QCT to identify obstructive coronary stenosis at the ≥50% and ≥70% threshold would have reduced ICA by 87% and 95%, respectively. Clinical outcomes for patients without AI-QCT-identified obstructive stenosis was excellent; for 78% of patients with maximum stenosis < 50%, no cardiovascular death or acute myocardial infarction occurred. When applying an AI-QCT referral management approach to avoid ICA in patients with <50% or <70% stenosis, overall costs were reduced by 26% and 34%, respectively. CONCLUSIONS In stable patients referred for ACC/AHA guideline-indicated nonemergent ICA, application of artificial intelligence and machine learning for AI-QCT can significantly reduce ICA rates and costs with no change in 1-year MACE.
Collapse
Affiliation(s)
- Yumin Kim
- The George Washington University School of Medicine, Washington, District of Columbia, USA
| | - Andrew D Choi
- The George Washington University School of Medicine, Washington, District of Columbia, USA
| | - Anha Telluri
- The George Washington University School of Medicine, Washington, District of Columbia, USA
| | - Isabella Lipkin
- The George Washington University School of Medicine, Washington, District of Columbia, USA
| | - Andrew J Bradley
- The George Washington University School of Medicine, Washington, District of Columbia, USA
| | - Alfateh Sidahmed
- The George Washington University School of Medicine, Washington, District of Columbia, USA
| | - Rebecca Jonas
- Jefferson Medical Institute, Philadelphia, Pennsylvania, USA
| | | | - Ravi Bathina
- CARE Hospital and FACTS Foundation, Hyderabad, India
| | | | | | | | | | - So-Yeon Choi
- Ajou University Hospital, Gyeonggi-do, South Korea
| | - Namsik Chung
- Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, South Korea
| | - Jason Cole
- Cardiology Associates of Mobile, Mobile, Alabama, USA
| | - Joon-Hyung Doh
- Inje University, Ilsan Paik Hospital, Gyeonggi-do, South Korea
| | - Sang-Jin Ha
- Gangneung Asan Hospital, Gangwon-do, South Korea
| | - Ae-Young Her
- Kangwon National University Hospital, Gangwon-do, South Korea
| | - Cezary Kepka
- National Institute of Cardiology, Warsaw, Poland
| | | | - Jin Won Kim
- Korea University Guro Hospital, Seoul, South Korea
| | | | - Woong Kim
- Yeungnam University Hospital, Daegu, South Korea
| | | | - Todd C Villines
- University of Virginia Medical Center, Charlottesville, Virginia, USA
| | - Iksung Cho
- Chung-Ang University Hospital, Seoul, South Korea
| | | | - Ran Heo
- Hanyang University, Hanyang University Medical Center, Seoul, South Korea
| | - Sang-Eun Lee
- Myongji Hospital, Seonam University College of Medicine, Gyeonggi-do, South Korea
| | - Ji Hyun Lee
- Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, South Korea
| | - Hyung-Bok Park
- Myongji Hospital, Seonam University College of Medicine, Gyeonggi-do, South Korea.,International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, South Korea
| | - Ji-Min Sung
- Jefferson Medical Institute, Philadelphia, Pennsylvania, USA
| | | | - James P Earls
- The George Washington University School of Medicine, Washington, District of Columbia, USA.,Cleerly Inc, New York, New York, USA
| | | | - Hyuk-Jae Chang
- Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, South Korea
| |
Collapse
|
6
|
Kasinadhuni G, Batta A, Gawalkar AA, Budakoty S, Gupta A, Vijayvergiya R. Validity and correlation of quantitative flow ratio with fractional flow reserve for assessment of intermediate coronary lesions. Acta Cardiol 2023; 78:91-98. [PMID: 35382706 DOI: 10.1080/00015385.2022.2059857] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND The angiographic percent diameter stenosis (%DS) do not assess the physiological significance of epicardial coronary stenosis. The currently practised physiological indices require pressure wires with or without adenosine-induced hyperaemia. Quantitative flow ratio (QFR) is an angiography-based method to determine the functional significance of coronary stenosis. The present study aimed to analyse the diagnostic performance of QFR in comparison to fractional flow reserve (FFR) in intermediate coronary lesions. MATERIALS AND METHODS It was a single centre retrospective study to analyse the diagnostic performance of offline QFR with the previously performed FFR in the last six years. A total of 56 interrogated vessels were included for the analysis. Offline QFR analysis was performed and correlated with FFR values in the intermediate coronary stenoses. RESULTS The mean age of the study population was 62.4 ± 9.1 years, including 81% men. The left anterior descending artery (50%) was the most common analysed vessel followed by left circumflex (27%) and right coronary (21%) arteries. The mean % DS and % area stenosis were 45.25 ± 11.22% and 57.45% ± 16.25%, respectively. The mean FFR and QFR values were 0.83 ± 0.06 and 0.82 ± 0.10, respectively. A strong positive correlation was found between FFR and QFR with a Spearman correlation coefficient of 0.56. Receiver operating curve analysis for QFR and %DS with a FFR cut off value <0.80 showed an area under the curve of 0.97 and 0.77, respectively. The sensitivity, specificity and diagnostic accuracy of QFR were 87.5%, 95% and 92.8%, respectively. There was a discordance in four vessels (7.1%) between QFR and FFR. CONCLUSION QFR has a good diagnostic performance in comparison to the gold standard FFR for physiological assessment of intermediate lesions. Its performance is significantly better than the anatomical % DS (p < 0.001).
Collapse
Affiliation(s)
- Ganesh Kasinadhuni
- Department of Cardiology, Advanced Cardiac Centre, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Akash Batta
- Department of Cardiology, Advanced Cardiac Centre, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Atit A Gawalkar
- Department of Cardiology, Advanced Cardiac Centre, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Sudhanshu Budakoty
- Department of Cardiology, Advanced Cardiac Centre, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Ankush Gupta
- Department of Cardiology, Advanced Cardiac Centre, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Rajesh Vijayvergiya
- Department of Cardiology, Advanced Cardiac Centre, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| |
Collapse
|
7
|
Griffin WF, Choi AD, Riess JS, Marques H, Chang HJ, Choi JH, Doh JH, Her AY, Koo BK, Nam CW, Park HB, Shin SH, Cole J, Gimelli A, Khan MA, Lu B, Gao Y, Nabi F, Nakazato R, Schoepf UJ, Driessen RS, Bom MJ, Thompson R, Jang JJ, Ridner M, Rowan C, Avelar E, Généreux P, Knaapen P, de Waard GA, Pontone G, Andreini D, Earls JP. AI Evaluation of Stenosis on Coronary CTA, Comparison With Quantitative Coronary Angiography and Fractional Flow Reserve: A CREDENCE Trial Substudy. JACC Cardiovasc Imaging 2023; 16:193-205. [PMID: 35183478 DOI: 10.1016/j.jcmg.2021.10.020] [Citation(s) in RCA: 28] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 10/18/2021] [Accepted: 10/22/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Clinical reads of coronary computed tomography angiography (CTA), especially by less experienced readers, may result in overestimation of coronary artery disease stenosis severity compared with expert interpretation. Artificial intelligence (AI)-based solutions applied to coronary CTA may overcome these limitations. OBJECTIVES This study compared the performance for detection and grading of coronary stenoses using artificial intelligence-enabled quantitative coronary computed tomography (AI-QCT) angiography analyses to core lab-interpreted coronary CTA, core lab quantitative coronary angiography (QCA), and invasive fractional flow reserve (FFR). METHODS Coronary CTA, FFR, and QCA data from 303 stable patients (64 ± 10 years of age, 71% male) from the CREDENCE (Computed TomogRaphic Evaluation of Atherosclerotic DEtermiNants of Myocardial IsChEmia) trial were retrospectively analyzed using an Food and Drug Administration-cleared cloud-based software that performs AI-enabled coronary segmentation, lumen and vessel wall determination, plaque quantification and characterization, and stenosis determination. RESULTS Disease prevalence was high, with 32.0%, 35.0%, 21.0%, and 13.0% demonstrating ≥50% stenosis in 0, 1, 2, and 3 coronary vessel territories, respectively. Average AI-QCT analysis time was 10.3 ± 2.7 minutes. AI-QCT evaluation demonstrated per-patient sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 94%, 68%, 81%, 90%, and 84%, respectively, for ≥50% stenosis, and of 94%, 82%, 69%, 97%, and 86%, respectively, for detection of ≥70% stenosis. There was high correlation between stenosis detected on AI-QCT evaluation vs QCA on a per-vessel and per-patient basis (intraclass correlation coefficient = 0.73 and 0.73, respectively; P < 0.001 for both). False positive AI-QCT findings were noted in in 62 of 848 (7.3%) vessels (stenosis of ≥70% by AI-QCT and QCA of <70%); however, 41 (66.1%) of these had an FFR of <0.8. CONCLUSIONS A novel AI-based evaluation of coronary CTA enables rapid and accurate identification and exclusion of high-grade stenosis and with close agreement to blinded, core lab-interpreted quantitative coronary angiography. (Computed TomogRaphic Evaluation of Atherosclerotic DEtermiNants of Myocardial IsChEmia [CREDENCE]; NCT02173275).
Collapse
|
8
|
Quan W, Han H, Liu L, Sun Y, Zhu Z, Du R, Zhu T, Zhang R. Influence of LDL-Cholesterol Lowering on Coronary Plaque Progression of Non-Target Lesions in Patients Undergoing Percutaneous Coronary Intervention: Findings from a Retrospective Study. J Clin Med 2023; 12:jcm12030785. [PMID: 36769433 PMCID: PMC9917377 DOI: 10.3390/jcm12030785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 01/01/2023] [Accepted: 01/13/2023] [Indexed: 01/20/2023] Open
Abstract
The progression of NTLs after PCI accounts for a significant portion of future adverse cardiac events. The reduction in LDL-C reduces cardiovascular events. This has, however, not yet been shown in a real-world setting. We aimed to investigate the association between LDL-C changes with progression in NTLs. A total of 847 patients with successful PCI were enrolled. Patients with follow-up LDL-C ≥ 1.4 mmol/L or percent reduction <50% compared to baseline were Non-optimal group (n = 793); patients with follow-up LDL-C < 1.4 mmol/L and percent reduction ≥50% compared to baseline were Optimal group (n = 54). Compared to Non-optimal group, Optimal group presented a lower rate of NTL plaque progression (11.11% vs. 23.96%; p = 0.007) and a lower follow-up TC (2.77 ± 0.59 vs. 3.66 ± 0.97; p < 0.001) and LDL-C (1.09 ± 0.26 vs. 2.03 ± 0.71; p < 0.001). The univariate logistic regression analysis revealed that follow-up LDL-C < 1.4 mmol/L and a percent reduction ≥50% from baseline was a protective factor for NTL plaque progression (OR: 0.397; 95%CI: 0.167-0.941; p = 0.036). The multivariate logistic regression model revealed that follow-up LDL-C < 1.4 mmol/L and percent reduction ≥50% was indeed an independent factor associated with a lower rate of plaque progression of NTLs (OR: 0.398; 95% CI: 0.167-0.945; p = 0.037). Therefore, achieving guideline-recommended LDL-C level was associated with a significantly reduced risk of NTL plaque progression.
Collapse
Affiliation(s)
- Weiwei Quan
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Hui Han
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Lili Liu
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Yi Sun
- Department of Cardiovascular Medicine, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Zhengbin Zhu
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Run Du
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Tianqi Zhu
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Ruiyan Zhang
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
- Correspondence: ; Tel.: +86-021-64370045-665215; Fax: +86-021-64457177
| |
Collapse
|
9
|
Ikeda K, Kobayashi M, Chikamori T, Yanaka Y, Takagi R, Kani J, Oshima O, Yamada S, Hokama Y, Tanaka N. Comparison between the diagnostic performance of vessel fractional flow reserve and nonhyperemic pressure ratio for functionally significant coronary stenosis severity as assessed by fractional flow reserve. Catheter Cardiovasc Interv 2023; 101:72-78. [PMID: 36480810 DOI: 10.1002/ccd.30511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 11/20/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Fractional flow reserve (FFR) and nonhyperemic pressure ratios (NHPRs) have been widely used to assess the functional severity of coronary stenosis. However, their measurement requires using a pressure wire, making their use in all patients difficult. The recently developed vessel fractional flow reserve (vFFR), derived from three-dimensional quantitative coronary angiography, is expected to serve as a surrogate for pressure wire assessment. METHODS This retrospective study was conducted on patients with intermediate coronary stenosis who underwent FFR and NHPR measurements. The vFFR and NHPR values were compared for diagnosing coronary stenosis as defined by an FFR of ≤0.80, and the number of patients not requiring wire-based assessment was estimated. RESULTS In a total of 90 lesions from 74 patients (median [SD] age 75 [12] years; men 80%), the median FFR was 0.78 (0.72-0.84), and 57% of these lesions (N = 51) exhibited an FFR of ≤0.80. vFFR provided high discrimination for coronary stenosis (area under the curve 0.80, 95% confidence interval 0.70-0.90), which was comparable to that of NHPRs (p = 0.42). High diagnostic accuracy was consistently observed across a variety of clinical presentations (i.e., old age, diabetes, target coronary artery, and left ventricular hypertrophy) (pinteraction > 0.05). In total, 55 lesions (61%) demonstrated positive or negative likelihood of coronary stenosis when vFFR was <0.73 (specificity 90%) or >0.87 (sensitivity 88%), respectively. CONCLUSION vFFR demonstrated excellent diagnostic performance for detecting functionally significant coronary stenosis as evaluated by FFR. vFFR may be used as a surrogate for pressure wire assessment.
Collapse
Affiliation(s)
- Kazumasa Ikeda
- Department of Cardiology, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - Masatake Kobayashi
- Department of Cardiology, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | | | - Yohei Yanaka
- Central Clinical Laboratory Division, Tokyo Medical University Hachiouji Medical Center, Tokyo, Japan
| | - Ryu Takagi
- Department of Cardiology, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - Junya Kani
- Department of Cardiology, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - Outaro Oshima
- Department of Cardiology, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - Satoshi Yamada
- Department of Cardiology, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - Yohei Hokama
- Department of Cardiology, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - Nobuhiro Tanaka
- Department of Cardiology, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| |
Collapse
|
10
|
Henry TD, Kereiakes DJ. QFR Facilitated Functional Lesion Assessment to Guide Revascularization: The Next Paradigm Shift? JACC Cardiovasc Interv 2022; 15:2503-2505. [PMID: 36543444 DOI: 10.1016/j.jcin.2022.10.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 10/31/2022] [Indexed: 12/24/2022]
Affiliation(s)
- Timothy D Henry
- Carl and Edyth Lindner Center for Research and Education, the Christ Hospital, Cincinnati, Ohio, USA; Christ Hospital Heart and Vascular Institute, the Christ Hospital, Cincinnati, Ohio, USA.
| | - Dean J Kereiakes
- Carl and Edyth Lindner Center for Research and Education, the Christ Hospital, Cincinnati, Ohio, USA; Christ Hospital Heart and Vascular Institute, the Christ Hospital, Cincinnati, Ohio, USA
| |
Collapse
|
11
|
Scoccia A, Tomaniak M, Neleman T, Masdjedi K, Groenland FTW, Kardys I, Ligthart JMR, Van Mieghem NM, Spitzer E, Daemen J. Correlation of 3D Quantitative Coronary-Angiography Based Vessel FFR With Diastolic Pressure Ratio: A Single-Center Pooled Analysis of the FAST EXTEND and FAST II Studies. J Invasive Cardiol 2022; 34:E686-E688. [PMID: 35738562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Vessel fractional flow reserve (vFFR) has a high diagnostic accuracy in assessing functional lesion significance compared with FFR. Nonhyperemic pressure ratios (NHPRs) were noninferior to FFR to guide revascularization of intermediate lesions. Therefore, the diagnostic performance of vFFR compared with NHPR warrants interest. AIM To evaluate the diagnostic performance of vFFR with a generic diastolic pressure ratio (dPR) as a reference. METHODS The study population was derived from the FAST EXTEND and FAST II studies. Between January 2016 and September 2020, a total of 475 patients were enrolled. RESULTS Median dPR was 0.92 (interquartile range [IQR], 0.87-0.95), median vFFR was 0.86 (IQR, 0.80-0.90). The sensitivity, specificity, positive and negative predictive values, and diagnostic accuracy of vFFR ≤0.80 for dPR ≤0.89 were 66%, 92%, 79%, 85%, and 84%, respectively. Vessel FFR showed a good agreement with dPR (r=0.68), consistent among specific clinical lesion subsets and a high diagnostic accuracy for dPR ≤0.89 (area under the curve=0.89). Discordance between vFFR and dPR was observed in 78/492 cases (15.6%) and logistic regression analysis did not reveal any clinical, angiographic, or hemodynamic variables associated with vFFR and dPR discordance. CONCLUSION Vessel FFR shows a good agreement with dPR and a high diagnostic accuracy for dPR ≤0.89.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | - Joost Daemen
- Department of Cardiology, Room Rg- 628, Erasmus University Medical Center, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands.
| |
Collapse
|
12
|
de Moura Santos L, Borges Carvalho W, Ribeiro MH, Medeiros Lopes MAAA, da Silva EF, Fukushima JT, Abizaid AAC, Campos CM. Offline Assessment of the Quantitative Flow Ratio: Is it Useful in Clinical Practice? J Invasive Cardiol 2022; 34:E620-E626. [PMID: 35920731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Fractional flow reserve (FFR) has been established as the gold standard in the physiological assessment of coronary obstructions severity. However, the need to insert an intracoronary pressure guidewire is a factor that limits its use. Quantitative flow ratio (QFR) is a method that infers the value of FFR from 3-dimensional quantitative coronary angiography (3D-QCA), eliminating the use of a pressure wire and coronary hyperemia. The present study aims to evaluate the diagnostic accuracy of QFR and 3D-QCA in comparison with FFR for the identification of significant obstructive coronary lesions (FFR ≤.80) and the feasibility to assess QFR in a cohort of patients without dedicated angiographic acquisition. METHODS Consecutive patients with coronary angiography with moderate obstructive lesions that had previous FFR measurement were evaluated. Validation of QFR was assessed by the area under the curve (AUC) and other statistical tools, using FFR as the reference method. RESULTS Seventy-five arteries from 69 patients were evaluated. The accuracy of the QFR to detect FFR ≤.80 was 84.0% (95% confidence interval, 75.6-92.4). The correlation and agreement between FFR and QFR were r=0.54 (P<.01) and mean difference was -0.02 ± 0.09 (P=.09), respectively. The AUC of QFR and 3D-QCA identifying stenosis >50% was 0.854 and 0.755, respectively (P=.09). CONCLUSION QFR demonstrated good accuracy compared with FFR for the assessment of moderate obstructive coronary lesions in an unselected clinical practice population. However, many patients were excluded from the analysis and there was no statistical difference between the receiver operator characteristic curves of the QFR and percent diameter stenosis.
Collapse
Affiliation(s)
- Luciano de Moura Santos
- Heart Institute - InCor, University of Sao Paulo Medical School, Av. Dr. Eneas de Carvalho Aguiar, 44, Cerqueira Cesar, Sao Paulo, SP, Brazil.
| | | | | | | | | | | | | | | |
Collapse
|
13
|
Kim JW, Dayah TJ, Javaid A, Monlezun DJ, Balanescu DV, Donisan T, Karimzad K, Hakeem A, Boone DL, Palaskas N, Lopez-Mattei J, Kim PY, Durand JB, Song J, Balanescu SM, Yang EH, Herrmann J, Marmagkiolis K, Toutouzas K, Johnson NP, Iliescu CA. Reclassification of Treatment Strategy with Fractional Flow Reserve in Cancer Patients with Coronary Artery Disease. Medicina (Kaunas) 2022; 58:medicina58070884. [PMID: 35888603 PMCID: PMC9324828 DOI: 10.3390/medicina58070884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 06/25/2022] [Accepted: 06/28/2022] [Indexed: 01/21/2023]
Abstract
Background and Objectives: Cancer and coronary artery disease (CAD) often coexist. Compared to quantitative coronary angiography (QCA), fractional flow reserve (FFR) has emerged as a more reliable method of identifying significant coronary stenoses. We aimed to assess the specific management, safety and outcomes of FFR-guided percutaneous coronary intervention (PCI) in cancer patients with stable CAD. Materials and Methods: FFR was used to assess cancer patients that underwent coronary angiography for stable CAD between September 2008 and May 2016, and were found to have ≥50% stenosis by QCA. Patients with lesions with an FFR > 0.75 received medical therapy alone, while those with FFR ≤ 0.75 were revascularized. Procedure-related complications, all-cause mortality, nonfatal myocardial infarction, or urgent revascularizations were analyzed. Results: Fifty-seven patients with stable CAD underwent FFR on 57 lesions. Out of 31 patients with ≥70% stenosis as measured by QCA, 14 (45.1%) had an FFR ≥ 0.75 and lesions were reclassified as moderate and did not receive PCI nor DAPT. Out of 26 patients with <70% stenosis as measured by QCA, 6 (23%) had an FFR < 0.75 and were reclassified as severe and were treated with PCI and associated DAPT. No periprocedural complications, urgent revascularization, acute coronary syndromes, or cardiovascular deaths were noted. There was a 22.8% mortality at 1 year, all cancer related. Patients who received a stent by FFR assessment showed a significant association with decreased risk of all-cause death (HR: 0.37, 95% CI 0.15−0.90, p = 0.03). Conclusions: Further studies are needed to define the optimal therapeutic approach for cancer patients with CAD. Using an FFR cut-off point of 0.75 to guide PCI translates into fewer interventions and can facilitate cancer care. There was an overall reduction in mortality in patients that received a stent, suggesting increased resilience to cancer therapy and progression.
Collapse
Affiliation(s)
- Jin Wan Kim
- Department of Cardiology, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA; (T.J.D.); (D.L.B.); (N.P.J.); (C.A.I.)
- Correspondence:
| | - Tariq J. Dayah
- Department of Cardiology, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA; (T.J.D.); (D.L.B.); (N.P.J.); (C.A.I.)
| | - Awad Javaid
- Department of Cardiology, Kirk Kerkorian School of Medicine, University of Nevada Las Vegas, Las Vegas, NV 89154, USA;
| | - Dominique J. Monlezun
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (D.J.M.); (D.V.B.); (T.D.); (K.K.); (N.P.); (J.L.-M.); (P.Y.K.); (J.-B.D.)
| | - Dinu V. Balanescu
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (D.J.M.); (D.V.B.); (T.D.); (K.K.); (N.P.); (J.L.-M.); (P.Y.K.); (J.-B.D.)
| | - Teodora Donisan
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (D.J.M.); (D.V.B.); (T.D.); (K.K.); (N.P.); (J.L.-M.); (P.Y.K.); (J.-B.D.)
| | - Kaveh Karimzad
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (D.J.M.); (D.V.B.); (T.D.); (K.K.); (N.P.); (J.L.-M.); (P.Y.K.); (J.-B.D.)
| | - Abdul Hakeem
- Robert Wood Johnson Hospital, Rutgers University, New Brunswick, NJ 08901, USA;
| | - David L. Boone
- Department of Cardiology, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA; (T.J.D.); (D.L.B.); (N.P.J.); (C.A.I.)
| | - Nicolas Palaskas
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (D.J.M.); (D.V.B.); (T.D.); (K.K.); (N.P.); (J.L.-M.); (P.Y.K.); (J.-B.D.)
| | - Juan Lopez-Mattei
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (D.J.M.); (D.V.B.); (T.D.); (K.K.); (N.P.); (J.L.-M.); (P.Y.K.); (J.-B.D.)
| | - Peter Y. Kim
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (D.J.M.); (D.V.B.); (T.D.); (K.K.); (N.P.); (J.L.-M.); (P.Y.K.); (J.-B.D.)
| | - Jean-Bernard Durand
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (D.J.M.); (D.V.B.); (T.D.); (K.K.); (N.P.); (J.L.-M.); (P.Y.K.); (J.-B.D.)
| | - Juhee Song
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
| | - Serban M. Balanescu
- Department of Cardiology, Elias Emergency University Hospital, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania;
| | - Eric H. Yang
- Department of Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA;
| | - Joerg Herrmann
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905, USA;
| | | | - Konstantinos Toutouzas
- First Department of Cardiology, Athens Medical School, Hippokration Hospital, 11527 Athens, Greece;
| | - Nils P. Johnson
- Department of Cardiology, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA; (T.J.D.); (D.L.B.); (N.P.J.); (C.A.I.)
| | - Cezar A. Iliescu
- Department of Cardiology, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA; (T.J.D.); (D.L.B.); (N.P.J.); (C.A.I.)
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (D.J.M.); (D.V.B.); (T.D.); (K.K.); (N.P.); (J.L.-M.); (P.Y.K.); (J.-B.D.)
| |
Collapse
|
14
|
Tar B, Ágoston A, Üveges Á, Szabó GT, Szűk T, Komócsi A, Czuriga D, Csippa B, Paál G, Kőszegi Z. Pressure- and 3D-Derived Coronary Flow Reserve with Hydrostatic Pressure Correction: Comparison with Intracoronary Doppler Measurements. J Pers Med 2022; 12:jpm12050780. [PMID: 35629202 PMCID: PMC9146986 DOI: 10.3390/jpm12050780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 05/06/2022] [Accepted: 05/09/2022] [Indexed: 02/05/2023] Open
Abstract
Purpose: To develop a method of coronary flow reserve (CFR) calculation derived from three-dimensional (3D) coronary angiographic parameters and intracoronary pressure data during fractional flow reserve (FFR) measurement. Methods: Altogether 19 coronary arteries of 16 native and 3 stented vessels were reconstructed in 3D. The measured distal intracoronary pressures were corrected to the hydrostatic pressure based on the height differences between the levels of the vessel orifice and the sensor position. Classical fluid dynamic equations were applied to calculate the flow during the resting state and vasodilatation based on morphological data and intracoronary pressure values. 3D-derived coronary flow reserve (CFRp-3D) was defined as the ratio between the calculated hyperemic and the resting flow and was compared to the CFR values simultaneously measured by the Doppler sensor (CFRDoppler). Results: Haemodynamic calculations using the distal coronary pressures corrected for hydrostatic pressures showed a strong correlation between the individual CFRp-3D values and the CFRDoppler measurements (r = 0.89, p < 0.0001). Hydrostatic pressure correction increased the specificity of the method from 46.1% to 92.3% for predicting an abnormal CFRDoppler < 2. Conclusions: CFRp-3D calculation with hydrostatic pressure correction during FFR measurement facilitates a comprehensive hemodynamic assessment, supporting the complex evaluation of macro-and microvascular coronary artery disease.
Collapse
Affiliation(s)
- Balázs Tar
- Kálmán Laki Doctoral School of Biomedical and Clinical Sciences, University of Debrecen, 4032 Debrecen, Hungary; (B.T.); (A.Á.); (Á.Ü.); (G.T.S.); (T.S.); (D.C.)
- Szabolcs–Szatmár–Bereg County Hospitals, University Teaching Hospital, 4400 Nyíregyháza, Hungary
| | - András Ágoston
- Kálmán Laki Doctoral School of Biomedical and Clinical Sciences, University of Debrecen, 4032 Debrecen, Hungary; (B.T.); (A.Á.); (Á.Ü.); (G.T.S.); (T.S.); (D.C.)
- Szabolcs–Szatmár–Bereg County Hospitals, University Teaching Hospital, 4400 Nyíregyháza, Hungary
| | - Áron Üveges
- Kálmán Laki Doctoral School of Biomedical and Clinical Sciences, University of Debrecen, 4032 Debrecen, Hungary; (B.T.); (A.Á.); (Á.Ü.); (G.T.S.); (T.S.); (D.C.)
- Szabolcs–Szatmár–Bereg County Hospitals, University Teaching Hospital, 4400 Nyíregyháza, Hungary
| | - Gábor Tamás Szabó
- Kálmán Laki Doctoral School of Biomedical and Clinical Sciences, University of Debrecen, 4032 Debrecen, Hungary; (B.T.); (A.Á.); (Á.Ü.); (G.T.S.); (T.S.); (D.C.)
- Institute of Cardiology, University of Debrecen, 4032 Debrecen, Hungary
| | - Tibor Szűk
- Kálmán Laki Doctoral School of Biomedical and Clinical Sciences, University of Debrecen, 4032 Debrecen, Hungary; (B.T.); (A.Á.); (Á.Ü.); (G.T.S.); (T.S.); (D.C.)
- Institute of Cardiology, University of Debrecen, 4032 Debrecen, Hungary
| | | | - Dániel Czuriga
- Kálmán Laki Doctoral School of Biomedical and Clinical Sciences, University of Debrecen, 4032 Debrecen, Hungary; (B.T.); (A.Á.); (Á.Ü.); (G.T.S.); (T.S.); (D.C.)
- Institute of Cardiology, University of Debrecen, 4032 Debrecen, Hungary
| | - Benjamin Csippa
- Department of Hydrodynamic Systems, Budapest University of Technology and Economics, 1111 Budapest, Hungary; (B.C.); (G.P.)
| | - György Paál
- Department of Hydrodynamic Systems, Budapest University of Technology and Economics, 1111 Budapest, Hungary; (B.C.); (G.P.)
| | - Zsolt Kőszegi
- Kálmán Laki Doctoral School of Biomedical and Clinical Sciences, University of Debrecen, 4032 Debrecen, Hungary; (B.T.); (A.Á.); (Á.Ü.); (G.T.S.); (T.S.); (D.C.)
- Szabolcs–Szatmár–Bereg County Hospitals, University Teaching Hospital, 4400 Nyíregyháza, Hungary
- Institute of Cardiology, University of Debrecen, 4032 Debrecen, Hungary
- Correspondence:
| |
Collapse
|
15
|
Sugiyama T, Kanno Y, Hamaya R, Kanaji Y, Hoshino M, Murai T, Lee T, Yonetsu T, Sasano T, Kakuta T. Determinants of visual-functional mismatches as assessed by coronary angiography and quantitative flow ratio. Catheter Cardiovasc Interv 2021; 98:1047-1056. [PMID: 33197120 DOI: 10.1002/ccd.29388] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 10/04/2020] [Accepted: 10/26/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVE We aimed to evaluate the determinants of visual-functional mismatches between quantitative coronary angiography (QCA) and the quantitative flow ratio (QFR). BACKGROUND The fractional flow reserve (FFR) has been established as a method to estimate the functional stenosis severity of coronary artery disease and to optimize decision-making for revascularization. The QFR is a novel angiography-derived computational index that can estimate the FFR without pharmacologically induced hyperemia or the use of pressure wire. METHODS A total of 504 de novo intermediate-to-severe stable lesions that underwent angiographic and physiological assessments were analyzed. All lesions were divided into four groups based on the significance of visual (QCA-diameter stenosis [DS] > 50% and ≤ 50%) and functional (QFR ≤ 0.80 and > 0.80) stenosis severity. Patient characteristics, angiographic findings, and physiological indices were compared. RESULTS One-hundred seventy-eight lesions (35.3%) showed discordant visual-functional assessments; mismatch (QCA-DS > 50% and QFR > 0.80) in 75 lesions (14.9%) and reverse mismatch (QCA-DS ≤ 50% and QFR ≤ 0.80) in 103 lesions (20.4%), respectively. Reverse mismatch was associated with non-diabetes, lower ejection fraction, higher Duke jeopardy score, and lower coronary flow reserve (CFR). Mismatch was associated with smaller QCA-DS, larger reference diameter, shorter lesion length, lower Duke jeopardy score, and higher CFR. Lesion location and microcirculatory resistance was not associated with the prevalence of mismatches. Reverse mismatch group had the higher prevalence of discordant decision-makings between QFR and FFR than the other three groups. CONCLUSIONS The CFR and subtended myocardial mass were predictors of visual-functional mismatches between QCA-DS and the QFR. Caution should be exercised in lesions showing QCA-DS/QFR reverse mismatch.
Collapse
Affiliation(s)
- Tomoyo Sugiyama
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - Yoshinori Kanno
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - Rikuta Hamaya
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - Yoshihisa Kanaji
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - Masahiro Hoshino
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - Tadashi Murai
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - Tetsumin Lee
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - Taishi Yonetsu
- Department of Interventional Cardiology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tetsuo Sasano
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tsunekazu Kakuta
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| |
Collapse
|
16
|
Abizaid A, Kedev S, Ali RBM, Santoso T, Cequier A, van Geuns RJVG, Chevalier B, Hellig F, Costa R, Onuma Y, Costa JR, Serruys P, Bangalore S. Imaging and 2-year clinical outcomes of thin strut sirolimus-eluting bioresorbable vascular scaffold: The MeRes-1 extend trial. Catheter Cardiovasc Interv 2021; 98:1102-1110. [PMID: 33269506 DOI: 10.1002/ccd.29396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 10/29/2020] [Accepted: 11/09/2020] [Indexed: 11/10/2022]
Abstract
OBJECTIVES This study explores the safety and efficacy of thin strut MeRes100 sirolimus-eluting bioresorbable vascular scaffold (BRS) in patients with de novo coronary artery lesions. BACKGROUND In interventional cardiology, the emergence of BRS technology is catalyzing the next paradigm shift. METHODS The MeRes-1 Extend was a multicenter, prospective, single-arm, open-label study enrolling 64 patients in Spain, Macedonia, Brazil, South Africa, Malaysia, and Indonesia. The safety endpoint was major adverse cardiac events (MACE) which composed of cardiac death, myocardial infarction (MI), and ischemia-driven target lesion revascularization (ID-TLR). The imaging efficacy endpoint was mean in-scaffold late lumen loss (LLL) evaluated by quantitative coronary angiography (QCA). Optical coherence tomography (OCT) imaging was performed at baseline and 6-month follow-up. RESULTS A total of 69 target lesions were identified in 64 enrolled patients (mean age 58.30 ± 9.02 years). Of the treated lesions, 49 (71.01%) lesions were of type B2/C. Procedural and device success was achieved in 64 and 62 patients, respectively. At 2-year follow-up, MACE was reported in one patient (1.61%) in the form of ID-TLR. There was no case of MI, cardiac death or scaffold thrombosis through 2-year. In a subset of 32 patients, paired QCA showed mean in-scaffold LLL of 0.18 ± 0.31 mm at 6-month follow-up. In a subset of 21 patients, OCT revealed 97.95 ± 3.69% strut coverage with mean scaffold area of 7.56 ± 1.79 mm2 and no evidence of strut malapposition. CONCLUSIONS The clinical and imaging outcomes of MeRes-1 Extend trial demonstrated favorable safety and efficacy of MeRes100 sirolimus-eluting BRS in patients with de novo coronary artery lesions.
Collapse
Affiliation(s)
- Alexandre Abizaid
- Department of Interventional Cardiology, Instituto Dante Pazzanese de Cardiologia and Hospital Albert Einstein, Sao Paulo, Brazil
| | - Sasko Kedev
- Department of Cardiology, University Clinic of Cardiology, Skopje, Macedonia
| | - Rosli Bin Mohd Ali
- Department of Cardiology, National Heart Institute, Kuala Lumpur, Malaysia
| | - Teguh Santoso
- Department of Cardiology, Medistra Hospital, South Jakarta, Indonesia
| | - Angel Cequier
- Department of Cardiology, Hospital Universitari de Bellvitge, Barcelona, Spain
| | | | - Bernard Chevalier
- Department of Cardiology, Institut Cardiovasculaire Paris Sud, Massy, France
| | - Farrel Hellig
- Division of Cardiology, Sunninghill Hospital, Johannesburg, South Africa
| | - Ricardo Costa
- Department of Interventional Cardiology, Instituto Dante Pazzanese de Cardiologia and Hospital Albert Einstein, Sao Paulo, Brazil
| | - Yoshinobu Onuma
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
| | - Jose Ribamar Costa
- Department of Interventional Cardiology, Instituto Dante Pazzanese de Cardiologia and Hospital Albert Einstein, Sao Paulo, Brazil
| | - Patrick Serruys
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
| | - Sripal Bangalore
- Division of Cardiology, New York University School of Medicine, New York, New York, USA
| |
Collapse
|
17
|
Scarsini R, Fezzi S, Pesarini G, Del Sole PA, Venturi G, Mammone C, Marcoli M, Gambaro A, Tavella D, Pighi M, Ribichini F. Impact of physiologically diffuse versus focal pattern of coronary disease on quantitative flow reserve diagnostic accuracy. Catheter Cardiovasc Interv 2021; 99:736-745. [PMID: 34761492 PMCID: PMC9544909 DOI: 10.1002/ccd.30007] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 10/19/2021] [Indexed: 12/02/2022]
Abstract
Background Fractional flow reserve (FFR) and instantaneous wave‐free ratio (iFR) disagree in about 20% of intermediate coronary lesions. As the physiological pattern of coronary artery disease has a significant influence on FFR‐iFR discordance, we sought to assess it may impact on the diagnostic accuracy of quantitative flow reserve (QFR). Methods One hundred and ninety‐four patients with 224 intermediate coronary lesions were investigated with iFR, FFR, and QFR. The physiological pattern of disease was assessed with iFR Scout pullback and QFR virtual pullback in all the cases. Results A predominantly physiologically focal pattern was observed in 81 (36.2%) lesions, whereas a predominantly physiologically diffuse was observed in 143 (63.8%) cases. QFR demonstrated a significant correlation (r = 0.581, p < 0.001) and a substantial agreement with iFR, both in diffuse (AUC = 0.798) and in focal (AUC = 0.812) pattern of disease. Discordance between QFR and iFR was observed in 51 (22.8%) lesions, consisting of iFR+/QFR− (64.7%) and iFR−/QFR+ (35.3%). Notably, the physiological pattern of disease was the only variable significantly associated with iFR/QFR discordance. QFR virtual pullback demonstrated an excellent agreement (83.9%) with iFR Scout pullback in classifying the physiological pattern of disease. Conclusions QFR has a good diagnostic accuracy in assessing myocardial ischemia independently of the pattern of coronary disease. However, the physiological pattern of disease has an influence on the QFR/iFR discordance, which occurs in ~20% of the cases. The QFR virtual pullback correctly defined the physiological pattern of disease in the majority of the cases using the iFR pullback as reference.
Collapse
Affiliation(s)
- Roberto Scarsini
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Simone Fezzi
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Gabriele Pesarini
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | | | - Gabriele Venturi
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Concetta Mammone
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Michele Marcoli
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Alessia Gambaro
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Domenico Tavella
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Michele Pighi
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Flavio Ribichini
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| |
Collapse
|
18
|
Improta R, Scarparo P, Wilschut J, Wolff Q, Daemen J, Den Dekker WK, Zijlstra F, Van Mieghem NM, Diletti R. Elastic stent recoil in coronary total occlusions: Comparison of durable-polymer zotarolimus eluting stent and ultrathin strut bioabsorbable-polymer sirolimus eluting stent. Catheter Cardiovasc Interv 2021; 99:88-97. [PMID: 33961730 PMCID: PMC9543547 DOI: 10.1002/ccd.29739] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 03/26/2021] [Accepted: 04/15/2021] [Indexed: 11/09/2022]
Abstract
Objectives To compare stent recoil (SR) of the thin‐strut durable‐polymer Zotarolimus‐eluting stent (dp‐ZES) and the ultrathin‐strut bioabsorbable‐polymer Sirolimus‐eluting stent (bp‐SES) in chronic total occlusions (CTOs) and to investigate the predictors of high SR in CTOs. Background Newer ultrathin drug eluting stent might be associated with lower radial force and higher elastic recoil due to the thinner strut design, possibly impacting on the rate of in‐stent restenosis and thrombosis. Methods Between January 2017 and November 2019, consecutive patients with CTOs undergoing percutaneous coronary intervention were evaluated. Only patients treated with dp‐ZES or bp‐SES were included and stratified accordingly. Quantitative coronary angiography analysis was used to assess absolute SR, relative SR, absolute focal SR, relative focal SR, high absolute, and high relative focal SR. Results A total of 128 lesions (67 treated with dp‐ZES and 61 with bp‐SES) in 123 patients were analyzed. Between bp‐SES and dp‐ZES no differences were found in absolute SR (p = .188), relative SR (p = .138), absolute focal SR (p = .069), and relative focal SR (p = .064). High absolute and high relative focal SR occurred more frequently in bp‐SES than in dp‐ZES (p = .004 and p = .015). Bp‐SES was a predictor of high absolute focal SR (Odds ratio [OR] 3.29, 95% confidence interval [CI] 1.50–7.22, p = .003]. High‐pressure postdilation and bp‐SES were predictors of high relative focal SR (OR 2.22, 95% CI 1.01–4.86, p = .047; OR 2.74, 95% CI 1.24–6.02, p = .012, respectively). Conclusions Both stents showed an overall low SR. However, ultra‐thin strut bp‐SES was a predictor of high absolute and high relative focal SR.
Collapse
Affiliation(s)
- Riccardo Improta
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Paola Scarparo
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Jeroen Wilschut
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Quinten Wolff
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Joost Daemen
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Wijnand K Den Dekker
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Felix Zijlstra
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Nicolas M Van Mieghem
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Roberto Diletti
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, The Netherlands
| |
Collapse
|
19
|
Cai X, Tian F, Jing J, Jin Q, Zhou S, Yin W, Chen Y, Wu Q, Fu Z, Chen Y. Prognostic value of quantitative flow ratio measured immediately after drug-coated balloon angioplasty for in-stent restenosis. Catheter Cardiovasc Interv 2021; 97 Suppl 2:1048-1054. [PMID: 33742738 DOI: 10.1002/ccd.29640] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 02/23/2021] [Accepted: 02/25/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVES This study aimed to evaluate prognostic value of quantitative flow ratio (QFR) in drug-coated balloon (DCB) angioplasty for in-stent restenosis (ISR). BACKGROUND There is a high incidence of recurrent ISR after DCB angioplasty. QFR is a novel method for fast computation of fractional flow reserve for the target vessel based on quantitative coronary angiography (QCA) and fluid dynamics algorithms. METHODS Patients participating in the RESTORE ISR China randomized trial were enrolled and classified into the recurrent restenosis group and the non-recurrent restenosis group. The binary classifications followed the QCA standards of ISR. Clinical and angiographic characteristics of the groups were analyzed, and the QFRs before and after lesion preparation and after final DCB angioplasty were measured and compared. RESULTS A total of 208 patients who underwent follow-up angiography were enrolled in the study, with 226 lesions measured in total. QFR value after DCB angioplasty (odds ratio [OR] 0.88; 95% confidence interval [CI] 0.83-0.93; p < .0001 for 1 mm increase), lesion length (OR: 1.08; 95% CI: 1.01-1.15; p = .017), and vessel caliber lumen diameter (OR: 0.35; 95% CI 0.13-0.89; p = .027) were independently associated with recurrent restenosis after DCB angioplasty. The optimal QFR cut-off value was determined to be 0.90 with a sensitivity of 0.94, specificity of 0.56, and accuracy of 0.79 in predicting recurrent restenosis. CONCLUSIONS The QFR value after DCB angioplasty is a promising predictor of DES ISR.
Collapse
Affiliation(s)
- Xiaoqing Cai
- Department of Cardiology, PLA General Hospital, Beijing, China.,Department of Cardiology, The 940th Hospital of Joint Logistics Support Force of PLA, Lanzhou, China
| | - Feng Tian
- Department of Cardiology, PLA General Hospital, Beijing, China
| | - Jing Jing
- Department of Cardiology, PLA General Hospital, Beijing, China
| | - Qinhua Jin
- Department of Cardiology, PLA General Hospital, Beijing, China
| | - Shanshan Zhou
- Department of Cardiology, PLA General Hospital, Beijing, China
| | - Weijun Yin
- Department of Cardiology, PLA General Hospital, Beijing, China
| | - Yufang Chen
- Department of Pharmacology, School of Basic Medicine, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Qiang Wu
- Division of Geriatric Cardiology, PLA General Hospital, Beijing, China
| | - Zhenhong Fu
- Department of Cardiology, PLA General Hospital, Beijing, China
| | - Yundai Chen
- Department of Cardiology, PLA General Hospital, Beijing, China
| |
Collapse
|
20
|
Pagnoni M, Meier D, Candreva A, Maillard L, Adjedj J, Collet C, Mahendiran T, Cook S, Mujcinovic A, Dupré M, Rubimbura V, Roguelov C, Eeckhout E, De Bruyne B, Muller O, Fournier S. Future culprit detection based on angiography-derived FFR. Catheter Cardiovasc Interv 2021; 98:E388-E394. [PMID: 33913606 DOI: 10.1002/ccd.29736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 03/23/2021] [Accepted: 04/12/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVES We sought to characterize the hemodynamic impact of mild coronary artery disease (CAD) using quantitative flow ratio (QFR, an angiography-derived fractional flow reserve [FFR]) in a population of patients with only non-significant CAD at baseline that subsequently experienced a myocardial infarction (MI). BACKGROUND The discriminatory value of FFR in patients with mild CAD remains imperfect. METHODS We retrospectively included patients who underwent invasive coronary angiography for an MI, in whom another angiogram had been performed within the previous 5 years. Three-dimensional quantitative coronary angiography, QFR, and lesion length analysis were conducted on lesions responsible for the MI (future culprit lesions, [FCL]) as well as on control lesions (non-culprit lesions, [NCL]). RESULTS Eighty-three FCL and 117 NCL were analyzed in 83 patients: FCL were more severe (median % diameter of stenosis [DS] 39.1% [29.8; 45.7] vs. 29.8% [25.0; 37.2], p < .001), had lower QFR values (0.94 [0.86; 0.98] vs. 0.98 [0.96; 1.00], p < .001) and tended to be longer (15.2 mm [10.0; 27.3] vs. 12.7 mm [9.3; 22.4], p = .070) than NCL. In lesions with an interval < 2 years between baseline angiography and MI, the difference in QFR was more pronounced compared to the lesions with a longer interval (FCL: 0.92 [0.85; 0.97] vs. NCL: 0.98 [0.94; 1.00], p < .001 and FCL: 0.96 [0.88; 1.00] vs. NCL: 0.98 [0.96;1.00], p = .006 respectively) CONCLUSION: Mild coronary stenoses that are subsequently responsible for an MI (FCL) exhibit a higher DS and lower QFR years before the event. Furthermore, FCL with a lower QFR at baseline appear to lead earlier to MI.
Collapse
Affiliation(s)
- Mattia Pagnoni
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - David Meier
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | | | - Luc Maillard
- Department of Cardiology, GCS ES Axium Rambot, Aix en Provence, France
| | - Julien Adjedj
- Department of Cardiology, Arnault Tzank Institute, Saint Laurent Du Var, France
| | - Carlos Collet
- Cardiovascular Center, OLV Ziekenhuis, Aalst, Belgium
| | - Thabo Mahendiran
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Stephane Cook
- Department of Cardiology, HFR Fribourg, Fribourg, Switzerland
| | - Alma Mujcinovic
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Marion Dupré
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Vladimir Rubimbura
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Christan Roguelov
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Eric Eeckhout
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Bernard De Bruyne
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland.,Cardiovascular Center, OLV Ziekenhuis, Aalst, Belgium
| | - Olivier Muller
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Stephane Fournier
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland.,Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| |
Collapse
|
21
|
Affiliation(s)
- Sanjay Kaul
- Department of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California.
| |
Collapse
|
22
|
Smit JM, Koning G, van Rosendael AR, El Mahdiui M, Mertens BJ, Schalij MJ, Jukema JW, Delgado V, Reiber JHC, Bax JJ, Scholte AJ. Referral of patients for fractional flow reserve using quantitative flow ratio. Eur Heart J Cardiovasc Imaging 2020; 20:1231-1238. [PMID: 30535361 DOI: 10.1093/ehjci/jey187] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 11/10/2018] [Indexed: 01/11/2023] Open
Abstract
AIMS Quantitative flow ratio (QFR) is a recently developed technique to calculate fractional flow reserve (FFR) based on 3D quantitative coronary angiography and computational fluid dynamics, obviating the need for a pressure-wire and hyperaemia induction. QFR might be used to guide patient selection for FFR and subsequent percutaneous coronary intervention (PCI) referral in hospitals not capable to perform FFR and PCI. We aimed to investigate the feasibility to use QFR to appropriately select patients for FFR referral. METHODS AND RESULTS Patients who underwent invasive coronary angiography in a hospital where FFR and PCI could not be performed and were referred to our hospital for invasive FFR measurement, were included. Angiogram images from the referring hospitals were retrospectively collected for QFR analysis. Based on QFR cut-off values of 0.77 and 0.86, our patient cohort was reclassified to 'no referral' (QFR ≥0.86), referral for 'FFR' (QFR 0.78-0.85), or 'direct PCI' (QFR ≤0.77). In total, 290 patients were included. Overall accuracy of QFR to detect an invasive FFR of ≤0.80 was 86%. Based on a QFR cut-off value of 0.86, a 50% reduction in patient referral for FFR could be obtained, while only 5% of these patients had an invasive FFR of ≤0.80 (thus, these patients were incorrectly reclassified to the 'no referral' group). Furthermore, 22% of the patients that still need to be referred could undergo direct PCI, based on a QFR cut-off value of 0.77. CONCLUSION QFR is feasible to use for the selection of patients for FFR referral.
Collapse
Affiliation(s)
- Jeff M Smit
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, ZA Leiden, The Netherlands
| | - Gerhard Koning
- Medis Medical Imaging Systems B.V., Schuttersveld 9, XG Leiden, The Netherlands
| | - Alexander R van Rosendael
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, ZA Leiden, The Netherlands
| | - Mohammed El Mahdiui
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, ZA Leiden, The Netherlands
| | - Bart J Mertens
- Department of Medical Statistics, Leiden University Medical Center, Albinusdreef 2, ZA Leiden, The Netherlands
| | - Martin J Schalij
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, ZA Leiden, The Netherlands
| | - J Wouter Jukema
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, ZA Leiden, The Netherlands
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, ZA Leiden, The Netherlands
| | - Johan H C Reiber
- Medis Medical Imaging Systems B.V., Schuttersveld 9, XG Leiden, The Netherlands.,Department of Radiology, Leiden University Medical Center, Albinusdreef 2, ZA Leiden, The Netherlands
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, ZA Leiden, The Netherlands
| | - Arthur J Scholte
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, ZA Leiden, The Netherlands
| |
Collapse
|
23
|
Masdjedi K, van Zandvoort LJ, Balbi MM, Nuis RJ, Wilschut J, Diletti R, de Jaegere PPT, Zijlstra F, Van Mieghem NM, Daemen J. Validation of novel 3-dimensional quantitative coronary angiography based software to calculate fractional flow reserve post stenting. Catheter Cardiovasc Interv 2020; 98:671-677. [PMID: 33022098 PMCID: PMC8519140 DOI: 10.1002/ccd.29311] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 08/02/2020] [Accepted: 09/21/2020] [Indexed: 12/11/2022]
Abstract
Objectives To validate novel dedicated 3D‐QCA based on the software to calculate post PCI vessel‐FFR (vFFR) in a consecutive series of patients, to assess the diagnostic accuracy, and to assess inter‐observer variability. Background Low post percutaneous coronary intervention (PCI) fractional flow reserve (FFR) predicts future adverse cardiac events. However, FFR assessment requires the insertion of a pressure wire in combination with the use of a hyperemic agent. Methods FAST POST study is an observational, retrospective, single‐center cohort study. One hundred patients presenting with stable angina or non ST‐elevation myocardial infarction, who underwent post PCI FFR assessment using a dedicated microcatheter were included. Two orthogonal angiographic projections were acquired to create a 3D reconstruction of the coronary artery using the CAAS workstation 8.0. vFFR was subsequently calculated using the aortic root pressure. Results Mean age was 65±12 years and 70% were male. Mean microcatheter based FFR and vFFR were 0.91±0.07 and 0.91±0.06, respectively. A good linear correlation was found between FFR and vFFR (r = 0.88; p <.001). vFFR had a higher accuracy in the identification of patients with FFR values <0.90, AUC 0.98 (95% CI: 0.96‐1.00) as compared with 3D‐QCA AUC 0.62 (95% CI: 0.94‐0.74). Assessment of vFFR had a low inter‐observer variability (r = 0.95; p <.001). Conclusion 3D‐QCA derived post PCI vFFR correlates well with invasively measured microcatheter based FFR and has a high diagnostic accuracy to detect FFR <0.90 with low inter‐observer variability.
Collapse
Affiliation(s)
- Kaneshka Masdjedi
- Department of cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Matthew M Balbi
- Department of cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Rutger-Jan Nuis
- Department of cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Jeroen Wilschut
- Department of cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Roberto Diletti
- Department of cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Peter P T de Jaegere
- Department of cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Felix Zijlstra
- Department of cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Nicolas M Van Mieghem
- Department of cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Joost Daemen
- Department of cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
| |
Collapse
|
24
|
Lee J, Seo KW, Yang HM, Lim HS, Choi BJ, Choi SY, Tahk SJ, Yoon MH. Comparison of three-dimensional quantitative coronary angiography and intravascular ultrasound for detecting functionally significant coronary lesions. Cardiovasc Diagn Ther 2020; 10:1256-1263. [PMID: 33224749 DOI: 10.21037/cdt-20-560] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Three-dimensional quantitative coronary angiography (3D-QCA) can provide more accurate measurement of true vessel size and may be comparable to intravascular ultrasound (IVUS) in identifying functionally significant coronary stenosis, as determined by fractional flow reserve (FFR). This study aimed to evaluate the diagnostic accuracy of 3D-QCA for predicting FFR <0.8. Methods We assessed 175 lesions in 175 patients by FFR, IVUS, and 3D-QCA. Correlations between 3D-QCA values, IVUS values, and FFR values were analyzed. Receiver operating characteristic (ROC) curves were used to evaluate diagnostic accuracy of 3D-QCA for predicting FFR <0.8 and to determine the appropriate cut-off value. Results Upon evaluating 3D-QCA values, minimum lumen area (MLA) correlated with FFR value (r=0.48, P<0.001). Considering IVUS values, MLA correlated with FFR value (r=0.43, P<0.001). Also, 3D-QCA MLA was well correlated with IVUS MLA (r=0.61, P<0.001). The area under the ROC curve (AUC) for 3D-QCA MLA was 0.77, and the best cut-off value was 2.37 (sensitivity: 73%, specificity: 71%). The AUC for IVUS MLA was 0.73, and the best cut-off value was 3.01 (sensitivity: 71%, specificity: 65%). There was no significant difference in AUC for 3D-MLA and IVUS-MLA (P=0.27). Conclusions 3D-QCA is not inferior to IVUS for functional assessment of intermediate coronary lesions. We can consider 3D-QCA as a suitable substitute for IVUS or FFR in determining coronary intervention.
Collapse
Affiliation(s)
- Jooho Lee
- Division of Cardiology, Department of Internal Medicine, Seoul Medical Center, Seoul, Korea
| | - Kyoung-Woo Seo
- Department of Cardiology, Ajou University School of Medicine, Suwon, Korea
| | - Hyoung-Mo Yang
- Department of Cardiology, Ajou University School of Medicine, Suwon, Korea
| | - Hong-Seok Lim
- Department of Cardiology, Ajou University School of Medicine, Suwon, Korea
| | - Byoung-Joo Choi
- Department of Cardiology, Ajou University School of Medicine, Suwon, Korea
| | - So-Yeon Choi
- Department of Cardiology, Ajou University School of Medicine, Suwon, Korea
| | - Seung-Jae Tahk
- Department of Cardiology, Ajou University School of Medicine, Suwon, Korea
| | - Myeong-Ho Yoon
- Department of Cardiology, Ajou University School of Medicine, Suwon, Korea
| |
Collapse
|
25
|
Xu Y, Li Y, Shen H, Zhang B, Zhao Q, Cheng Y, Zhao Z, Guo Q, Yang J, Zhou Y. Clinical effectiveness and radial artery remodeling assessment via very-high-frequency ultrasound/ultra biomicroscopy after applying slender 7Fr sheath for transradial approach in left main bifurcation disease. Curr Med Res Opin 2020; 36:1643-1652. [PMID: 32847430 DOI: 10.1080/03007995.2020.1815684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To explore the clinical effect and radial remodeling of transradial slender 7 Fr sheath for left main bifurcation disease (LM bifurcation). METHODS From January 2018 to September 2019, 236 patients with LM bifurcation undergoing transradial percutaneous coronary intervention (PCI) from two heart centers were divided into slender 7 Fr sheath group (n = 127) and 6 Fr sheath group (n = 109). Quantitative coronary angiography (QCA) and very high-frequency ultrasound/ultra biomicroscopy (VHFUBM) were used to assess the clinical effect and radial remodeling of transradial sheath. RESULTS Slender 7 Fr sheath group had a higher preoperative distal bifurcation angle (67.271 ± 22.886) than 6 Fr group (55.831 ± 20.245) (p < .05). Post-PCI QCA results showed significant differences in minimum lumen diameter at proximal left anterior descending artery (LAD) and left circumflex artery (LCX) between two groups (p < .05). There were no significant differences in target vessel myocardial infarction, target vessel revascularization, death and major adverse cardiocerebrovascular events (MACCE) at 30-day and 1-year follow-up between two groups (p>.05). No significant differences were observed in radial artery diameter (RAD), intimal-medial thickness (IMT) and radial artery injury at 24-h and 90-day follow-up between two groups. CONCLUSION With larger main and side branch diameter, larger angle of bifurcation and higher SYNTAX score, transradial slender 7 Fr sheath obtained similar clinical effects as 6 Fr sheath without increasing the occurrence of adverse events. Similar follow-up RAD, IMT and radial artery injury were observed. Therefore, slender 7 Fr sheath has safety and feasibility in applying to transradial LM-Bifurcation PCI.
Collapse
Affiliation(s)
- Yingkai Xu
- Department of Cardiology, Beijing Anzhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Disease, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing, China
| | - Yingkai Li
- Departments of Cardiology and Clinical Laboratory, Cangzhou Teaching Hospital of Tianjin Medical University, Cangzhou Central Hospital, Cangzhou, Hebei, China
| | - Hua Shen
- Department of Cardiology, Beijing Anzhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Disease, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing, China
| | - Beibei Zhang
- Department of Cardiology, Beijing Anzhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Disease, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing, China
| | - Qi Zhao
- Department of Cardiology, Beijing Anzhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Disease, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing, China
| | - Yujing Cheng
- Department of Cardiology, Beijing Anzhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Disease, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing, China
| | - Ziwei Zhao
- Department of Cardiology, Beijing Anzhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Disease, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing, China
| | - Qianyun Guo
- Department of Cardiology, Beijing Anzhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Disease, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing, China
| | - Jiaqi Yang
- Department of Cardiology, Beijing Anzhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Disease, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing, China
| | - Yujie Zhou
- Department of Cardiology, Beijing Anzhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Disease, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing, China
| |
Collapse
|
26
|
Ito S, Kinoshita K, Endo A, Kami R, Kotake Y, Nakamura M. Inter- and intra-core laboratory variability in the quantitative coronary angiography analysis for drug-eluting stent treatment and follow up. Ther Adv Cardiovasc Dis 2020; 14:1753944720958982. [PMID: 32993464 PMCID: PMC7534069 DOI: 10.1177/1753944720958982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
AIM To evaluate inter-core laboratory variability of quantitative coronary angiography (QCA) parameters in comparison with intra-core laboratory variability in a randomized controlled trial evaluating drug-eluting stents. METHODS A total of 50 patients with 62 coronary lesions were analyzed by four analysis experts belonging to an Angiographic Core Laboratory (ACL: 1 expert) and a Cardiovascular Imaging Core Laboratory (CICL: 3 experts). QCA was based on the same standard operating procedure, but selections of projection and cine frames were at the discretion of each analyst. Inter- and intra-core laboratory variabilities were evaluated by accuracy, precision, Bland Altman analysis, and coefficient of variation. RESULTS Pre-MLD (minimal lumen diameter) was significantly smaller in results from ACL than those from all CICL experts. Number of analyzed projections did not affect pre-MLD results. Acute gain was larger in ACL than in CICL2. No significant difference was observed in late loss and loss index between inter-core laboratories. Agreement between core labs in the Bland-Altman analysis for each QCA parameter was as follows (mean difference, 95% limits of agreement): pre-MLD (-0.32, -0.74 to 0.10), stent MLD (0.08, -0.28 to 0.44), acute gain (0.22, -0.44 to 0.88), and late loss (-0.07, -0.69 to 0.55). Agreement between analysts in CICL (mean difference, 95% limits of agreement) was: pre MLD (-0.03, -0.37 to 0.31), stent MLD (0.15, -0.15 to 0.45), acute gain (0.05, -0.45 to 0.55), and late loss (0.04, -0.52 to 0.60). The widest limits of agreement among three analyses were shown in both analyses. Width of limited agreement in the intra-core laboratory analysis tended to be smaller than the inter-core laboratory analysis with these parameters. Coefficient of variation tended to be larger in lesion length (LL), acute gain, late loss, and loss index in inter- and in intra- core laboratory comparisons. CONCLUSION Inter-core laboratory QCA variability in late loss and loss index analysis could be similar to intra-core laboratory variability, but more strict alignment between core laboratories would be necessary for initial procedural data analysis.
Collapse
Affiliation(s)
- Shigenori Ito
- Division of Cardiology, Sankuro Hospital, 7-80 Kosaka-cho, Toyota-shi, Aichi-ken, 471-0035, Japan.,Japan Cardiovascular Imaging Core Laboratory, Tokyo, Japan
| | | | - Akiko Endo
- Japan Cardiovascular Imaging Core Laboratory, Tokyo, Japan
| | - Ryoko Kami
- Japan Cardiovascular Imaging Core Laboratory, Tokyo, Japan
| | - Yuko Kotake
- Japan Cardiovascular Imaging Core Laboratory, Tokyo, Japan
| | - Masato Nakamura
- Division of Cardiology, Toho University Medical Center Ohashi Hospital, Tokyo, Japan.,Japan Cardiovascular Imaging Core Laboratory, Tokyo, Japan
| |
Collapse
|
27
|
Sheth T, Pinilla-Echeverri N, Moreno R, Wang J, Wood DA, Storey RF, Mehran R, Bainey KR, Bossard M, Bangalore S, Schwalm JD, Velianou JL, Valettas N, Sibbald M, Rodés-Cabau J, Ducas J, Cohen EA, Bagai A, Rinfret S, Newby DE, Feldman L, Laster SB, Lang IM, Mills JD, Cairns JA, Mehta SR. Nonculprit Lesion Severity and Outcome of Revascularization in Patients With STEMI and Multivessel Coronary Disease. J Am Coll Cardiol 2020; 76:1277-1286. [PMID: 32912441 DOI: 10.1016/j.jacc.2020.07.034] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 07/10/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND In the COMPLETE (Complete vs Culprit-only Revascularization to Treat Multi-vessel Disease After Early PCI for STEMI) trial, angiography-guided percutaneous coronary intervention (PCI) of nonculprit lesions with the aim of complete revascularization reduced major cardiovascular (CV) events in patients with ST-segment elevation myocardial infarction (MI) and multivessel coronary artery disease. OBJECTIVES The purpose of this study was to determine the effect of nonculprit-lesion stenosis severity measured by quantitative coronary angiography (QCA) on the benefit of complete revascularization. METHODS Among 4,041 patients randomized in the COMPLETE trial, nonculprit lesion stenosis severity was measured using QCA in the angiographic core laboratory in 3,851 patients with 5,355 nonculprit lesions. In pre-specified analyses, the treatment effect in patients with QCA stenosis ≥60% versus <60% on the first coprimary outcome of CV death or new MI and the second co-primary outcome of CV death, new MI, or ischemia-driven revascularization was determined. RESULTS The first coprimary outcome was reduced with complete revascularization in the 2,479 patients with QCA stenosis ≥60% (2.5%/year vs. 4.2%/year; hazard ratio [HR]: 0.61; 95% confidence interval [CI]: 0.47 to 0.79), but not in the 1,372 patients with QCA stenosis <60% (3.0%/year vs. 2.9%/year; HR: 1.04; 95% CI: 0.72 to 1.50; interaction p = 0.02). The second coprimary outcome was reduced in patients with QCA stenosis ≥60% (2.9%/year vs. 6.9%/year; HR: 0.43; 95% CI: 0.34 to 0.54) to a greater extent than patients with QCA stenosis <60% (3.3%/year vs. 5.2%/year; HR: 0.65; 95% CI: 0.47 to 0.89; interaction p = 0.04). CONCLUSIONS Among patients with ST-segment elevation MI and multivessel coronary artery disease, complete revascularization reduced major CV outcomes to a greater extent in patients with stenosis severity of ≥60% compared with <60%, as determined by quantitative coronary angiography.
Collapse
Affiliation(s)
- Tej Sheth
- Population Health Research Institute, Hamilton, Ontario, Canada; McMaster University, Hamilton Health Sciences, Hamilton, Ontario, Canada. https://twitter.com/PHRIresearch
| | - Natalia Pinilla-Echeverri
- Population Health Research Institute, Hamilton, Ontario, Canada; McMaster University, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | | | - Jia Wang
- Population Health Research Institute, Hamilton, Ontario, Canada; McMaster University, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - David A Wood
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Robert F Storey
- Department of Infection, Immunity, and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
| | - Roxana Mehran
- Zena A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Kevin R Bainey
- University of Alberta, Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada
| | - Matthias Bossard
- Cardiology Division, Heart Center, Luzerner Kantonsspital, Luzern, Switzerland
| | | | - Jon-David Schwalm
- Population Health Research Institute, Hamilton, Ontario, Canada; McMaster University, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - James L Velianou
- McMaster University, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Nicholas Valettas
- McMaster University, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Matthew Sibbald
- McMaster University, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Josep Rodés-Cabau
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - John Ducas
- University of Manitoba, Winnipeg, Manitoba, Canada
| | - Eric A Cohen
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Akshay Bagai
- Terrence Donnelly Heart Centre, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Laurent Feldman
- Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Steven B Laster
- St. Luke's Mid-America Heart Institute, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
| | - Irene M Lang
- Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Joseph D Mills
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - John A Cairns
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Shamir R Mehta
- Population Health Research Institute, Hamilton, Ontario, Canada; McMaster University, Hamilton Health Sciences, Hamilton, Ontario, Canada. https://twitter.com/PHRIresearch
| |
Collapse
|
28
|
|
29
|
Bourantas CV, Zanchin T, Torii R, Serruys PW, Karagiannis A, Ramasamy A, Safi H, Coskun AU, Koning G, Onuma Y, Zanchin C, Krams R, Mathur A, Baumbach A, Mintz G, Windecker S, Lansky A, Maehara A, Stone PH, Raber L, Stone GW. Shear Stress Estimated by Quantitative Coronary Angiography Predicts Plaques Prone to Progress and Cause Events. JACC Cardiovasc Imaging 2020; 13:2206-2219. [PMID: 32417338 DOI: 10.1016/j.jcmg.2020.02.028] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 02/05/2020] [Accepted: 02/14/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES This study examined the value of endothelial shear stress (ESS) estimated in 3-dimensional quantitative coronary angiography (3D-QCA) models in detecting plaques that are likely to progress and cause events. BACKGROUND Cumulative evidence has shown that plaque characteristics and ESS derived from intravascular ultrasound (IVUS)-based reconstructions enable prediction of lesions that will cause cardiovascular events. However, the prognostic value of ESS estimated by 3D-QCA in nonflow limiting lesions is yet unclear. METHODS This study analyzed baseline virtual histology (VH)-IVUS and angiographic data from 28 lipid-rich lesions (i.e., fibroatheromas) that caused major adverse cardiovascular events or required revascularization (MACE-R) at 5-year follow-up and 119 lipid-rich plaques from a control group that remained quiescent. The segments studied by VH-IVUS at baseline were reconstructed using 3D-QCA software. In the obtained geometries, blood flow simulation was performed, and the pressure gradient across the lipid-rich plaque and the mean ESS values in 3-mm segments were estimated. The additive value of these hemodynamic indexes in predicting MACE-R beyond plaque characteristics was examined. RESULTS MACE-R lesions were longer, had smaller minimum lumen area, increased plaque burden (PB), were exposed to higher ESS, and exhibited a higher pressure gradient. In multivariable analysis, PB (hazard ratio: 1.08; p = 0.004) and the maximum 3-mm ESS value (hazard ratio: 1.11; p = 0.001) were independent predictors of MACE-R. Lesions exposed to high ESS (>4.95 Pa) with a high-risk anatomy (minimal lumen area <4 mm2 and PB >70%) had a higher MACE-R rate (53.8%) than those with a low-risk anatomy exposed to high ESS (31.6%) or those exposed to low ESS who had high- (20.0%) or low-risk anatomy (7.1%; p < 0.001). CONCLUSIONS In the present study, 3D-QCA-derived local hemodynamic variables provided useful prognostic information, and, in combination with lesion anatomy, enabled more accurate identification of MACE-R lesions.
Collapse
Affiliation(s)
- Christos V Bourantas
- Department of Cardiology, Barts Heart Centre, Barts Health NHS, London, United Kingdom; Institute of Cardiovascular Sciences, University College London, London, United Kingdom; Centre for Cardiovascular Medicine and Device Innovation, Queen Mary University London, London, United Kingdom.
| | - Thomas Zanchin
- Department of Cardiology, Barts Heart Centre, Barts Health NHS, London, United Kingdom; Department of Cardiology, Bern University Hospital, Bern, Switzerland; Department of Mechanical Engineering, University College London, London, United Kingdom
| | - Ryo Torii
- Department of Mechanical Engineering, University College London, London, United Kingdom
| | - Patrick W Serruys
- Faculty of Medicine, National Heart & Lung Institute, Imperial College London, United Kingdom
| | - Alexios Karagiannis
- CTU Bern, Institute of Social and Preventive Medicine, Bern University, Bern, Switzerland
| | - Anantharaman Ramasamy
- Department of Cardiology, Barts Heart Centre, Barts Health NHS, London, United Kingdom; Centre for Cardiovascular Medicine and Device Innovation, Queen Mary University London, London, United Kingdom
| | - Hannah Safi
- Institute of Cardiovascular Sciences, University College London, London, United Kingdom
| | - Ahmet Umit Coskun
- Mechanical and Industrial Engineering, Northeastern University, Boston, Massachusetts
| | - Gerhard Koning
- Medis medical imaging systems bv, Leiden, the Netherlands
| | - Yoshinobu Onuma
- Department of Interventional Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Christian Zanchin
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - Rob Krams
- Department of Molecular Bioengineering Engineering and Material Sciences, Queen Mary University London, London, United Kingdom
| | - Anthony Mathur
- Department of Cardiology, Barts Heart Centre, Barts Health NHS, London, United Kingdom; Centre for Cardiovascular Medicine and Device Innovation, Queen Mary University London, London, United Kingdom
| | - Andreas Baumbach
- Department of Cardiology, Barts Heart Centre, Barts Health NHS, London, United Kingdom; Centre for Cardiovascular Medicine and Device Innovation, Queen Mary University London, London, United Kingdom
| | - Gary Mintz
- Department of Cardiology, Columbia University Medical Center and the Cardiovascular Research Foundation, New York, New York
| | - Stephan Windecker
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - Alexandra Lansky
- Institute of Cardiovascular Sciences, University College London, London, United Kingdom; Division of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Akiko Maehara
- Department of Cardiology, Columbia University Medical Center and the Cardiovascular Research Foundation, New York, New York
| | - Peter H Stone
- Cardiovascular Division, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Lorenz Raber
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - Gregg W Stone
- Division of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| |
Collapse
|
30
|
Ito S, Kinoshita K, Endo A, Nakamura M. Impact of Cine Frame Selection on Quantitative Coronary Angiography Results. Clin Med Insights Cardiol 2019; 13:1179546819838232. [PMID: 30967747 PMCID: PMC6444776 DOI: 10.1177/1179546819838232] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 02/19/2019] [Indexed: 11/15/2022]
Abstract
We evaluated intra- and interobserver variability of quantitative coronary
angiography (QCA) due to cine frame selection for 9 coronary stenoses. The
projection was selected in advance. Cine frames were selected by 2 blinded
experts (blind frame QCA) followed by assignment by supervisor (pre-selected
frame QCA). Each expert analyzed 18 frames twice with a 3-month interval. A
total of 72 measurements by 2 experts were used for intra- and interobserver
variability analysis in calibration factor (CF), minimal lumen diameter (MLD),
percent diameter stenosis (%DS), interpolated reference diameter (Int R), and
lesion length (LL). Accuracy, precision, and coefficient of variation (CV) were
calculated based on 2 measurements. For interobserver variability, intraclass
correlation coefficient (ICC) was evaluated. Regarding intraobserver
variability, precision (CV) was 0.0026 (1.45), 0.220 (25.1), 0.282 (11.0), 7.626
(11.8), and 4.042 (28.7) for blind frame QCA and 0.0044 (2.46), 0.094 (11.2),
0.225 (8.6), 3.924 (5.9), and 1.941 (12.1) for pre-selected frame QCA and
regarding interobserver variability, precision (CV) was 0.0037 (2.09), 0.271
(31.8), 0.307 (11.9), 10.10 (15.4), and 5.121 (39.5) for blind frame QCA and
0.0050 (2.82), 0.098 (11.4), 0.246 (9.5), 5.253 (8.0), and 2.857 (19.0) for
pre-selected frame QCA in CF, MLD, Int R, %DS, and LL, respectively. Intraclass
correlation coefficient of Int R was almost perfect in blind and pre-selected
frame QCA. Intraclass correlation coefficient of MLD, %DS, and LL were
substantial/lower by blind frame QCA and improved to almost perfect by
pre-selected frame QCA. Blind cine film selection might affect intra- and
interobserver variability, especially in MLD and LL. In the multiple linear
regression analysis, blind frame QCA was selected as an explanatory factor of
QCA variability in MLD, %DS, and LL. The error range due to frame selection must
be taken into consideration in clinical use.
Collapse
Affiliation(s)
- Shigenori Ito
- Japan Cardiovascular Imaging Core Laboratory, Tokyo, Japan.,Division of Cardiology, Nagoya City East Medical Center, Nagoya, Japan.,Division of Cardiology, Sankuro Hospital, Toyota, Japan
| | | | - Akiko Endo
- Japan Cardiovascular Imaging Core Laboratory, Tokyo, Japan
| | - Masato Nakamura
- Japan Cardiovascular Imaging Core Laboratory, Tokyo, Japan.,Division of Cardiology, Toho University Medical Center Ohashi Hospital, Tokyo, Japan
| |
Collapse
|
31
|
Bezerra CG, Hideo-Kajita A, Bulant CA, Maso-Talou GD, Mariani J, Pinton FA, Falcão BAA, Esteves-Filho A, Franken M, Feijóo RA, Kalil-Filho R, Garcia-Garcia HM, Blanco PJ, Lemos PA. Coronary fractional flow reserve derived from intravascular ultrasound imaging: Validation of a new computational method of fusion between anatomy and physiology. Catheter Cardiovasc Interv 2018; 93:266-274. [PMID: 30277641 DOI: 10.1002/ccd.27822] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 07/15/2018] [Indexed: 12/26/2022]
Abstract
OBJECTIVES To evaluate the diagnostic performance of a novel computational algorithm based on three-dimensional intravascular ultrasound (IVUS) imaging in estimating fractional flow reserve (IVUSFR ), compared to gold-standard invasive measurements (FFRINVAS ). BACKGROUND IVUS provides accurate anatomical evaluation of the lumen and vessel wall and has been validated as a useful tool to guide percutaneous coronary intervention. However, IVUS poorly represents the functional status (i.e., flow-related information) of the imaged vessel. METHODS Patients with known or suspected stable coronary disease scheduled for elective cardiac catheterization underwent FFRINVAS measurement and IVUS imaging in the same procedure to evaluate intermediate lesions. A processing methodology was applied on IVUS to generate a computational mesh condensing the geometric characteristics of the vessel. Computation of IVUSFR was obtained from patient-level morphological definition of arterial districts and from territory-specific boundary conditions. FFRINVAS measurements were dichotomized at the 0.80 threshold to define hemodynamically significant lesions. RESULTS A total of 24 patients with 34 vessels were analyzed. IVUSFR significantly correlated (r = 0.79; P < 0.001) and showed good agreement with FFRINVAS , with a mean difference of -0.008 ± 0.067 (P = 0.47). IVUSFR presented an overall accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of 91%, 89%, 92%, 80%, and 96%, respectively, to detect significant stenosis. CONCLUSION The computational processing of IVUSFR is a new method that allows the evaluation of the functional significance of coronary stenosis in an accurate way, enriching the anatomical information of grayscale IVUS.
Collapse
Affiliation(s)
- Cristiano G Bezerra
- Division of Interventional Cardiology, Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo, Brazil.,Division of Cardiology, Sirio-Libanes Hospital, Sao Paulo, Brazil.,National Institute of Science and Technology in Medicine Assisted by Scientific Computing, INCT-MACC, São Paulo, Brazil
| | - Alexandre Hideo-Kajita
- MedStar Cardiovascular Research Network, MedStar Washington Hospital Center, Washington, District of Columbia.,Division of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Carlos A Bulant
- National Institute of Science and Technology in Medicine Assisted by Scientific Computing, INCT-MACC, São Paulo, Brazil.,National Laboratory for Scientific Computing, LNCC/MCTIC, Petrópolis, Brazil
| | - Gonzalo D Maso-Talou
- National Institute of Science and Technology in Medicine Assisted by Scientific Computing, INCT-MACC, São Paulo, Brazil.,National Laboratory for Scientific Computing, LNCC/MCTIC, Petrópolis, Brazil
| | - Jose Mariani
- Division of Interventional Cardiology, Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo, Brazil.,Division of Cardiology, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - Fabio A Pinton
- Division of Interventional Cardiology, Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo, Brazil.,Division of Cardiology, Sirio-Libanes Hospital, Sao Paulo, Brazil
| | - Breno A A Falcão
- Division of Interventional Cardiology, Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo, Brazil.,Division of Cardiology, Sirio-Libanes Hospital, Sao Paulo, Brazil
| | - Antônio Esteves-Filho
- Division of Interventional Cardiology, Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo, Brazil.,Division of Cardiology, Sirio-Libanes Hospital, Sao Paulo, Brazil
| | - Marcelo Franken
- Division of Cardiology, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - Raúl A Feijóo
- National Institute of Science and Technology in Medicine Assisted by Scientific Computing, INCT-MACC, São Paulo, Brazil.,National Laboratory for Scientific Computing, LNCC/MCTIC, Petrópolis, Brazil
| | - Roberto Kalil-Filho
- Division of Interventional Cardiology, Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo, Brazil.,Division of Cardiology, Sirio-Libanes Hospital, Sao Paulo, Brazil
| | - Hector M Garcia-Garcia
- MedStar Cardiovascular Research Network, MedStar Washington Hospital Center, Washington, District of Columbia.,Division of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Pablo J Blanco
- National Institute of Science and Technology in Medicine Assisted by Scientific Computing, INCT-MACC, São Paulo, Brazil.,National Laboratory for Scientific Computing, LNCC/MCTIC, Petrópolis, Brazil
| | - Pedro A Lemos
- Division of Interventional Cardiology, Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo, Brazil.,National Institute of Science and Technology in Medicine Assisted by Scientific Computing, INCT-MACC, São Paulo, Brazil.,Division of Cardiology, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| |
Collapse
|
32
|
Westra J, Andersen BK, Campo G, Matsuo H, Koltowski L, Eftekhari A, Liu T, Di Serafino L, Di Girolamo D, Escaned J, Nef H, Naber C, Barbierato M, Tu S, Neghabat O, Madsen M, Tebaldi M, Tanigaki T, Kochman J, Somi S, Esposito G, Mercone G, Mejia-Renteria H, Ronco F, Bøtker HE, Wijns W, Christiansen EH, Holm NR. Diagnostic Performance of In-Procedure Angiography-Derived Quantitative Flow Reserve Compared to Pressure-Derived Fractional Flow Reserve: The FAVOR II Europe-Japan Study. J Am Heart Assoc 2018; 7:JAHA.118.009603. [PMID: 29980523 PMCID: PMC6064860 DOI: 10.1161/jaha.118.009603] [Citation(s) in RCA: 215] [Impact Index Per Article: 35.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Background Quantitative flow ratio (QFR) is a novel modality for physiological lesion assessment based on 3‐dimensional vessel reconstructions and contrast flow velocity estimates. We evaluated the value of online QFR during routine invasive coronary angiography for procedural feasibility, diagnostic performance, and agreement with pressure‐wire–derived fractional flow reserve (FFR) as a gold standard in an international multicenter study. Methods and Results FAVOR II E‐J (Functional Assessment by Various Flow Reconstructions II Europe‐Japan) was a prospective, observational, investigator‐initiated study. Patients with stable angina pectoris were enrolled in 11 international centers. FFR and online QFR computation were performed in all eligible lesions. An independent core lab performed 2‐dimensional quantitative coronary angiography (2D‐QCA) analysis of all lesions assessed with QFR and FFR. The primary comparison was sensitivity and specificity of QFR compared with 2D‐QCA using FFR as a reference standard. A total of 329 patients were enrolled. Paired assessment of FFR, QFR, and 2D‐QCA was available for 317 lesions. Mean FFR, QFR, and percent diameter stenosis were 0.83±0.09, 0.82±10, and 45±10%, respectively. FFR was ≤0.80 in 104 (33%) lesions. Sensitivity and specificity by QFR was significantly higher than by 2D‐QCA (sensitivity, 86.5% (78.4–92.4) versus 44.2% (34.5–54.3); P<0.001; specificity, 86.9% (81.6–91.1) versus 76.5% (70.3–82.0); P=0.002). Area under the receiver curve was significantly higher for QFR compared with 2D‐QCA (area under the receiver curve, 0.92 [0.89–0.96] versus 0.64 [0.57–0.70]; P<0.001). Median time to QFR was significantly lower than median time to FFR (time to QFR, 5.0 minutes [interquartile range, –6.1] versus time to FFR, 7.0 minutes [interquartile range, 5.0–10.0]; P<0.001). Conclusions Online computation of QFR in the catheterization laboratory is clinically feasible and is superior to angiographic assessment for evaluation of intermediary coronary artery stenosis using FFR as a reference standard. Clinical Trial Registration URL: https://www.clinicaltrials.gov. Unique identifier: NCT02959814.
Collapse
Affiliation(s)
- Jelmer Westra
- Department of Cardiology, Aarhus University Hospital, Skejby, Denmark
| | | | - Gianluca Campo
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona, Italy.,Maria Cecilia Hospital, GVM Care and Research, Cotignola (RA), Italy
| | - Hitoshi Matsuo
- Department of Cardiovascular Medicine, Gifu Heart Center, Gifu City, Japan
| | - Lukasz Koltowski
- Department of Cardiology, Medical University of Warsaw, Warszawa, Poland
| | - Ashkan Eftekhari
- Department of Cardiology, Aarhus University Hospital, Skejby, Denmark
| | - Tommy Liu
- Department of Cardiology, Hagaziekenhuis, The Hague, The Netherlands
| | - Luigi Di Serafino
- Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | | | - Javier Escaned
- Hospital Clinico San Carlos IDISSC, Complutense University, Madrid, Spain
| | - Holger Nef
- Department of Cardiology and Angiology, University of Giessen, Giessen, Germany
| | | | - Marco Barbierato
- Emodinamica Aziendale AULSS 3 Serenissima, Ospedale Dell'Angelo, Mestre, Italy
| | - Shengxian Tu
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Omeed Neghabat
- Department of Cardiology, Aarhus University Hospital, Skejby, Denmark
| | - Morten Madsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Skejby, Denmark
| | - Matteo Tebaldi
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona, Italy
| | - Toru Tanigaki
- Department of Cardiovascular Medicine, Gifu Heart Center, Gifu City, Japan
| | - Janusz Kochman
- Department of Cardiology, Medical University of Warsaw, Warszawa, Poland
| | - Samer Somi
- Department of Cardiology, Hagaziekenhuis, The Hague, The Netherlands
| | - Giovanni Esposito
- Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | | | | | - Federico Ronco
- Emodinamica Aziendale AULSS 3 Serenissima, Ospedale Dell'Angelo, Mestre, Italy
| | - Hans Erik Bøtker
- Department of Cardiology, Aarhus University Hospital, Skejby, Denmark
| | - William Wijns
- The Lambe Institute for Translational Medicine and Curam, National University of Ireland Galway, Galway, Ireland
| | | | | |
Collapse
|
33
|
Xu B, Tu S, Qiao S, Qu X, Chen Y, Yang J, Guo L, Sun Z, Li Z, Tian F, Fang W, Chen J, Li W, Guan C, Holm NR, Wijns W, Hu S. Diagnostic Accuracy of Angiography-Based Quantitative Flow Ratio Measurements for Online Assessment of Coronary Stenosis. J Am Coll Cardiol 2017; 70:3077-3087. [PMID: 29101020 DOI: 10.1016/j.jacc.2017.10.035] [Citation(s) in RCA: 313] [Impact Index Per Article: 44.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 10/13/2017] [Accepted: 10/16/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND Quantitative flow ratio (QFR) is a novel angiography-based method for deriving fractional flow reserve (FFR) without pressure wire or induction of hyperemia. The accuracy of QFR when assessed online in the catheterization laboratory has not been adequately examined to date. OBJECTIVES The goal of this study was to assess the diagnostic performance of QFR for the diagnosis of hemodynamically significant coronary stenosis defined by FFR ≤0.80. METHODS This prospective, multicenter trial enrolled patients who had at least 1 lesion with a diameter stenosis of 30% to 90% and a reference diameter ≥2 mm according to visual estimation. QFR, quantitative coronary angiography (QCA), and wire-based FFR were assessed online in blinded fashion during coronary angiography and re-analyzed offline at an independent core laboratory. The primary endpoint was that QFR would improve the diagnostic accuracy of coronary angiography such that the lower boundary of the 2-sided 95% confidence interval (CI) of this estimate exceeded 75%. RESULTS Between June and July 2017, a total of 308 patients were consecutively enrolled at 5 centers. Online QFR and FFR results were both obtained in 328 of 332 interrogated vessels. Patient- and vessel-level diagnostic accuracy of QFR was 92.4% (95% CI: 88.9% to 95.1%) and 92.7% (95% CI: 89.3% to 95.3%), respectively, both of which were significantly higher than the pre-specified target value (p < 0.001). Sensitivity and specificity in identifying hemodynamically significant stenosis were significantly higher for QFR than for QCA (sensitivity: 94.6% vs. 62.5%; difference: 32.0% [p < 0.001]; specificity: 91.7% vs. 58.1%; difference: 36.1% [p < 0.001]). Positive predictive value, negative predictive value, positive likelihood ratio, and negative likelihood ratio for QFR were 85.5%, 97.1%, 11.4, and 0.06. Offline analysis also revealed that vessel-level QFR had a high diagnostic accuracy of 93.3% (95% CI: 90.0% to 95.7%). CONCLUSIONS The study met its prespecified primary performance goal for the level of diagnostic accuracy of QFR in identifying hemodynamically significant coronary stenosis. (The FAVOR [Functional Diagnostic Accuracy of Quantitative Flow Ratio in Online Assessment of Coronary Stenosis] II China study]; NCT03191708).
Collapse
Affiliation(s)
- Bo Xu
- Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Shengxian Tu
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China.
| | - Shubin Qiao
- Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Xinkai Qu
- Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yundai Chen
- Chinese PLA General Hospital, Beijing, China
| | | | - Lijun Guo
- Peking University Third Hospital, Beijing, China
| | - Zhongwei Sun
- Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Zehang Li
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Feng Tian
- Chinese PLA General Hospital, Beijing, China
| | - Weiyi Fang
- Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Jiyan Chen
- Guangdong General Hospital, Guangzhou, China
| | - Wei Li
- Medical Research and Biometrics Center, National Center for Cardiovascular Diseases, Beijing, China
| | - Changdong Guan
- Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | | | - William Wijns
- The Lambe Institute for Translational Medicine and Curam, National University of Ireland, Galway, and Saolta University Healthcare Group, Galway, Ireland
| | - Shengshou Hu
- Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China.
| |
Collapse
|
34
|
Tu S, Westra J, Yang J, von Birgelen C, Ferrara A, Pellicano M, Nef H, Tebaldi M, Murasato Y, Lansky A, Barbato E, van der Heijden LC, Reiber JHC, Holm NR, Wijns W. Diagnostic Accuracy of Fast Computational Approaches to Derive Fractional Flow Reserve From Diagnostic Coronary Angiography: The International Multicenter FAVOR Pilot Study. JACC Cardiovasc Interv 2017; 9:2024-2035. [PMID: 27712739 DOI: 10.1016/j.jcin.2016.07.013] [Citation(s) in RCA: 356] [Impact Index Per Article: 50.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 06/25/2016] [Accepted: 06/30/2016] [Indexed: 12/24/2022]
Abstract
OBJECTIVES The aim of this prospective multicenter study was to identify the optimal approach for simple and fast fractional flow reserve (FFR) computation from radiographic coronary angiography, called quantitative flow ratio (QFR). BACKGROUND A novel, rapid computation of QFR pullbacks from 3-dimensional quantitative coronary angiography was developed recently. METHODS QFR was derived from 3 flow models with: 1) fixed empiric hyperemic flow velocity (fixed-flow QFR [fQFR]); 2) modeled hyperemic flow velocity derived from angiography without drug-induced hyperemia (contrast-flow QFR [cQFR]); and 3) measured hyperemic flow velocity derived from angiography during adenosine-induced hyperemia (adenosine-flow QFR [aQFR]). Pressure wire-derived FFR, measured during maximal hyperemia, served as the reference. Separate independent core laboratories analyzed angiographic images and pressure tracings from 8 centers in 7 countries. RESULTS The QFR and FFR from 84 vessels in 73 patients with intermediate coronary lesions were compared. Mean angiographic percent diameter stenosis (DS%) was 46.1 ± 8.9%; 27 vessels (32%) had FFR ≤ 0.80. Good agreement with FFR was observed for fQFR, cQFR, and aQFR, with mean differences of 0.003 ± 0.068 (p = 0.66), 0.001 ± 0.059 (p = 0.90), and -0.001 ± 0.065 (p = 0.90), respectively. The overall diagnostic accuracy for identifying an FFR of ≤0.80 was 80% (95% confidence interval [CI]: 71% to 89%), 86% (95% CI: 78% to 93%), and 87% (95% CI: 80% to 94%). The area under the receiver-operating characteristic curve was higher for cQFR than fQFR (difference: 0.04; 95% CI: 0.01 to 0.08; p < 0.01), but did not differ significantly between cQFR and aQFR (difference: 0.01; 95% CI: -0.04 to 0.06; p = 0.65). Compared with DS%, both cQFR and aQFR increased the area under the receiver-operating characteristic curve by 0.20 (p < 0.01) and 0.19 (p < 0.01). The positive likelihood ratio was 4.8, 8.4, and 8.9 for fQFR, cQFR, and aQFR, with negative likelihood ratio of 0.4, 0.3, and 0.2, respectively. CONCLUSIONS The QFR computation improved the diagnostic accuracy of 3-dimensional quantitative coronary angiography-based identification of stenosis significance. The favorable results of cQFR that does not require pharmacologic hyperemia induction bears the potential of a wider adoption of FFR-based lesion assessment through a reduction in procedure time, risk, and costs.
Collapse
Affiliation(s)
- Shengxian Tu
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China.
| | - Jelmer Westra
- Department of Cardiology, Aarhus University Hospital, Skejby, Denmark
| | - Junqing Yang
- Department of Cardiology, Guangdong General Hospital, Guangzhou, China
| | - Clemens von Birgelen
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, and Health Technology and Services Research, MIRA Institute, University of Twente, Enschede, the Netherlands
| | - Angela Ferrara
- Cardiovascular Research Centre, OLV Hospital, Aalst, Belgium
| | - Mariano Pellicano
- Cardiovascular Research Centre, OLV Hospital, Aalst, Belgium; Department of Advanced Biomedical Sciences, University of Naples, Federico II, Naples, Italy
| | - Holger Nef
- Department of Cardiology and Angiology, University of Giessen, Giessen, Germany
| | - Matteo Tebaldi
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Ferrara, Italy
| | - Yoshinobu Murasato
- Department of Cardiology, Clinical Research Center, Kyushu Medical Center, Fukuoka, Japan
| | - Alexandra Lansky
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Emanuele Barbato
- Cardiovascular Research Centre, OLV Hospital, Aalst, Belgium; Department of Advanced Biomedical Sciences, University of Naples, Federico II, Naples, Italy
| | - Liefke C van der Heijden
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, and Health Technology and Services Research, MIRA Institute, University of Twente, Enschede, the Netherlands
| | - Johan H C Reiber
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Niels R Holm
- Department of Cardiology, Aarhus University Hospital, Skejby, Denmark
| | - William Wijns
- Cardiovascular Research Centre, OLV Hospital, Aalst, Belgium; The Lambe Institute for Translational Medicine and Curam, National University of Ireland, Galway, and Saolta University Healthcare Group, Galway, Ireland
| | | |
Collapse
|
35
|
Ko BS, Cameron JD, Munnur RK, Wong DTL, Fujisawa Y, Sakaguchi T, Hirohata K, Hislop-Jambrich J, Fujimoto S, Takamura K, Crossett M, Leung M, Kuganesan A, Malaiapan Y, Nasis A, Troupis J, Meredith IT, Seneviratne SK. Noninvasive CT-Derived FFR Based on Structural and Fluid Analysis: A Comparison With Invasive FFR for Detection of Functionally Significant Stenosis. JACC Cardiovasc Imaging 2017; 10:663-73. [PMID: 27771399 DOI: 10.1016/j.jcmg.2016.07.005] [Citation(s) in RCA: 137] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 07/11/2016] [Accepted: 07/14/2016] [Indexed: 01/16/2023]
Abstract
OBJECTIVES This study describes the feasibility and accuracy of a novel computed tomography (CT) fractional flow reserve (FFR) technique based on alternative boundary conditions. BACKGROUND Techniques used to compute FFR based on images acquired from coronary computed tomography angiography (CTA) are described. Boundary conditions were typically determined by allometric scaling laws and assumptions regarding microvascular resistance. Alternatively, boundary conditions can be derived from the structural deformation of coronary lumen and aorta, although its accuracy remains unknown. METHODS Forty-two patients (78 vessels) in a single institution prospectively underwent 320-detector coronary CTA and FFR. Deformation of coronary cross-sectional lumen and aorta, computed from coronary CTA images acquired over diastole, was used to determine the boundary conditions based on hierarchical Bayes modeling. CT-FFR was derived using a reduced order model performed using a standard desktop computer and dedicated software. First, 12 patients (20 vessels) formed the derivation cohort to determine optimal CT-FFR threshold with which to detect functional stenosis, defined as FFR of ≤0.8, which was validated in the subsequent 30 patients (58 vessels). RESULTS Derivation cohort results demonstrated optimal threshold for CT-FFR was 0.8 with 67% sensitivity and 91% specificity. In the validation cohort, CT-FFR was successfully computed in 56 of 58 vessels (97%). Compared with coronary CTA, CT-FFR at ≤0.8 demonstrated a higher specificity (87% vs. 74%, respectively) and positive predictive value (74% vs. 60%, respectively), with comparable sensitivity (78% vs. 79%, respectively), negative predictive value (89% vs. 88%, respectively), and accuracy (area under the curve: 0.88 vs. 0.77, respectively; p = 0.22). Based on Bland-Altman analysis, mean intraobserver and interobserver variability values for CT-FFR were, respectively, -0.02 ± 0.05 (95% limits of agreement: -0.12 to 0.08) and 0.03 ± 0.06 (95% limits: 0.07 to 0.19). Mean time per patient for CT-FFR analysis was 27.07 ± 7.54 min. CONCLUSIONS CT-FFR based on alternative boundary conditions and reduced-order fluid model is feasible, highly reproducible, and may be accurate in detecting FFR ≤ 0.8. It requires a short processing time and can be completed at point-of-care. Further validation is required in large prospective multicenter settings.
Collapse
|
36
|
Zhang YJ, Zhu H, Shi SY, Muramatsu T, Pan DR, Ye F, Zhang JJ, Tian NL, Bourantas CV, Chen SL. Comparison between two-dimensional and three-dimensional quantitative coronary angiography for the prediction of functional severity in true bifurcation lesions: Insights from the randomized DK-CRUSH II, III, and IV trials. Catheter Cardiovasc Interv 2016; 87 Suppl 1:589-98. [PMID: 26876688 DOI: 10.1002/ccd.26405] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 12/21/2015] [Indexed: 11/11/2022]
Abstract
OBJECTIVE This study investigated the diagnostic accuracy of three-dimensional quantitative coronary angiography (3D-QCA) compared with conventional 2D-QCA for predicting functional severity assessed by fractional flow reserve (FFR) for true bifurcation lesions. METHODS Based on pooled data from the randomized DK-CRUSH II, III, and IV trials, we evaluated the patients with true bifurcation lesions who underwent coronary angiography together with functional evaluations using FFR in both the main vessel and the side branch. Off-line 2D- and 3D-QCA analyses were conducted using dedicated bifurcation QCA analysis software. Measurements of minimum lumen diameter (MLD), percentage diameter stenosis (% DS), and minimum lumen area (MLA) were compared between 2D- and 3D-QCA, and we evaluated their predictive values of functionally significant FFR. RESULTS Ninety patients were eligible for enrollment in the present study. In the main vessel, MLA measured by 3D-QCA was the most accurate predictor of FFR <0.75 (C statistic 0.85, P < 0.001), while MLD measured by 2D-QCA was a similarly accurate predictor (C statistic 0.85, P < 0.001). In the side branch, the best metrics for predicting FFR <0.75 were % DS measured by 2D-QCA with a C statistic value of 0.91 (P < 0.001) and MLA measured by 3D-QCA with a C statistic value of 0.81 (P < 0.001). However, both 2D- and 3D-QCA metrics exhibited low accuracies for predicting FFR <0.75 in intermediate bifurcation lesions. CONCLUSIONS 3D-QCA analysis for true bifurcation lesions did not improve the predictive accuracy of functionally significant FFR compared with 2D-QCA analysis. In lesions with intermediate stenosis, the diagnostic performance of both 2D- and 3D-QCA-derived measurements in differentiating functional severity is limited.
Collapse
Affiliation(s)
- Yao-Jun Zhang
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Hao Zhu
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Shun-Yi Shi
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Takashi Muramatsu
- Department of Cardiology, Fujita Health University Hospital, Toyoake, Japan
| | - Dao-Rong Pan
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Fei Ye
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Jun-Jie Zhang
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Nai-Liang Tian
- Department of Cardiology, Nanjing Heart Center, Nanjing, China
| | - Christos V Bourantas
- Department of Cardiology, University College London Hospitals, London, United Kingdom
| | - Shao-Liang Chen
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| |
Collapse
|
37
|
Hoppmann P, Kufner S, Cassese S, Wiebe J, Schneider S, Pinieck S, Scheler L, Bernlochner I, Joner M, Schunkert H, Laugwitz KL, Kastrati A, Byrne RA. Angiographic and clinical outcomes of patients treated with everolimus-eluting bioresorbable stents in routine clinical practice: Results of the ISAR-ABSORB registry. Catheter Cardiovasc Interv 2015; 87:822-9. [PMID: 26708019 DOI: 10.1002/ccd.26346] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 11/08/2015] [Indexed: 11/10/2022]
Abstract
OBJECTIVES We aimed to analyze angiographic and clinical results of patients undergoing BRS implantation in a real-world setting. BACKGROUND Angiographic and clinical outcome data from patients undergoing implantation of drug-eluting bioresorbable stents (BRS) in routine clinical practice is scant. METHODS Consecutive patients undergoing implantation of everolimus-eluting BRS at two high-volume centers in Munich, Germany were enrolled. Data were collected prospectively. All patients were scheduled for angiographic surveillance 6-8 months after stent implantation. Quantitative coronary angiographic analysis was performed in a core laboratory. Clinical follow-up was performed to 12 months and events were adjudicated by independent assessors. RESULTS A total of 419 patients were studied. Mean age was 66.6 ± 10.9 years, 31.5% had diabetes mellitus, 76.1% had multivessel disease, and 39.0% presented with acute coronary syndrome; 49.0% of lesions were AHA/ACC type B2/C, 13.1% had treatment of bifurcation lesions. Mean reference vessel diameter was 2.89 ± 0.46 mm. At angiographic follow-up in-stent late loss was 0.26 ± 0.51 mm, in-segment diameter stenosis was 27.5 ± 16.1, and binary angiographic restenosis was 7.5%. At 12 months, the rate of death, myocardial infarction, or target lesion revascularization was 13.1%. Definite stent thrombosis occurred in 2.6%. CONCLUSIONS The use of everolimus-eluting BRS in routine clinical practice is associated with high antirestenotic efficacy in patients undergoing angiographic surveillance. Overall clinical outcomes at 12 months are satisfactory though stent thrombosis rates are not insignificant. Further study with longer term follow-up and larger numbers of treated patients is required before we can be sure of the role of these devices in clinical practice.
Collapse
Affiliation(s)
- P Hoppmann
- 1. med. Klinik, Klinikum Rechts Der Isar, Technische Universität München, Ismaninger Strasse 22, 81675 Munich, Germany
| | - S Kufner
- Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, 80636 Munich, Germany
| | - S Cassese
- Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, 80636 Munich, Germany
| | - J Wiebe
- Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, 80636 Munich, Germany
| | - S Schneider
- 1. med. Klinik, Klinikum Rechts Der Isar, Technische Universität München, Ismaninger Strasse 22, 81675 Munich, Germany
| | - S Pinieck
- Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, 80636 Munich, Germany
| | - L Scheler
- 1. med. Klinik, Klinikum Rechts Der Isar, Technische Universität München, Ismaninger Strasse 22, 81675 Munich, Germany
| | - I Bernlochner
- 1. med. Klinik, Klinikum Rechts Der Isar, Technische Universität München, Ismaninger Strasse 22, 81675 Munich, Germany
| | - M Joner
- Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, 80636 Munich, Germany
| | - H Schunkert
- Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, 80636 Munich, Germany.,DZHK, German Centre for Cardiovascular Research, Partner Site Munich Heart Alliance, am Institut für Pharmakologie und Toxikologie der Technischen Universität München Biedersteiner Str. 29, 80802, München
| | - K-L Laugwitz
- 1. med. Klinik, Klinikum Rechts Der Isar, Technische Universität München, Ismaninger Strasse 22, 81675 Munich, Germany.,DZHK, German Centre for Cardiovascular Research, Partner Site Munich Heart Alliance, am Institut für Pharmakologie und Toxikologie der Technischen Universität München Biedersteiner Str. 29, 80802, München
| | - A Kastrati
- Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, 80636 Munich, Germany.,DZHK, German Centre for Cardiovascular Research, Partner Site Munich Heart Alliance, am Institut für Pharmakologie und Toxikologie der Technischen Universität München Biedersteiner Str. 29, 80802, München
| | - R A Byrne
- Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, 80636 Munich, Germany
| |
Collapse
|
38
|
Tu S, Barbato E, Köszegi Z, Yang J, Sun Z, Holm NR, Tar B, Li Y, Rusinaru D, Wijns W, Reiber JHC. Fractional flow reserve calculation from 3-dimensional quantitative coronary angiography and TIMI frame count: a fast computer model to quantify the functional significance of moderately obstructed coronary arteries. JACC Cardiovasc Interv 2015; 7:768-77. [PMID: 25060020 DOI: 10.1016/j.jcin.2014.03.004] [Citation(s) in RCA: 247] [Impact Index Per Article: 27.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 03/21/2014] [Accepted: 03/27/2014] [Indexed: 11/19/2022]
Abstract
OBJECTIVES This study sought to present a novel computer model for fast computation of myocardial fractional flow reserve (FFR) and to evaluate it in patients with intermediate coronary stenoses. BACKGROUND FFR is an indispensable tool to identify individual coronary stenoses causing ischemia. Calculation of FFR from x-ray angiographic data may increase the utility of FFR assessment. METHODS Consecutive patients with intermediate coronary stenoses undergoing pressure wire-based FFR measurements were analyzed by a core laboratory. Three-dimensional quantitative coronary angiography (QCA) was performed and the mean volumetric flow rate at hyperemia was calculated using TIMI (Thrombolysis In Myocardial Infarction) frame count combined with 3-dimensional QCA. Computational fluid dynamics was applied subsequently with a novel strategy for the computation of FFR. Diagnostic performance of the computed FFR (FFRQCA) was assessed using wire-based FFR as reference standard. RESULTS Computation of FFRQCA was performed on 77 vessels in 68 patients. Average diameter stenosis was 46.6 ± 7.3%. FFRQCA correlated well with FFR (r = 0.81, p < 0.001), with a mean difference of 0.00 ± 0.06 (p = 0.541). Applying the FFR cutoff value of ≤0.8 to FFRQCA resulted in 18 true positives, 50 true negatives, 4 false positives, and 5 false negatives. The area under the receiver-operating characteristic curve was 0.93 for FFRQCA, 0.73 for minimum lumen area, and 0.65 for percent diameter stenosis. CONCLUSIONS Computation of FFRQCA is a novel method that allows the assessment of the functional significance of intermediate stenosis. It may emerge as a safe, efficient, and cost-reducing tool for evaluation of coronary stenosis severity during diagnostic angiography.
Collapse
Affiliation(s)
- Shengxian Tu
- Division of Image Processing, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands.
| | - Emanuele Barbato
- Cardiovascular Center Aalst, Onze-Lieve-Vrouwziekenhuis (OLV) Hospital, Aalst, Belgium
| | - Zsolt Köszegi
- Invasive Cardiology Laboratory, Jósa András Teaching Hospital, Nyíregyháza, Hungary
| | - Junqing Yang
- Department of Cardiology, Guangdong General Hospital, Guangzhou, China
| | - Zhonghua Sun
- Department of Cardiology, TEDA International Cardiovascular Hospital, Tianjin, China
| | - Niels R Holm
- Department of Cardiology, Aarhus University Hospital, Skejby, Denmark
| | - Balázs Tar
- Invasive Cardiology Laboratory, Jósa András Teaching Hospital, Nyíregyháza, Hungary
| | - Yingguang Li
- Division of Image Processing, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Dan Rusinaru
- Cardiovascular Center Aalst, Onze-Lieve-Vrouwziekenhuis (OLV) Hospital, Aalst, Belgium
| | - William Wijns
- Cardiovascular Center Aalst, Onze-Lieve-Vrouwziekenhuis (OLV) Hospital, Aalst, Belgium
| | - Johan H C Reiber
- Division of Image Processing, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| |
Collapse
|
39
|
Wang G, Sun Z, Jin Q, Xu K, Li Y, Wang X, Ma Y, Liu H, Zhao X, Wang B, Deng J, Guan S, Ge M, Wang X, Xu B, Han Y. First-in-man study evaluating the safety and efficacy of a second generation biodegradable polymer sirolimus-eluting stent in the treatment of patients with de novo coronary lesions: clinical, Angiographic, and OCT outcomes of CREDIT-1. Catheter Cardiovasc Interv 2015; 85 Suppl 1:744-51. [PMID: 25630447 DOI: 10.1002/ccd.25862] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 01/07/2015] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To evaluate the preliminary safety and efficacy of the EXCEL II stent system. BACKGROUND Although the first biodegradable polymer drug-eluting stent (BP-DES), EXCEL, was launched nearly a decade ago, in-stent restenosis and stent thrombosis remain pertinent clinical problems in practice. A new cobalt-chromium BP-DES EXCEL II has been developed with the aim of improving stent safety and efficacy. METHODS Forty-five patients with single de novo native coronary lesions were enrolled and randomized to two groups in a 2:1 ratio, the 4-month follow-up group (n = 30) and the 12-month follow-up group (n = 15). All patients underwent percutaneous coronary intervention (PCI) with the EXCEL II stent system. Quantitative coronary angiography (QCA) and optical coherence tomography (OCT) were used to assess coronary vasculature at the designated 4- or 12-month follow-up. The primary outcome was major adverse cardiac events (MACE) at 30 days post-PCI. RESULTS No MACE, thrombotic events, or target lesion failure was found in the 45 patients during the 12-month follow-up. There was no significant difference (P > 0.05) between the two groups in terms of in-stent and in-segment late lumen loss (LLL). No in-stent and in-segment restenosis was found in either group. At follow-up, the ratio of >10% uncovered struts per lesion was 26.67% in the 4-month group and 0% in the 12-month group (P < 0.05). Neointimal coverage in the 12-month group was significantly better than in the 4-month group (98.58% vs. 93.51%, P < 0.01). CONCLUSIONS This first-in-man study demonstrates promising feasibility, safety, and efficacy of EXCEL II stents. These stents were found to have rapid endothelialization and low LLL rates at 4 and 12 months after implantation.
Collapse
Affiliation(s)
- Geng Wang
- Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, Liaoning, China
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
40
|
Campbell PT, Mahmud E, Marshall JJ. Interoperator and intraoperator (in)accuracy of stent selection based on visual estimation. Catheter Cardiovasc Interv 2015; 86:1177-83. [PMID: 25510826 DOI: 10.1002/ccd.25780] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 11/29/2014] [Indexed: 11/06/2022]
Abstract
OBJECTIVES The objectives of this study were to evaluate the ability of interventional cardiologists to accurately measure lesion length and select appropriate stents. BACKGROUND Inaccurate measurement of lesion length during percutaneous coronary intervention (PCI) increases the risk of restenosis. METHODS Interventional cardiologists (n = 40) evaluated 25 matched orthogonal angiographic images that were prescored using quantitative coronary angiography (QCA) by a core laboratory. Visual estimates of lesion length and stent length selection were compared to the maximum QCA value. A 2-4 mm stent overlap of both the proximal and distal lesion edges was considered to be optimal. Based on optimal stent overlap, accurate lesion lengths were those measured from -1 to +4 mm from the QCA. Likewise, appropriate stent lengths were those that measured between +4 mm to +8 mm from the QCA value. Five images were repeated to assess intrarater variability. RESULTS Lesion length measurements were short and long for 51.1% (95% CI 47.6-54.6%) and 19.0% (95% CI 16.3-21.9%) of the images, respectively. Stent length selections that were short and long were recorded for 55.0% (95% CI 51.5-58.5%) and 22.8% (95% CI 19.9-25.8%) of the images, respectively. Intrarater variability evaluation indicated that 38.5% (95% CI 31.7-45.6%) of lesion length measurements and 37.5% (95% CI 30.8-44.6%) of stent length selections were >3 mm different between the first and second evaluation of repeated images. CONCLUSIONS Visual estimation of coronary lesion length has a high degree of variability, which may lead to inappropriate stent selection. Improving the accuracy of lesion length measurement may improve patient outcomes.
Collapse
|
41
|
Mordini FE, Haddad T, Hsu LY, Kellman P, Lowrey TB, Aletras AH, Bandettini WP, Arai AE. Diagnostic accuracy of stress perfusion CMR in comparison with quantitative coronary angiography: fully quantitative, semiquantitative, and qualitative assessment. JACC Cardiovasc Imaging 2015; 7:14-22. [PMID: 24433707 DOI: 10.1016/j.jcmg.2013.08.014] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Revised: 08/19/2013] [Accepted: 08/22/2013] [Indexed: 12/13/2022]
Abstract
OBJECTIVES This study's primary objective was to determine the sensitivity, specificity, and accuracy of fully quantitative stress perfusion cardiac magnetic resonance (CMR) versus a reference standard of quantitative coronary angiography. We hypothesized that fully quantitative analysis of stress perfusion CMR would have high diagnostic accuracy for identifying significant coronary artery stenosis and exceed the accuracy of semiquantitative measures of perfusion and qualitative interpretation. BACKGROUND Relatively few studies apply fully quantitative CMR perfusion measures to patients with coronary disease and comparisons to semiquantitative and qualitative methods are limited. METHODS Dual bolus dipyridamole stress perfusion CMR exams were performed in 67 patients with clinical indications for assessment of myocardial ischemia. Stress perfusion images alone were analyzed with a fully quantitative perfusion (QP) method and 3 semiquantitative methods including contrast enhancement ratio, upslope index, and upslope integral. Comprehensive exams (cine imaging, stress/rest perfusion, late gadolinium enhancement) were analyzed qualitatively with 2 methods including the Duke algorithm and standard clinical interpretation. A 70% or greater stenosis by quantitative coronary angiography was considered abnormal. RESULTS The optimum diagnostic threshold for QP determined by receiver-operating characteristic curve occurred when endocardial flow decreased to <50% of mean epicardial flow, which yielded a sensitivity of 87% and specificity of 93%. The area under the curve for QP was 92%, which was superior to semiquantitative methods: contrast enhancement ratio: 78%; upslope index: 82%; and upslope integral: 75% (p = 0.011, p = 0.019, p = 0.004 vs. QP, respectively). Area under the curve for QP was also superior to qualitative methods: Duke algorithm: 70%; and clinical interpretation: 78% (p < 0.001 and p < 0.001 vs. QP, respectively). CONCLUSIONS Fully quantitative stress perfusion CMR has high diagnostic accuracy for detecting obstructive coronary artery disease. QP outperforms semiquantitative measures of perfusion and qualitative methods that incorporate a combination of cine, perfusion, and late gadolinium enhancement imaging. These findings suggest a potential clinical role for quantitative stress perfusion CMR.
Collapse
Affiliation(s)
- Federico E Mordini
- Cardiovascular and Pulmonary Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland; Department of Cardiology, Veterans Affairs Medical Center, Washington, DC
| | - Tariq Haddad
- Cardiovascular and Pulmonary Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland
| | - Li-Yueh Hsu
- Cardiovascular and Pulmonary Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland
| | - Peter Kellman
- Cardiovascular and Pulmonary Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland
| | - Tracy B Lowrey
- Cardiovascular and Pulmonary Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland
| | - Anthony H Aletras
- Cardiovascular and Pulmonary Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland; Department of Biomedical Informatics, University of Central Greece, Lamia, Greece
| | - W Patricia Bandettini
- Cardiovascular and Pulmonary Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland
| | - Andrew E Arai
- Cardiovascular and Pulmonary Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland.
| |
Collapse
|
42
|
Tomkowiak MT, Raval AN, Van Lysel MS, Funk T, Speidel MA. Calibration-free coronary artery measurements for interventional device sizing using inverse geometry x-ray fluoroscopy: in vivo validation. J Med Imaging (Bellingham) 2014; 1. [PMID: 25544948 DOI: 10.1117/1.jmi.1.3.033504] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Proper sizing of interventional devices to match coronary vessel dimensions improves procedural efficiency and therapeutic outcomes. We have developed a method that uses an inverse geometry x-ray fluoroscopy system [scanning beam digital x-ray (SBDX)] to automatically determine vessel dimensions from angiograms without the need for magnification calibration or optimal views. For each frame period (1/15th of a second), SBDX acquires a sequence of narrow beam projections and performs digital tomosynthesis at multiple plane positions. A three-dimensional model of the vessel is reconstructed by localizing the depth of the vessel edges from the tomosynthesis images, and the model is used to calculate the length and diameter in units of millimeters. The in vivo algorithm performance was evaluated in a healthy porcine model by comparing end-diastolic length and diameter measurements from SBDX to coronary computed tomography angiography (CCTA) and intravascular ultrasound (IVUS), respectively. The length error was -0.49 ± 1.76 mm(SBDX- CCTA, mean ± 1 SD). The diameter error was 0.07 ± 0.27 mm (SBDX - minimum IVUS diameter, mean ± 1 SD). The in vivo agreement between SBDX-based vessel sizing and gold standard techniques supports the feasibility of calibration-free coronary vessel sizing using inverse geometry x-ray fluoroscopy.
Collapse
Affiliation(s)
- Michael T Tomkowiak
- University of Wisconsin-Madison, Department of Medical Physics, 1111 Highland Ave, Madison, Wisconsin 53705, United States
| | - Amish N Raval
- University of Wisconsin-Madison, Department of Medicine, 600 Highland Ave, Madison, Wisconsin 53792, United States
| | - Michael S Van Lysel
- University of Wisconsin-Madison, Department of Medical Physics, 1111 Highland Ave, Madison, Wisconsin 53705, United States ; University of Wisconsin-Madison, Department of Medicine, 600 Highland Ave, Madison, Wisconsin 53792, United States
| | - Tobias Funk
- Triple Ring Technologies, Inc., 39655 Eureka Dr, Newark, California 94560, United States
| | - Michael A Speidel
- University of Wisconsin-Madison, Department of Medical Physics, 1111 Highland Ave, Madison, Wisconsin 53705, United States ; University of Wisconsin-Madison, Department of Medicine, 600 Highland Ave, Madison, Wisconsin 53792, United States
| |
Collapse
|
43
|
Onuma Y, Dudek D, Thuesen L, Webster M, Nieman K, Garcia-Garcia HM, Ormiston JA, Serruys PW. Five-year clinical and functional multislice computed tomography angiographic results after coronary implantation of the fully resorbable polymeric everolimus-eluting scaffold in patients with de novo coronary artery disease: the ABSORB cohort A trial. JACC Cardiovasc Interv 2014; 6:999-1009. [PMID: 24156961 DOI: 10.1016/j.jcin.2013.05.017] [Citation(s) in RCA: 135] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Revised: 05/03/2013] [Accepted: 05/24/2013] [Indexed: 12/18/2022]
Abstract
OBJECTIVES This study sought to demonstrate the 5-year clinical and functional multislice computed tomography angiographic results after implantation of the fully resorbable everolimus-eluting scaffold (Absorb BVS, Abbott Vascular, Santa Clara, California). BACKGROUND Multimodality imaging of the first-in-humans trial using a ABSORB BVS scaffold demonstrated at 2 years the bioresorption of the device while preventing restenosis. However, the long-term safety and efficacy of this therapy remain to be documented. METHODS In the ABSORB cohort A trial (ABSORB Clinical Investigation, Cohort A [ABSORB A] Everolimus-Eluting Coronary Stent System Clinical Investigation), 30 patients with a single de novo coronary artery lesion were treated with the fully resorbable everolimus-eluting Absorb scaffold at 4 centers. As an optional investigation in 3 of the 4 centers, the patients underwent multislice computed tomography (MSCT) angiography at 18 months and 5 years. Acquired MSCT data were analyzed at an independent core laboratory (Cardialysis, Rotterdam, the Netherlands) for quantitative analysis of lumen dimensions and was further processed for calculation of fractional flow reserve (FFR) at another independent core laboratory (Heart Flow, Redwood City, California). RESULTS Five-year clinical follow-up is available for 29 patients. One patient withdrew consent after 6 months, but the vital status of this patient remains available. At 46 days, 1 patient experienced a single episode of chest pain and underwent a target lesion revascularization with a slight troponin increase after the procedure. At 5 years, the ischemia-driven major adverse cardiac event rate of 3.4% remained unchanged. Clopidogrel was discontinued in all but 1 patient. Scaffold thrombosis was not observed in any patient. Two noncardiac deaths were reported, 1 caused by duodenal perforation and the other from Hodgkin's disease. At 5 years, 18 patients underwent MSCT angiography. All scaffolds were patent, with a median minimal lumen area of 3.25 mm(2) (interquartile range: 2.20 to 4.30). Noninvasive FFR analysis was feasible in 13 of 18 scans, which yielded a median distal FFR of 0.86 (interquartile range: 0.82 to 0.94). CONCLUSIONS The low event rate at 5 years suggests sustained safety after the implantation of a fully bioresorbable Absorb everolimus-eluting scaffold. Noninvasive assessment of the coronary artery with an option of functional assessment could be an alternative to invasive imaging after treatment of coronary narrowing with such a polymeric bioresorbable scaffold. (ABSORB Clinical Investigation, Cohort A [ABSORB A] Everolimus-Eluting Coronary Stent System Clinical Investigation [ABSORB]; NCT00300131).
Collapse
Affiliation(s)
- Yoshinobu Onuma
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands
| | | | | | | | | | | | | | | |
Collapse
|
44
|
Brunetti ND, Delli Carri F, Ruggiero MA, Cuculo A, Ruggiero A, Ziccardi L, De Gennaro L, Di Biase M. Comparative cath-lab assessment of coronary stenosis by radiology technician, junior and senior interventional cardiologist in patients treated with coronary angioplasty. Interv Med Appl Sci 2014; 6:26-30. [PMID: 24672672 DOI: 10.1556/imas.6.2014.1.4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Revised: 12/29/2013] [Accepted: 01/02/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Exact quantification of plaque extension during coronary angioplasty (PCI) usually falls on interventional cardiologist (IC). Quantitative coronary stenosis assessment (QCA) may be possibly committed to the radiology technician (RT), who usually supports cath-lab nurse and IC during PCI. We therefore sought to investigate the reliability of QCA performed by RT in comparison with IC. METHODS Forty-four consecutive patients with acute coronary syndrome underwent PCI; target coronary vessel size beneath target coronary lesion (S) and target coronary lesion length (L) were assessed by the RT, junior IC (JIC), and senior IC (SIC) and then compared. SIC evaluation, which determined the final stent selection for coronary stenting, was considered as a reference benchmark. RESULTS RT performance with QCA support in assessing target vessel size and target lesion length was not significantly different from SIC (r = 0.46, p < 0.01; r = 0.64, p < 0.001, respectively) as well as JIC (r = 0.79, r = 0.75, p < 0.001, respectively). JIC performance was significantly better than RT in assessing target vessel size (p < 0.05), while not significant when assessing target lesion length. CONCLUSIONS RT may reliably assess target lesion by using adequate QCA software in the cath-lab in case of PCI; RT performance does not differ from SIC.
Collapse
Affiliation(s)
| | | | | | - Andrea Cuculo
- Cardiology Department, University of Foggia Foggia Italy
| | | | - Luigi Ziccardi
- Cardiology Department, University of Foggia Foggia Italy
| | | | | |
Collapse
|
45
|
Tomkowiak MT, Raval AN, Van Lysel MS, Funk T, Speidel MA. Calibration-Free Coronary Artery Measurements for Interventional Device Sizing using Inverse Geometry X-ray Fluoroscopy: In Vivo Validation. Proc SPIE Int Soc Opt Eng 2014; 9033:90332H. [PMID: 24999298 PMCID: PMC4079058 DOI: 10.1117/12.2044078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Proper sizing of interventional devices to match coronary vessel dimensions improves procedural efficiency and therapeutic outcomes. We have developed a novel method using inverse geometry x-ray fluoroscopy to automatically determine vessel dimensions without the need for magnification calibration or optimal views. To validate this method in vivo, we compared results to intravascular ultrasound (IVUS) and coronary computed tomography angiography (CCTA) in a healthy porcine model. Coronary angiography was performed using Scanning-Beam Digital X-ray (SBDX), an inverse geometry fluoroscopy system that performs multiplane digital x-ray tomosynthesis in real time. From a single frame, 3D reconstruction of the arteries was performed by localizing the depth of vessel lumen edges. The 3D model was used to directly calculate length and to determine the best imaging plane to use for diameter measurements, where out-of-plane blur was minimized and the known pixel spacing was used to obtain absolute vessel diameter. End-diastolic length and diameter measurements were compared to measurements from CCTA and IVUS, respectively. For vessel segment lengths measuring 6 mm to 73 mm by CCTA, the SBDX length error was -0.49 ± 1.76 mm (SBDX - CCTA, mean ± 1 SD). For vessel diameters measuring 2.1 mm to 3.6 mm by IVUS, the SBDX diameter error was 0.07 ± 0.27 mm (SBDX - minimum IVUS diameter, mean ± 1 SD). The in vivo agreement between SBDX-based vessel sizing and gold standard techniques supports the feasibility of calibration-free coronary vessel sizing using inverse geometry x-ray fluoroscopy.
Collapse
Affiliation(s)
| | - Amish N Raval
- Dept. of Medicine, University of Wisconsin, Madison, WI, USA
| | - Michael S Van Lysel
- Dept. of Medical Physics, University of Wisconsin, Madison, WI, USA ; Dept. of Medicine, University of Wisconsin, Madison, WI, USA
| | - Tobias Funk
- Triple Ring Technologies, Inc, Newark, CA, USA
| | - Michael A Speidel
- Dept. of Medical Physics, University of Wisconsin, Madison, WI, USA ; Dept. of Medicine, University of Wisconsin, Madison, WI, USA
| |
Collapse
|
46
|
Ribichini F, Romano M, Rosiello R, La Vecchia L, Cabianca E, Caramanno G, Milazzo D, Loschiavo P, Rigattieri S, Musarò S, Pironi B, Fiscella A, Amico F, Indolfi C, Spaccarotella C, Bartorelli A, Trabattoni D, Della Rovere F, Rolandi A, Beqaraj F, Belli R, Sangiorgio P, Villani R, Berni A, Sheiban I, Lopera Quijada MJ, Cappi B, Ribaldi L, Vassanelli C. A clinical and angiographic study of the XIENCE V everolimus-eluting coronary stent system in the treatment of patients with multivessel coronary artery disease: the EXECUTIVE trial (EXecutive RCT: evaluating XIENCE V in a multi vessel disease). JACC Cardiovasc Interv 2013; 6:1012-22. [PMID: 24055444 DOI: 10.1016/j.jcin.2013.05.016] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Revised: 05/15/2013] [Accepted: 05/24/2013] [Indexed: 11/18/2022]
Abstract
OBJECTIVES This study sought to investigate the efficacy and performance of the XIENCE V everolimus-eluting stent (EES) (Abbott Vascular, Santa Clara, California) in the treatment of de novo coronary lesions in patients with 2- to 3-vessel multivessel coronary artery disease (MV-CAD). BACKGROUND Drug-eluting stents (DES) have emerged as an alternative to conventional coronary artery bypass surgery in patients with MV-CAD although first-generation DES yielded inferior efficacy and safety compared with surgery. METHODS Prospective, randomized (1:1), multicenter feasibility trial was designed to assess angiographic efficacy of EES compared with the TAXUS paclitaxel-eluting stent (PES) in 200 patients, and a prospective, open-label, single-arm, controlled registry was designed to analyze the clinical outcome of EES at 1-year follow-up in 400 MV-CAD patients. For the randomized trial, the primary endpoint was in-stent late loss at 9 months. For the registry, the primary endpoint was a composite of all-cause death, myocardial infarction, and ischemia-driven target vessel revascularization at 12 months. RESULTS The primary endpoint per single lesion was significantly lower in the EES group compared with the PES group (-0.03 ± 0.49 mm vs. 0.23 ± 0.51 mm, p = 0.001). Similar results were observed when analyzing all lesions (0.05 ± 0.51 mm vs. 0.24 ± 0.50 mm, p < 0.001). Clinical outcome at 1 year yielded a composite of major adverse cardiac events of 9.2% in the single-arm registry, and 11.1% and 16.5% in the EES and PES randomized groups, respectively (p = 0.30). CONCLUSIONS The EXECUTIVE trial was a randomized pilot trial dedicated to the comparison of the efficacy of 2 different DES among patients with 2- to 3-vessel MV-CAD. The study shows lower in-stent late loss at 9 months with the EES XIENCE V compared with the PES TAXUS Libertè, and a low major adverse cardiac event rate at 1 year in patients with 2-to 3-vessel MV-CAD. (EXECUTIVE [EXecutive RCT: Evaluating XIENCE V in a Multi Vessel Disease]; NCT00531011).
Collapse
|
47
|
Kubo T, Akasaka T, Shite J, Suzuki T, Uemura S, Yu B, Kozuma K, Kitabata H, Shinke T, Habara M, Saito Y, Hou J, Suzuki N, Zhang S. OCT compared with IVUS in a coronary lesion assessment: the OPUS-CLASS study. JACC Cardiovasc Imaging 2013; 6:1095-1104. [PMID: 24011777 DOI: 10.1016/j.jcmg.2013.04.014] [Citation(s) in RCA: 198] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2012] [Revised: 03/27/2013] [Accepted: 04/18/2013] [Indexed: 12/14/2022]
Abstract
OBJECTIVES The aim of this study was to investigate the reliability of frequency domain optical coherence tomography (FD-OCT) for coronary measurements compared with quantitative coronary angiography (QCA) and intravascular ultrasound (IVUS). BACKGROUND Accurate luminal measurement is expected in FD-OCT because this technology offers high resolution and excellent contrast between lumen and vessel wall. METHODS In 5 medical centers, 100 patients with coronary artery disease were prospectively studied by using angiography, FD-OCT, and IVUS. In addition, 5 phantom models of known lumen dimensions (lumen diameter 3.08 mm; lumen area 7.45 mm(2)) were examined using FD-OCT and IVUS. Quantitative image analyses of the coronary arteries and phantom models were performed by an independent core laboratory. RESULTS In the clinical study, the mean minimum lumen diameter measured by QCA was significantly smaller than that measured by FD-OCT (1.81 ± 0.72 mm vs. 1.91 ± 0.69 mm; p < 0.001) and the minimum lumen diameter measured by IVUS was significantly greater than that measured by FD-OCT (2.09 ± 0.60 mm vs. 1.91 ± 0.69 mm; p < 0.001). The minimum lumen area measured by IVUS was significantly greater than that by FD-OCT (3.68 ± 2.06 mm(2) vs. 3.27 ± 2.22 mm(2); p < 0.001), although a significant correlation was observed between the 2 imaging techniques (r = 0.95, p < 0.001; mean difference 0.41 mm(2)). Both FD-OCT and IVUS exhibited good interobserver reproducibility, but the root-mean-squared deviation between measurements was approximately twice as high for the IVUS measurements compared with the FD-OCT measurements (0.32 mm(2) vs. 0.16 mm(2)). In a phantom model, the mean lumen area according to FD-OCT was equal to the actual lumen area of the phantom model, with low SD; IVUS overestimated the lumen area and was less reproducible than FD-OCT (8.03 ± 0.58 mm(2) vs. 7.45 ± 0.17 mm(2); p < 0.001). CONCLUSIONS The results of this prospective multicenter study demonstrate that FD-OCT provides accurate and reproducible quantitative measurements of coronary dimensions in the clinical setting.
Collapse
Affiliation(s)
- Takashi Kubo
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Takashi Akasaka
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan.
| | - Junya Shite
- Division of Cardiovascular Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takahiko Suzuki
- Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan
| | - Shiro Uemura
- First Department of Internal Medicine, Nara Medical University, Kashihara, Japan
| | - Bo Yu
- Department of Cardiology, Key Laboratories of Education Ministry for Myocardial Ischemia Mechanism and Treatment, 2nd Affiliated Hospital of Harbin Medical University, Harbin, People's Republic of China
| | - Ken Kozuma
- Department of Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Hironori Kitabata
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Toshiro Shinke
- Division of Cardiovascular Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Maoto Habara
- Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan
| | - Yoshihiko Saito
- First Department of Internal Medicine, Nara Medical University, Kashihara, Japan
| | - Jingbo Hou
- Department of Cardiology, Key Laboratories of Education Ministry for Myocardial Ischemia Mechanism and Treatment, 2nd Affiliated Hospital of Harbin Medical University, Harbin, People's Republic of China
| | - Nobuaki Suzuki
- Department of Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Shaosong Zhang
- Lightlab Imaging/St. Jude Medical, Westford, Massachusetts
| |
Collapse
|
48
|
Rahman S, Leesar T, Cilingiroglu M, Effat M, Arif I, Helmy T, Leesar MA. Impact of kissing balloon inflation on the main vessel stent volume, area, and symmetry after side-branch dilation in patients with coronary bifurcation lesions: a serial volumetric intravascular ultrasound study. JACC Cardiovasc Interv 2013; 6:923-31. [PMID: 23954062 DOI: 10.1016/j.jcin.2013.04.019] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Revised: 04/12/2013] [Accepted: 04/25/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Intravascular ultrasound (IVUS) was performed to investigate the impact of kissing balloon inflation (KBI) on the main vessel (MV) stent volume, area, and symmetry after side-branch (SB) dilation in patients with coronary bifurcation lesions (CBL). BACKGROUND It remains controversial whether KBI would restore the MV stent area and symmetry loss after SB dilation. METHODS A total of 88 serial IVUS examinations of the MV were performed after MV angioplasty, MV stenting, SB dilation, and KBI in 22 patients with CBL. The MV stent was divided into proximal, bifurcation, and distal segments; the stent volume index (SVI), minimal stent area (MSA), stent symmetry index (SSI), and external elastic membrane (EEM) volume index were measured in 198 stent segments and compared after MV stenting, SB dilation, and KBI. RESULTS In the bifurcation segment, SVI, MSA, and SSI were significantly smaller after SB dilation than after MV stenting and KBI (SVI was 6.10 ± 1.50 mm(3)/mm vs. 6.68 ± 1.60 mm(3)/mm and 6.57 ± 1.60 mm(3)/mm, respectively, p < 0.05; MSA was 5.15 ± 1.30 mm(2) vs. 6.08 ± 1.40 mm(2) and 5.86 ± 1.50 mm(2), respectively, p < 0.05; and SSI was 0.78 ± 0.02 mm(2) vs. 0.87 ± 0.03 mm(2) and 0.84 ± 0.03 mm(2), respectively, p < 0.05). KBI restored the MV SVI, MSA, and SSI after SB dilation. In the proximal segment, SVI, MSA, and EEM volume index were significantly larger, but SSI was smaller after KBI than after MV stenting and SB dilation. In the distal segment, neither SB dilation nor KBI had a significant impact on the MV stent volume or symmetry. CONCLUSIONS This is the first comprehensive volumetric IVUS analysis of CBL, to our knowledge, demonstrating that KBI restores the MV stent volume, area, and symmetry loss after SB dilation in the bifurcation segment, and induces asymmetric stent expansion in the proximal segment.
Collapse
Affiliation(s)
- Shahid Rahman
- Division of Cardiology, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | | | | | | | | | | | | |
Collapse
|
49
|
Yan RT, Miller JM, Rochitte CE, Dewey M, Niinuma H, Clouse ME, Vavere AL, Brinker J, Lima JAC, Arbab-Zadeh A. Predictors of inaccurate coronary arterial stenosis assessment by CT angiography. JACC Cardiovasc Imaging 2013; 6:963-72. [PMID: 23932641 DOI: 10.1016/j.jcmg.2013.02.011] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Revised: 01/16/2013] [Accepted: 02/21/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVES This study sought to investigate the clinical and imaging characteristics associated with diagnostic inaccuracy of computed tomography angiography (CTA) for detecting obstructive coronary artery disease (CAD) defined by quantitative coronary angiography (QCA). BACKGROUND Although diagnostic performance metrics of CTA have been reported, there are sparse data on predictors of diagnostic inaccuracy by CTA. METHODS The clinical characteristics of 291 patients (mean age: 59 ± 10 years; female: 25.8%) enrolled in the multicenter CorE-64 (Coronary Artery Evaluation Using 64-Row Multi-detector Computed Tomography Angiography) study were examined. Pre-defined CTA segment-level characteristics of all true-positive (N = 237), false-positive (N = 115), false-negative (FN) (N = 159), and a random subset of true-negative segments (N = 511) for ≥50% stenosis with QCA as the reference standard were blindly abstracted in a central core laboratory. Factors independently associated with corresponding levels of CTA diagnostic inaccuracies on a patient level and coronary artery segment level were determined using multivariable logistic regression models and generalized estimating equations, respectively. RESULTS An Agatston calcium score of ≥1 per patient (odds ratio [OR]: 5.2; 95% confidence interval [CI]: 1.1 to 24.6) and the presence of within-segment calcification (OR: 10.2; 95% CI: 5.2 to 19.8) predicted false-positive diagnoses. Conversely, absence of within-segment calcification was an independent predictor of an FN diagnosis (OR: 2.0; 95% CI: 1.2 to 3.5). Prior percutaneous revascularization was independently associated with patient-level misdiagnosis of obstructive CAD (OR: 4.2; 95% CI: 1.6 to 11.2). Specific segment characteristics on CTA, notably segment tortuosity (OR: 3.5; 95% CI: 2.4 to 5.1), smaller luminal caliber (OR: 0.48; 95% CI: 0.36 to 0.63 per 1-mm increment), and juxta-arterial vein conspicuity (OR: 2.1; 95% CI: 1.4 to 3.2), were independently associated with segment-level misdiagnoses. Attaining greater intraluminal contrast enhancement independently lowered the risk of an FN diagnosis (OR: 0.96; 95% CI: 0.94 to 0.99 per 10-Hounsfield unit increment). CONCLUSIONS We identified clinical and readily discernible imaging characteristics on CTA predicting inaccurate CTA diagnosis of obstructive CAD defined by QCA. Knowledge and appropriate considerations of these features may improve the diagnostic accuracy in clinical CTA interpretation. (Diagnostic Accuracy of Multi-Detector Spiral Computed Tomography Angiography Using 64 Detectors [CORE-64]; NCT00738218).
Collapse
Affiliation(s)
- Raymond T Yan
- Division of Cardiology, Johns Hopkins Hospital, Baltimore, Maryland
| | | | | | | | | | | | | | | | | | | |
Collapse
|
50
|
Lopez-Palop R, Carrillo P, Agudo P, Frutos A, Cordero A, López-Aranda MA, Ramos D. Correlation between intracoronary ultrasound and fractional flow reserve in long coronary lesions. A three-dimensional intracoronary ultrasound study. ACTA ACUST UNITED AC 2013; 66:707-14. [PMID: 24773676 DOI: 10.1016/j.rec.2013.04.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Accepted: 04/29/2013] [Indexed: 10/26/2022]
Abstract
INTRODUCTION AND OBJECTIVES Intracoronary ultrasound estimation of the functional significance of intermediate angiographic lesions has mainly been based on measuring the minimal lumen area. These estimates take no account of lesion length and pay insufficient attention to long coronary lesions. METHODS We included 61 lesions with visual angiographic stenosis of 40% to 70% that required treatment with a ≥20mm stent, studied with ultrasound and fractional flow reserve. Three-dimensional analysis of the ultrasound study was conducted offline and blinded to fractional reserve values. Angiographic and ultrasound parameters were correlated with fractional reserve. RESULTS From the angiography we obtained data on mean reference diameter (2.87 [0.57] mm), length (29.8 [10.01] mm), and severity of stenosis (50.3% [8.7]%). Mean fractional flow reserve was 0.78 (0.09). We found a weak linear correlation (R) between fractional reserve and the ultrasound parameters that did not include lesion length: fractional reserve-minimal luminal area (R=0.4; P=.003). The correlation was stronger when lesion length was included: fractional reserve-volume of plaque (R=-0.65; P<.0005); fractional reserve-length/mean luminal area (R=0.73; P<.0005). The strongest correlation came from the product of mean stenosis by area multiplied by lesion length (R=-0.78; P<.0005). CONCLUSIONS In long coronary lesions, the correlation between ultrasound-measured minimal lumen area and functional significance is weak. In these cases, estimates of functional significance should incorporate lesion length or be derived from direct fractional flow reserve measurement.
Collapse
Affiliation(s)
- Ramon Lopez-Palop
- Unidad de Hemodinámica, Sección de Cardiología, Hospital Universitario de San Juan de Alicante, San Juan de Alicante, Alicante, Spain.
| | - Pilar Carrillo
- Unidad de Hemodinámica, Sección de Cardiología, Hospital Universitario de San Juan de Alicante, San Juan de Alicante, Alicante, Spain
| | - Pilar Agudo
- Unidad de Hemodinámica, Sección de Cardiología, Hospital Universitario de San Juan de Alicante, San Juan de Alicante, Alicante, Spain
| | - Araceli Frutos
- Unidad de Hemodinámica, Sección de Cardiología, Hospital Universitario de San Juan de Alicante, San Juan de Alicante, Alicante, Spain
| | - Alberto Cordero
- Unidad de Hemodinámica, Sección de Cardiología, Hospital Universitario de San Juan de Alicante, San Juan de Alicante, Alicante, Spain
| | | | - David Ramos
- Unidad de Hemodinámica, Sección de Cardiología, Hospital General de Elche, Elche, Alicante, Spain
| |
Collapse
|