Quantitative Coronary Arteriography

Reiber, Johan H. C.; Koning, Gerard; Tuinenburg, Joan C.; Lansky, Alexandra J.; Goedhart, Bob

doi:10.1007/978-3-662-06419-1_3

Cited by 25 publications

(34 citation statements)

References 26 publications

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“…Quantitative coronary angiography has been validated as an accurate means of measuring coronary severity. 51 Only two studies have used quantitative coronary angiography to examine CAD severity in patients with NIDDM. 48 52 Both found increased CAD severity in the diabetic groups.…”

Section: Severity Of Cad In Diabetic Patientsmentioning

confidence: 99%

Anatomy of coronary disease in diabetic patients: an explanation for poorer outcomes after percutaneous coronary intervention and potential target for intervention

Morgan

2004

Heart

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Section: Severity Of Cad In Diabetic Patientsmentioning

confidence: 99%

Anatomy of coronary disease in diabetic patients: an explanation for poorer outcomes after percutaneous coronary intervention and potential target for intervention

Morgan

2004

Heart

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“…R s was calculated using the analytical method developed by Kirkeeide, Gould and others. [11][12][13] R s is assumed to consist of a flow independent component that results from vicious losses and a flow dependent component that results from kinetic losses.…”

Section: Methodsmentioning

confidence: 99%

Feasibility of Intracoronary Frequency Domain Optical Coherence Tomography Derived Fractional Flow Reserve for the Assessment of Coronary Artery Stenosis

2014

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SummaryFrequency domain optical coherence tomography (FD-OCT) provides cross-sectional images of coronary arteries and deployed stents with micron resolution and measures lumen dimensions with excellent reproducibility. FD-OCT combined with a blood flow resistances model can overcome many limitations of conventional measures of stenosis severity based on quantitative coronary angiography (QCA) and intravascular ultrasound (IVUS). The aim of this feasibility study was to investigate the relationship between pressure derived fractional flow reserve (FFR) and FD-OCT derived FFR, a new method for quantitative measure of stenosis severity that estimates the blood flow resistance and microvascular resistance of the vessel segments imaged by FD-OCT. A total of 26 coronary stenoses in 20 patients were studied consecutively with QCA, pressure derived FFR, and FD-OCT. There was a moderate but significant correlation between pressure derived FFR and FD-OCT derived FFR (r = 0.69, P < 0.001). Bland-Altman analysis showed that the mean differences between pressure derived FFR and FD-OCT derived FFR were 0.05 ± 0.14 (limits of agreement: -0.09 to 0.19). The root mean square error (RMSE) between FD-OCT derived FFR and pressure derived FFR was found to be ± 0.087 FFR units. FD-OCT derived FFR has the potential to become a valuable tool for the assessment of coronary artery stenosis. ( 1-4) Intracoronary optical coherence tomography (OCT) provides cross-sectional images of coronary arteries and deployed stents with resolution 10-15 times higher than intravascular ultrasound (IVUS). OCT is used for anatomic and morphological assessment of coronary stenosis and provides lumen measurements with excellent reproducibility. [5][6][7][8] OCT also provides information about plaque vulnerability, calcification, and other parameters which helps in guiding the procedure along with diagnostics. The frequency domain OCT (FD-OCT) systems provide faster image acquisition speeds, higher frame rates, and greater scan depths as compared to time domain OCT (TD-OCT) systems. FD-OCT combined with a blood flow model can overcome many limitations of conventional measures of stenosis severity based on QCA and IVUS. The main objective of this feasibility study was to investigate the potential of FD-OCT derived FFR for the assessment of coronary artery stenosis. Through the volumetric analysis of FD-OCT images, FFR was calculated from the blood flow resistance and the microvascular resistance. A comparison between FD-OCT derived FFR and pressure derived FFR was also conducted in this study. MethodsA total of 26 coronary stenoses in 20 patients with stable angina and/or ischemia documented on exercise stress test were studied consecutively with QCA, pressure derived FFR, and FD-OCT during diagnostic coronary angiography. The study was approved by Galway clinical research ethics committee and informed consent for all procedures was obtained from each patient. Eligible patients had a single de novo stenosis in a native coronary artery with diameter stenosis...

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“…Various calibration methods have been proposed for conventional QCA algorithms, 18 the most common of which is to image a contrast filled catheter near the vessel of interest Alternatively, an external calibration object, such as an x-ray visible ruler with more conspicuous features can be used; however, this increases calibration uncertainty because a vessel within the body and a calibration object outside of the body experience different magnifications. Eliminating the calibration step altogether removes a potential source of error and improves procedure workflow, which increases the likelihood that such a QCA method would be used clinically.…”

Section: Discussionmentioning

confidence: 99%

“…Several strategies have been proposed, 18 the most common of which is to image a contrast filled catheter near the vessel of interest. For example, dividing the true inner diameter of the catheter lumen by the apparent diameter, in pixels, produces the necessary scaling factor to convert pixel measurements to physical units.…”

Section: Iib Quantitative Coronary Angiographymentioning

confidence: 99%

“…A key component to accurate QCA is the calibration step required to convert image measurements to physical dimensions. 18 In x-ray imaging with a point source and large area detector, all anatomy is projected onto a plane and the magnification of each point on a vessel must be determined to accurately convert image pixel measurements to physical vessel dimensions. Imaging an object of known size in the same field-of-view provides a reference to determine the magnification of the angiogram.…”

Section: Introductionmentioning

confidence: 99%

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Calibration‐free device sizing using an inverse geometry x‐ray system

et al. 2010

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Purpose: Quantitative coronary angiography ͑QCA͒ can be used to support device size selection for cardiovascular interventions. The accuracy of QCA measurements using conventional x-ray fluoroscopy depends on proper calibration using a reference object and avoiding vessel foreshortening. The authors have developed a novel interventional device sizing method using the inverse geometry scanning-beam digital x-ray ͑SBDX͒ fluoroscopy system. The proposed method can measure the diameter and length of vessel segments without imaging a reference object and when vessels appear foreshortened. Methods: SBDX creates multiple tomosynthetic x-ray images corresponding to planes through the patient volume. The structures that lie in the plane are in focus and the features above and below the plane are blurred. Three-dimensional localization of the vessel edges was performed by examining the degree of blurring at each image plane. A 3D vessel centerline was created and used to determine vessel magnification and angulation relative to the image planes. Diameter measurements were performed using a model-based method and length measurements were calculated from the 3D centerline. Phantom validation was performed by measuring the diameter and length of vessel segments with nominal diameters ranging from 0.5 to 2.8 mm and nominal lengths of 42 mm. The phantoms were imaged at a range of positions between the source and the detector ͑Ϯ16 cm relative to isocenter͒ and with a range of foreshortening angles ͑0°-75°͒. Results: Changes in vessel phantom position created magnifications ranging from 87% to 118% relative to isocenter magnification. Average diameter errors were less than 0.15 mm. Average length measurements were within 1% ͑0.3 mm͒ of the true length. No trends were observed between measurement accuracy and magnification. Changes in vessel phantom orientation resulted in decreased apparent length down to 28% of the original nonforeshortened length. Average diameter errors were less than 0.25 mm across all vessel angulations; errors were less than 0.1 mm for smaller diameter vessels and low to moderate vessel angles. Diameter errors increased with true diameter and vessel angle relative to the image plane. Average length measurement errors were also within 1% ͑0.3 mm͒ for each angulation. Conclusions: Tomosynthetic imaging with SBDX can accurately measure dimensions of vessels in various magnifications and angulations without calibration. This method may be more accurate and convenient than conventional QCA techniques.

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Quantitative Coronary Arteriography

Abstract: Ouantitative coronary arteriography I edited by Johan H.C. Reiber and Patrlck W. Serruys. p. cm. --(Developments in cardiovascular medicine ; v. 117) lnc 1 udes index.

Cited by 25 publications

References 26 publications

Anatomy of coronary disease in diabetic patients: an explanation for poorer outcomes after percutaneous coronary intervention and potential target for intervention

Anatomy of coronary disease in diabetic patients: an explanation for poorer outcomes after percutaneous coronary intervention and potential target for intervention

Feasibility of Intracoronary Frequency Domain Optical Coherence Tomography Derived Fractional Flow Reserve for the Assessment of Coronary Artery Stenosis

Calibration‐free device sizing using an inverse geometry x‐ray system

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