Does the quantitative assessment of coronary artery dimensions predict the physiologic significance of a coronary stenosis?

Zijlstra, Felix; Ommeren, Jan Van; Reiber, J. H. C.; Serruys, Patrick W.

doi:10.1161/01.cir.75.6.1154

Cited by 156 publications

(45 citation statements)

References 34 publications

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“…13 The film speed was 25 frames/sec with a pulse time of 4 msec. For the right coronary artery, a left or right anterior oblique projection was used; for the left coronary artery, a left anterior oblique projection was used.…”

Section: Coronary Flow Reserve Measurementsmentioning

confidence: 99%

“…Regional flow values were quantitatively determined from the relation in which regional blood flow equals regional vascular volume divided by the transit time. 13 Regional vascular volume was assessed from the logarithmic maskmode subtraction images with the Lambert-Beer relation. Coronary flow reserve can then be calculated as…”

Section: Coronary Flow Reserve Measurementsmentioning

confidence: 99%

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Assessment of immediate and long-term functional results of percutaneous transluminal coronary angioplasty.

et al. 1988

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Assessment of the functional significance of coronary artery lesions during cardiac catheterization has recently become possible by calculating coronary flow reserve from both myocardial contrast appearance time and density in the resting and hyperemic states determined from digitized coronary cineangiograms. However, the interobserver and intraobserver variabilities, as well as the short-, medium-, and long-term variabilities of the coronary flow reserve measurements, have to be established before this technique becomes an acceptable means of assessing the immediate and long-term functional results of revascularization procedures such as percutaneous transluminal coronary angioplasty (PTCA). Variability was defined as the mean difference and standard deviation of the difference between duplicate determinations of coronary flow reserve. The intraobserver variability (mean difference SD) in the measurement of coronary flow reserve was -0.01+± 0.07. Interobserver variability by two observers was + 0.08 0.52. Short-term variability based on the analysis of two coronary cineangiograms taken 5 minutes apart was -0.02 0.26. Medium-term variability (coronary cineangiographies repeated 1-3 hours apart) was found to be -0.06 0.52. Long-term variability (coronary cineangiographies repeated 3-5 months apart) was 0.11 0.63. Having established the reproducibility of this radiographic method, we studied the prospective changes in coronary flow reserve in 25 patients undergoing PTCA for single vessel coronary artery disease. Coronary flow reserve measurements and quantitative coronary cineangiography were performed before, immediately after, and 3-5 months after PTCA. PTCA resulted in an immediate increase in coronary flow reserve from 1 0.3 to 2.3 0.6 with a concomitant increase in obstruction area from 0.9 0.3 to 3.3t±0.7 mm2. Nine of the 25 patients developed restenosis defined as a diameter stenosis greater than 50% at follow-up. The other 16 patients had a coronary flow reserve of 3.3+±0.6, which was measured 3-5 months after PTCA.

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Section: Coronary Flow Reserve Measurementsmentioning

confidence: 99%

Section: Coronary Flow Reserve Measurementsmentioning

confidence: 99%

Assessment of immediate and long-term functional results of percutaneous transluminal coronary angioplasty.

et al. 1988

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“…This is further underlined by the fact that invasive coronary angiography is very poorly correlated with postmortem coronary anatomy (5,6). Most importantly, angiographic findings are poor predictors of physiologic relevance of a coronary stenosis (4,(7)(8)(9)(10). A substantial fraction -namely between 20% and 40% -of all diagnostic invasive coronary angiograms reveal clinically insignificant disease (1).…”

Section: Coronary Stenoses and Ischemic Heart Disease: Two Faces Of Tmentioning

confidence: 99%

Cardiac hybrid imaging: state-of-the-art

Kaufmann

2009

Ann Nucl Med

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“…Although the morphologic severity of coronary obstructions can be measured with high accuracy and precision with computer-assisted image processing techniques [1], the physiologic or functional significance of an obstruction in an individual patient cannot be determined with sufficient accuracy from the geometry of the narrowing alone; there are many factors which may influence the mathematical formulas relating the geometric and functional descriptions, such as collateral circulation, previous myocardial infarction, etc. Despite these limitations, Gould et al and Zijlstra et al have attempted with increasing success to determine the coronary flow reserve from the pressure gradient-flow relation, which is based on the geometric description of a coronary obstruction [2,3]. Until such approaches have proven to be reliable predictors of coronary flow reserve in an individual patient, other techniques should be used to assess the functional consequences of coronary obstructions.…”

Section: Introductionmentioning

confidence: 99%

“…With the introduction of intracoronary papaverine, maximal coronary blood flow can be safely induced during routine cardiac catherization [5,6]. Although this technique is usually applied on-line to video images of the coronary arterial system acquired directly from the image intensifier of the X-ray system, we have implemented this technique for off-line analysis from cinefilm [3,7].…”

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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Does the quantitative assessment of coronary artery dimensions predict the physiologic significance of a coronary stenosis?

Cited by 156 publications

References 34 publications

Assessment of immediate and long-term functional results of percutaneous transluminal coronary angioplasty.

Assessment of immediate and long-term functional results of percutaneous transluminal coronary angioplasty.

Cardiac hybrid imaging: state-of-the-art

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

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