Quantitative coronary arteriography: estimation of dimensions, hemodynamic resistance, and atheroma mass of coronary artery lesions using the arteriogram and digital computation.

Brown, Bruce; Bolson, Edwardl .; Frimer, Morris; Dodge, Harold T.

doi:10.1161/01.cir.55.2.329

Cited by 628 publications

(155 citation statements)

References 25 publications

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“…There is conflicting evidence whether inter-observer variability improves with increasing observer experience.I5. 17, 243 33 If it does not, then the recent trainee status of the observers in this study does not affect the findings and conclusions. If it does, then the results of the current study underestimate the reproducibility and accuracy which can be expected in the normal clinical setting, where more experienced angiographers are available to review arteriographic data.…”

Section: Limitationsmentioning

confidence: 81%

Accuracy and reproducibility of visual coronary stenosis estimates using information from multiple observers

1992

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Summary:The reliability of visual estimation of severity of coronary artery stenosis may be improved using data from multiple independent observers. Data were collected from the results of a video format examination used on an experimental basis in 1987 by the American Board of Internal Medicine to test 61 candidates for certification in cardiovascular diseases. Twenty arteriographic cases were presented in a standardized format. Each artery was viewed in multiple projections including angled views. Each view was shown in both real time and slow motion, and each case was seen twice in its entirety. The observers rated stenosis severity on a four-point scale ranging from 1 4 . A two-way repeated measures analysis of variance was performed on the tabulated results, yielding variance components for the arteriographic data (signal), the differences among observers, and the observer by case interaction (both considered noise). These components then allowed calculation of 68 and 95% confidence intervals, the signal-to-noise ratio, and the reproducibility coefficient for any number of observers. When a single observer was considered, reproducibility was low, with 95% confidence intervals of k 0.9 points, corresponding to approximately f 22% diameter stenosis. However, when data of three ob- servers were averaged, the 95% confidence interval decreased to It 0.52 points (13% stenosis), signal-to-noise ratio rose to 12.2, and reproducibility coefficient was 0.92. Relatively small increments in these values were noted when data from a fourth or fifth observer were added. In comparison to a computer-assisted quantitative method, 86% accuracy was found for the results of averaged subjective determinations of stenosis severity. These data indicate that the reliability of visual estimation of coronary stenosis severity may be increased to acceptable levels by use of data from as few as three observers. Averaging of estimates from several independent observers should be reconsidered as a practical method which has the potential to realize considerable cost savings in the interpretation of coronary arteriograms.

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Section: Limitationsmentioning

confidence: 81%

Accuracy and reproducibility of visual coronary stenosis estimates using information from multiple observers

1992

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“…1981 to April 3, 1983, 77 consecutive patients who were seen at the University of Iowa Hospitals after the clinical onset of acute myocardial infarction were entered into the study. Criteria for admission into the study were as follows: (t) history of prolonged (greater than 20 min) chest pain consistent with acute myocardial infarction; (2) onset of chest pain within 9 hr preceding presentation to the cardiac catheterization laboratory, (3) age less than 80 years, (4) no prior history or evidence of infarction in the myocardial region currently involved in the acute event, (5) electrocardiographic findings suggesting acute transmural myocardial infarction, defined as at least 1 mm ST segment elevation (80 msec after the J point) in two or more leads that reflect characteristics of the infarcting wall (inferior: leads II, II, and aVF; anterior: I, aVL, and V1-V6), (6) persistent ST segment elevation after administration of sublingual nitroglycerin (0.4 mg), (7) no recent (within 14 days) history of a cerebrovascular event, major trauma, or surgical procedure.…”

Section: Methodsmentioning

confidence: 99%

Rethrombosis after reperfusion with streptokinase: importance of geometry of residual lesions.

Harrison¹,

Ferguson²,

Collins³

et al. 1984

Circulation

326

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We tested the hypothesis that lesion rethrombosis after streptokinase reperfusion is related to luminal size of the residual stenosis. Two independent techniques of analyzing coronary angiograms, quantitative coronary angiography and computer-based videodensitometry, were used to estimate the size of the residual lumen immediately after discontinuation of streptokinase. These techniques were selected because they provide independent estimates of cross-sectional area of a lesion with high degrees of reproducibility and minimal observer variability. Twenty-four patients who had undergone successful reperfusion with streptokinase were studied. Seven patients had lesion rethrombosis documented either on a repeat angiogram, at autopsy, or, in one case, by the fact that the patient had an acute transmural infarction resulting in death. Vessel patency was documented by repeat coronary angiography 8 to 14'days after initial streptokinase reperfusion in the other 17 patients. As assessed by quantitative coronary angiography, seven of 13 patients (54%) with minimal luminal crosssectional areas of less than 0.4 mm2 had rethrombosis. None of the 1 1 patients with lumens greater than 0.4 mm2 had rethrombosis. In the 17 patients with vessels that remained patent the size of the residual lesion at repeat catheterization was compared with its size immediately after reperfusion with streptokinase. Over the intervening 8 to 14 day interval, an average percentage increase in minimal crosssectional area of 116 + 34% was observed. In seven patients minimal luminal cross-sectional area more than doubled. Integrated optical density, an index of the severity of coronary stenosis derived from computer-based videodensitometry, was also useful in identifying a subgroup of patients at high risk for rethrombosis of lesion. Sixteen patients were identified as having integrated optical densities less than 2.5, and seven (44%) of these had rethrombosis of their lesions. Among the eight patients with integrated optical densities greater than 2.5, none had rethrombosis. These results show that rethrombosis of the vessel is in part related to the size of the residual lesion immediately after reperfusion with streptokinase. Vessels with residual stenotic cross-sectional areas less than 0.4 mm2 are at high risk for rethrombosis whereas vessels with minimal cross-sectional areas of greater than 0.4 mm2 are unlikely to develop rethrombosis. Furthermore, residual size of the lumen may change significantly during the 8 to 14 days after reperfusion. These changes may be due to remodeling of a ruptured atherosclerotic plaque, resolution of persistent coronary spasm, or lysis of persistent thrombi.Circulation 69, No. 5, 991-999, 1984. AFTER REPERFUSION WITH STREPTOKINASE residual high-grade stenoses are frequently present at the site of the previous obstruction. ' Decisions regarding the definitive care of these patients are based in part on the appearance of these lesions. In particular, treat-

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“…Therefore, in the present study, we focused on patients both with angina pectoris and with angiographically documented coronary artery narrowings. QCA analysis has the advantage of being more accurate and reproducible than visual hand-held caliper measurements (13)(14)(15)(16). However, in particular patients with diffuse narrowings it is difficult to identify a reference segment against which diseased lesions can be compared.…”

Section: Angiographic Characteristics In Patients With Igtmentioning

confidence: 99%

Quantitative Coronary Angiographic Studies of Patients With Angina Pectoris and Impaired Glucose Tolerance

et al. 2005

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OBJECTIVE -We investigated the morphological characteristics of coronary arteries in patients with impaired glucose tolerance (IGT) using computer-assisted quantitative coronary angiography. IGT is an independent risk factor for cardiovascular disease. However, the morphological changes developing in the coronary arteries of patients with IGT remain unknown.RESEARCH DESIGN AND METHODS -A total of 534 patients with angina pectoris were studied. Of these, 144 patients were being treated for diabetes. The remaining 390 patients were classified as follows depending on the results of a 75-g oral glucose tolerance test: normal glucose tolerance (NGT) (n ϭ 117), impaired fasting glucose (n ϭ 3), IGT (n ϭ 136), and diabetes pattern (preclinical diabetes) (n ϭ 134). The diameters of the middle section of all major coronary artery segments were measured and averaged to determine the averaged vessel diameter (AVD). We defined segments of a diameter of Յ1.5 mm as diseased lesions and determined the averaged lesion length (ALL).RESULTS -AVD and ALL were significantly different among patients with IGT and those with NGT. Patients with diabetes (preclinical and/or treated) had smaller AVD and longer ALL than those with IGT. By multivariate analysis, postprandial glucose levels were shown to be independently associated with an AVD Ͻ3.0 mm and an ALL Ͼ20 mm.CONCLUSIONS -Diffuse coronary artery narrowing develops not only in patients with diabetes but also in those with IGT. This morphological change is associated with postprandial hyperglycemia. Diabetes Care 28:2217-2222, 2005I mpaired glucose tolerance (IGT) has been regarded as intermediate between normal glucose tolerance (NGT) and overt diabetes. Recently, evidence has been accumulating that IGT may play a pathological role as one aspect of the metabolic syndrome. Epidemiological studies, i.e., the Funagata and DECODE (Diabetes Epidemiology: Collaborative Analysis of Diagnostic Criteria in Europe) studies (1,2), indicated that IGT characterized as postprandial hyperglycemia is an independent risk factor for cardiovascular disease. However, it is not known whether morphological changes develop in the coronary arteries of patients with IGT, as in those of diabetic patients for whom small vessel diameter and long lesion length (diffuse narrowing) are found in multiple vessels (3,4). In the present study, we assessed coronary angiographic features in patients with IGT by using computer-assisted quantitative analysis. RESEARCH DESIGN AND METHODS -From April 2000 toJune 2002, 1,529 patients were hospitalized due to nonischemic and ischemic heart disease in our facility of the National Cardiovascular Center, a tertiary referral hospital in the northern district of Osaka, Japan. We obtained informed consent and performed quantitative coronary angiography (QCA) in patients with recurrent chest pain associated with electrocardiographic and/or echocardiographic evidence of myocardial ischemia and without contraindications to the administration of iodinated contrast agent (e.g., predia...

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Quantitative coronary arteriography: estimation of dimensions, hemodynamic resistance, and atheroma mass of coronary artery lesions using the arteriogram and digital computation.

Cited by 628 publications

References 25 publications

Accuracy and reproducibility of visual coronary stenosis estimates using information from multiple observers

Accuracy and reproducibility of visual coronary stenosis estimates using information from multiple observers

Rethrombosis after reperfusion with streptokinase: importance of geometry of residual lesions.

Quantitative Coronary Angiographic Studies of Patients With Angina Pectoris and Impaired Glucose Tolerance

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