Estimation of coronary artery hyperemic blood flow based on arterial lumen volume using angiographic images

Molloi, Sabee; Chalyan, David; Lê, Huy; Wong, Jerry

doi:10.1007/s10554-010-9766-1

Cited by 16 publications

(15 citation statements)

References 46 publications

(82 reference statements)

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“…In contrast, the exponent ␤ in our study decreased from 0.79 to 0.55 for truncation radii ranging from 50 to 1,000 m. A value of 3/4 (0.75) for the exponent was previously suggested based on the measured relationship between flow and segment length and the derived relationship between segment length and cumulative arterial volume (31). This value was validated by angiographic imaging at the limited resolution of 500 m (7,15,30). Using theoretical derivation based on rules for branching at bifurcations, a value of 7/9 (0.78) has been suggested (4), which agrees well with ␤ ϭ 0.79 found at our smallest truncation radius (50 m).…”

Section: Discussionsupporting

confidence: 67%

“…These relationships are expressed in terms of allometric scaling laws relating, among others, coronary flow to myocardial mass (1), cumulative arterial branch length, stem diameter, or the total crown volume, as summarized elsewhere (4). Using this last method, FFR prediction is based on the hypothetical flow in the absence of the stenosis, as estimated from the luminal volume of the arterial tree distal to the stenosis (7). The rationale of this approach is that larger vascular trees perfuse larger myocardial volumes and therefore transport more flow.…”

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confidence: 99%

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Influence of segmented vessel size due to limited imaging resolution on coronary hyperemic flow prediction from arterial crown volume

Horssen

Lier

Wijngaard

et al. 2016

American Journal of Physiology-Heart and Circulatory Physiology

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van Horssen P, van Lier MG, van den Wijngaard JP, VanBavel E, Hoefer IE, Spaan JA, Siebes M. Influence of segmented vessel size due to limited imaging resolution on coronary hyperemic flow prediction from arterial crown volume. Am J Physiol Heart Circ Physiol 310: H839 -H846, 2016. First published January 29, 2016 doi:10.1152/ajpheart.00728.2015.-Computational predictions of the functional stenosis severity from coronary imaging data use an allometric scaling law to derive hyperemic blood flow (Q) from coronary arterial volume (V), Q ϭ ␣V ␤ . Reliable estimates of ␣ and ␤ are essential for meaningful flow estimations. We hypothesize that the relation between Q and V depends on imaging resolution. In five canine hearts, fluorescent microspheres were injected into the left anterior descending coronary artery during maximal hyperemia. The coronary arteries of the excised heart were filled with fluorescent cast material, frozen, and processed with an imaging cryomicrotome to yield a three-dimensional representation of the coronary arterial network. The effect of limited image resolution was simulated by assessing scaling law parameters from the virtual arterial network at 11 truncation levels ranging from 50 to 1,000 m segment radius. Mapped microsphere locations were used to derive the corresponding relative Q using a reference truncation level of 200 m. The scaling law factor ␣ did not change with truncation level, despite considerable intersubject variability. In contrast, the scaling law exponent ␤ decreased from 0.79 to 0.55 with increasing truncation radius and was significantly lower for truncation radii above 500 m vs. 50 m (P Ͻ 0.05). Hyperemic Q was underestimated for vessel truncation above the reference level. In conclusion, flow-crown volume relations confirmed overall power law behavior; however, this relation depends on the terminal vessel radius that can be visualized. The scaling law exponent ␤ should therefore be adapted to the resolution of the imaging modality. FRACTIONAL FLOW RESERVE (FFR) has been shown to be a reliable and a widely accepted method to assess whether a coronary artery stenosis is responsible for myocardial ischemia (11). Conceptually, FFR is defined as the hyperemic flow in a vessel with a stenosis relative to the hypothetical hyperemic flow in the undiseased vessel. In practice, FFR is measured invasively as the ratio between pressure distal to a stenosis and aortic pressure, during adenosine-induced hyperemia. This requires passing of a guide wire with a pressure sensor through the stenosis. Despite the reliability of this method, risks of vessel and plaque rupture, procedure time, and costs have inspired the search for new less-invasive alternatives for assessing FFR (18), based on computational methods applied to arterial models obtained from angiography (27) or CT (6). By using experimentally established form-function relationships, coronary flow can be calculated from image-derived morphological data. These relationships are expressed in terms of allometric scaling laws r...

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Section: Discussionsupporting

confidence: 67%

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confidence: 99%

Influence of segmented vessel size due to limited imaging resolution on coronary hyperemic flow prediction from arterial crown volume

Horssen

Lier

Wijngaard

et al. 2016

American Journal of Physiology-Heart and Circulatory Physiology

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“…Several noninvasive modalities have been developed for assessing CFR and FFR such as PET, MRI, CT, transthoracic Doppler echocardiography, and synchrotron radiation (SR) imaging. 19 In the case of flow measurement using PET, the measured flow is normalized by the myocardial mass (ml/min/100 g of tissue). Although PET offers unique clinical insight, such as the assessment of myocardial viability and perfusion, it is a complex and expensive technology and remains primarily an investigative tool.…”

Section: Estimation Of CC Using Angiographic Imagesmentioning

confidence: 99%

Assessment of Coronary Hemodynamics and Vascular Function

Drenjančević-Perić

Koller

Selthofer-Relatić

et al. 2015

Progress in Cardiovascular Diseases

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“…However, volumetric coronary blood flow and the calculated resistance are dependent on the arterial perfusion bed size. Previous reports (21,25) have shown that the arterial lumen volume is related to the myocardial mass and can be used to account for the dependent arterial bed size. Therefore, the normalized MR (NMR) (43) can be calculated as:…”

Section: Methodsmentioning

confidence: 99%

Assessment of coronary microcirculation in a swine animal model

Zhang

Takarada

Molloi

2011

American Journal of Physiology-Heart and Circulatory Physiology

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Coronary microvascular dysfunction has important prognostic implications. Several hemodynamic indexes, such as coronary flow reserve (CFR), microvascular resistance, and zero-flow pressure (Pzf), were used to establish the most reliable index to assess coronary microcirculation. Fifteen swine were instrumented with a flow probe, and a pressure wire was advanced into the distal left anterior descending artery. Adenosine was used to produce maximum hyperemia. Microspheres were used to create microvascular dysfunction. An occluder was used to produce stenosis. Blood flow from the probe (Q p), aortic pressure, distal coronary pressure, and right atrium pressure were recorded. Angiographic flow (Q a) was calculated using a time-density curve. Flow probe-based CFR and angiographic CFR were calculated using Q p and Q a, respectively. Flow probe-based (NMRqh) and angiographic normalized microvascular resistance (NMRah) were determined using Q p and Q a, respectively, during hyperemia. Pzf was calculated using Q p and distal coronary pressure. Two series of receiver operating characteristic curves were generated: normal epicardial artery model (N model) and stenosis model (S model). The areas under the receiver operating characteristic curves for flow probe-based CFR, angiographic CFR, NMRqh, NMRah, and Pzf were 0. 855, 0.836, 0.976, 0.956, and 0.855 in N model and 0.737, 0.700, 0.935, 0.889, and 0.698 in S model. Both NMRqh and NMRah were significantly more reliable than CFR and Pzf in detecting the microvascular deterioration. Compared with CFR and Pzf, NMR provided a more accurate assessment of microcirculation. This improved accuracy was more prevalent when stenosis existed. Moreover, NMRah is potentially a less invasive method for assessing coronary microcirculation.angiography; blood flow; cardiovascular imaging; coronary microvascular function CORONARY ANGIOGRAPHY, a routine examination for patients with heart disease, provides an assessment of stenosis severity by visualizing the opacified arterial lumen. However, in many cases (12,40), the severity of myocardium ischemia correlates poorly with epicardial stenosis. Therefore, intracoronary physiological techniques have been developed to provide physiological evaluations for patients who undergo coronary angiography (8,34). Recently, the medical community's interest in coronary microcirculation has grown with the increasing awareness that microvascular dysfunction occurs in a number of myocardial disease states and has important prognostic implications (19,20). With this recognition comes the need for a method to accurately assess the functional capacity of coronary microcirculation for diagnostic purposes and to monitor the effects of therapeutic interventions targeted at reversing the extent of coronary microvascular dysfunction. To assess changes in the microcirculatory bed, several indexes have been proposed, such as coronary flow reserve (CFR), microvascular resistance (MR), and zero-flow pressure (P zf ). In the early 1990s, Gould et al. (14) introduced CFR...

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Estimation of coronary artery hyperemic blood flow based on arterial lumen volume using angiographic images

Cited by 16 publications

References 46 publications

Influence of segmented vessel size due to limited imaging resolution on coronary hyperemic flow prediction from arterial crown volume

Influence of segmented vessel size due to limited imaging resolution on coronary hyperemic flow prediction from arterial crown volume

Assessment of Coronary Hemodynamics and Vascular Function

Assessment of coronary microcirculation in a swine animal model

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