Application of digital techniques to selective coronary arteriography: Use of myocardial contrast appearance time to measure coronary flow reserve

Vogel, Robert A.; LeFree, Michael T.; Bates, Eric R.; O’Neill, William W.; Foster, Richard H.; Kirlin, Philip C.; Smith, David; Pitt, Bertram

doi:10.1016/0002-8703(84)90150-9

Cited by 197 publications

(34 citation statements)

References 28 publications

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“…From these measurements, a relative coronary flow index (F1) was obtained [1][2][3][4]10 106 microspheres suspended in 10 ml of 370 C saline was used. The sample was carefully ultrasonicated and vortexed and then injected over 60 seconds through the left atrial line.…”

Section: Coronary Blood Flow Measurementsmentioning

confidence: 99%

Determination of coronary flow reserve by parametric imaging.

et al. 1990

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Nine mongrel dogs were instrumented with electromagnetic flow probes (EMF) to measure coronary blood flow through the left anterior descending (LAD) and left circumflex (LCx) coronary arteries at rest and after maximal coronary vasodilation (1 mg/kg/min adenosine). Relative coronary blood flow was determined by parametric imaging in the left posterior oblique projection using digital subtraction angiography (DSA). Transmural myocardial perfusion of the LAD and LCx beds was determined with tracer-labeled microspheres. Coronary flow reserve (maximal coronary blood flow divided by resting blood flow) was calculated under control conditions and after constriction of the proximal LAD or LCx by a screw occluder. Heart rate decreased significantly from 140 beats/min at rest to 122 beats/min after adenosine (p<0.001) and from 134 (rest) to 120 beats/min (adenosine; p<0.05) after coronary constriction. Peak systolic pressure was kept constant with an aortic constrictor. Left ventricular end-diastolic pressure increased significantly from 18 mm Hg at rest to 23 mm Hg (p<0.05) after coronary constriction. At baseline, coronary flow reserve was 4.2 with DSA, 3.8 with EMF, and 3.7 with microspheres; after coronary constriction,it was 2.6 (DSA), 1.9 (EMF), and 1.5 (microspheres) (all p<0.001 versus baseline). Coronary blood flow showed a good correlation between EMF and microspheres (r=0.87,p<0.001), with a standard error of estimate (SEE) of 0.78 ml/g/min.

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Section: Coronary Blood Flow Measurementsmentioning

confidence: 99%

Determination of coronary flow reserve by parametric imaging.

et al. 1990

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“…New developments in X-ray imaging introduced by Vogel et al have led to the computation of relative regional myocardial flow in the control and maximal flow states by means of contrast medium appearance techniques following the administration of a coronary vasodilator [4]. By means of this approach, coronary flow reserve (CFR), defined as the ratio of maximum coronary flow after a maximal vasodilatory stimulus to resting flow, can be determined.…”

Section: Introductionmentioning

confidence: 99%

Three-dimensional reconstruction of myocardial contrast perfusion from biplane cineangiograms by means of linear programming techniques

et al. 1988

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SummaryThe assessment of coronary flow reserve from the instantaneous distribution of the contrast agent within the coronary vessels and myocardial muscle at the control state and at maximal flow has been limited by the superimposition of myocardial regions of interest in the two-dimensional images. To overcome these limitations, we are in the process of developing a three-dimensional (3D) reconstruction technique to compute the contrast distribution in cross sections of the myocardial muscle from two orthogonal cineangiograms. To limit the number of feasible solutions in the 3D-reconstruction space, the 3D-geometry of the endo-and epicardial boundaries of the myocardium must be determined. For the geometric reconstruction of the epicardium, the centerlines of the left coronary arterial tree are manually or automatically traced in the biplane views. Next, the bifurcations are detected automatically and matched in these two views, allowing a 3D-representation of the coronary tree. Finally, the circumference of the left ventricular myocardium in a selected cross section can be computed from the intersection points of this cross section with the 3D coronary tree using B-splines. For the geometric reconstruction of the left ventricular cavity, we envision to apply the elliptical approximation technique using the LV boundaries defined in the two orthogonal views, or by applying more complex 3D-reconstruction techniques including densitometry. The actual 3D-reconstruction of the contrast distribution in the myocardium is based on a linear programming technique (Transportation model) using cost coefficient matrices. Such a cost coefficient matrix must contain h maximum amount of a priori information, provided by a computer generated model and updated with actual data from the angiographic views. We have only begun to solve this complex problem. However, based on our first experimental results we expect that the linear programming approach with advanced cost coefficient matrices and computed model will lead to acceptable solutions in the 3D-reconstruction of the myocardial contrast distribution from biplane cineangiograms.142

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“…The intrinsic limitations of angiography, proven time after time by intravascular ultrasound and direct translesional physiology, should, by now, be wellunderstood and accepted. The percent diameter stenosis [2], the angiographic stenotic flow reserve (calculated from the angiographic anatomy) [3], and, in some respect, the attempt to equate contrast flow image edge rates with true coronary blood flow [4][5][6] cannot substitute for, nor accurately gauge, the real physiologic effects of an intervention. The use of mean transit time of contrast flowing through a coronary artery to measure blood flow has already been proven too difficult to be used clinically [4][5][6].…”

mentioning

confidence: 99%

Can digital subtraction myocardial perfusion imaging studies offer information for postangioplasty lesion assessment?

Kern

1998

Cathet. Cardiovasc. Diagn.

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Application of digital techniques to selective coronary arteriography: Use of myocardial contrast appearance time to measure coronary flow reserve

Cited by 197 publications

References 28 publications

Determination of coronary flow reserve by parametric imaging.

Determination of coronary flow reserve by parametric imaging.

Three-dimensional reconstruction of myocardial contrast perfusion from biplane cineangiograms by means of linear programming techniques

Can digital subtraction myocardial perfusion imaging studies offer information for postangioplasty lesion assessment?

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