Optical coherence tomography versus intravascular ultrasound in patients with myocardial infarction: a diagnostic performance study of pre-percutaneous coronary interventions

Accurate coronary measurements are important in guiding percutaneous coronary intervention. Intravascular ultrasound is a widely accepted diagnostic modality for coronary measurement before percutaneous coronary intervention. The spatial resolution of optical coherence tomography is 10 times larger than that of intravascular ultrasound. The objective of the study was to compare quantitative and qualitative parameters of frequency domain optical coherence tomography (FDOCT) with those of intravascular ultrasound and coronary angiography in patients with acute myocardial infarction. Diagnostic parameters of coronary angiography, intravascular ultrasound, and FDOCT of 250 patients with coronary artery disease who required admission diagnosis were included in the analyses. Minimum lumen diameter detected by FDOCT was larger than that detected by quantitative coronary angiography (2.11±0.1 vs 1.89±0.09 mm, P<0.0001, q=34.67) but smaller than that detected by intravascular ultrasound (2.11±0.1 vs 2.19±0.11 mm, P<0.0001, q=12.61). Minimum lumen area detected by FDOCT was smaller than that detected by intravascular ultrasound (3.41±0.01 vs 3.69±0.01 mm2, P<0.0001). FDOCT detected higher numbers of thrombus, tissue protrusion, dissection, and incomplete stent apposition than those detected by intravascular ultrasound (P<0.0001 for all). More accurate and sensitive results of the coronary lumen can be detected by FDOCT than coronary angiography and intravascular ultrasound (level of evidence: III).

Findings of Single-Photon Emission Computed Tomography and Its Relation with Quantitative Coronary Angiography in Patients with Significant Stenosis of the Left Main Coronary Artery

OBJECTIVE: Unrecognized left main coronary artery disease (LMCD) is often fatal; however, accuracy of non-invasive tests for diagnosing LMCD is still unsatisfactory. This study was performed to elucidate single-photon emission computed tomography (SPECT) detection of LMCD using quantitative coronary angiography (QCA) data. MATERIALS AND METHODS: Fifty-five patients (39 men; mean age, 68.1 ± 10.9 years) diagnosed with significant left main (LM) stenosis (≥ 50%) by invasive coronary angiography (ICA) were retrospectively reviewed. All study patients underwent SPECT with pharmacologic stress within 30 days of ICA. All coronary lesions were quantified via QCA, and SPECT findings were compared with QCA results. RESULTS: Only four patients (7.3%) had isolated LMCD; all others had combined significant stenosis (≥ 70%) of one or more other epicardial coronary arteries. Patients with more severe coronary artery disease tended to have higher values for summed difference scores in a greater number of regions, but the specific pattern was not clearly defined. Summed stress score of SPECT did not differ according to LM stenosis severity. Only three patients (5.4%) had a typical LM pattern of reversible perfusion defect on SPECT. A significant negative linear correlation between stenosis severity and stress perfusion percent was found in the left anterior descending artery region (r = −0.455, p < 0.001) but not in the left circumflex artery. CONCLUSION: Single-photon emission computed tomography findings were heterogeneous, not specific and poorly correlated to QCA data in patients with significant LMCD. This may be due to highly prevalent significant stenosis of other epicardial coronary arteries.

A study in the correlation between vascular factors and plaque imaging morphology of coronary borderline lesions in patients with coronary heart disease / 中华急诊医学杂志

Objective To investigate the correlation between the levels of placenta growth factor (PLGF),soluble angiopoietin receptor-2 (sTie-2) and critical coronary artery plaque imaging morphology of coronary borderline lesions in patients with coronary heart disease (CHD).Methods In three consecutive years from April 2007 to September 2009,a cohort of 719 patients with borderline coronary lesions with stenosis in three main vessels with lumen diameter reduction varied all the way from more than 20％ to less than 70％ and with greater than 2.25 mm of the inner diameter were selected in this study from 4 teaching hospitals of tertiary class A in Beijing.These patients fell into three categories:unstable angina pectoris (UAP,n =292),stable angina pectoris (SAP,n =219) and coronary arteriosclerosis (AS,n =208).The vessels involved were analyzed using quantitative coronary angiography (QCA).Plasma levels of PLGF and sTie-2 were measured by using protein chip.The relationship between plasma levels of vascular factors,sTie-2,PLGF and coronary artery plaque imaging morphology among three groups were analyzed.Results (1) Plasma level of PLGF was 80.33 ng/L in the UAP group,which was significantly higher than 54.29 ng/L in the SAP group and 45.16 ng/L in AS group (both P ＜0.05).Plasma level of sTie-2 was 1353.06 ng/L in the UAP group,which was significantly higher than 1308.28 ng/L in the AS group (P =0.008).(2) There was significantly statistical differences in QCA between the SAP group and the UAP group as well as the AS group (both P ＜ 0.05) in terms of the minimal lumen diameter,diameter stenosis rate,minimal lumen cross-sectional area and cross-sectional area of stenosis.The plaque area in the UAP group was larger than that in the AS group (P =0.013).(3) The relationship between vascular factors and plaque imaging morphology was analyzed.There was significantly statistical difference in the involved lesions among the three groups (P ＜ 0.01).(4) There was a positive correlation between plasma level of PLGF and minimal lumen cross-sectional area (r =0.493,P =0.009).Conclusions The plasma levels of PLGF and sTie-2 reflect the level of neo-vascularization in the plaque,and could be taken as predictive factors for potential pathogenesis of coronary plaque.

Reanalysis of criminals vascular with fixed stenosis of acute ST segment elevation myocardial infarction / 中国综合临床

Objective To evaluate quantitative coronary angiography (QCA) measurement of culprit vessel fixed stenosis in acute ST segment elevation myocardial infarction (STEMI) emergency interventional thrombus aspiration.Methods One hundred and sixty-fore cases of STEMI patients accepting emergency interventional operation and thrombus aspiration treatment were choosed from September 2012 to October 2013 in the First Affiliated Hospital of Wenzhou Medical University.Thrombus Aspiration measuring vessel was carried after criminals using fixed stenosis rate QCA methods.Results The vascular stenosis rate was more than 50％ in 69.5％ of the male patients,vascular stenosis rate was more than 70％ in 40.2％ of the female patients,the anterior descending branch of the rami anterior descendens(LAD) (54.75％ ± 29.72％,n=76),Left circumflex artery (LCX) (55.25％ ± 32.23％,n =20),arteriae coronaria dextra (RCA) (56.40％ ± 29.76％,n =68).There was no difference between LAD,LCX and RCA (F=6.036,0.955,0.055;P＞0.05).Conclusion The most majority of serious vascular stenosis patients have acute STEMI.

Myocardial FFR (Fractional Flow Reserve) in patients with angiographically intermediate coronary artery stenosis - an initial institutional experience.

RESEARCH ARTICLE January-March 2013 | Volume 1 | Issue 1 | Page: 4-11 Myocardial FFR (Fractional Flow Reserve) in patients with angiographically intermediate coronary artery stenosis - an initial institutional experience Jagadish H. Ramaiah*, Raghu T. Ramegowda, Srinivas B. Chikkaswamy, Manjunath C. Nanjappa Sri Jayadeva Institute of Cardiovascular Sciences & Research, Jaya Nagar 9th Block, BG Road, Bangalore - 560069, Karnataka, INDIA Correspondence to: Dr. Jagadish H. Ramaiah, Email: jagadishhr@rediffmail.com Background: The clinical significance of coronary artery stenosis of intermediate severity can be difficult to determine. The management of intermediate coronary lesions, defined by a diameter stenosis of ≥40% to ≤70%, continues to be a therapeutic dilemma for cardiologists. The 2-dimensional representation of the arterial lesion provided by angiography is limited in distinguishing intermediate lesions that require stenting from those that simply need appropriate medical therapy. In the era of drug-eluting stents, some might propose that stenting all intermediate coronary lesions is an appropriate solution. However, the possibility of procedural complications such as coronary dissection, no reflow phenomenon, in-stent restenosis, and stent thrombosis requires accurate stratification of patients with intermediate coronary lesions to appropriate therapy. Myocardial fractional flow reserve (FFR) is an index of the functional severity of coronary stenosis that is calculated from pressure measurements made during coronary angiography. The objective of the study is to evaluate the usefulness of FFR in patients with angiographically intermediate coronary artery stenosis. Methods: 20 patients with intermediate coronary stenosis and chest pain of uncertain origin. The Exercise Electrocardiography (TMT), Myocardial Perfusion Imaging study (MPI), Quantitative Coronary Angiography (QCA) were compared with the results of FFR measurements. Results: 20 patients were undergone FFR measurement during the study period. With the mean age of 57.25±11.2 and male patients were 16 (80%), female patients 4 (20%), in all 13 patients with an FFR of <0.75, reversible myocardial ischemia was demonstrated unequivocally on at least one noninvasive test. In contrast, 5 of 7 patients with an FFR of >0.75 tested negative for reversible myocardial ischemia on TMT and MPI study. No revascularization procedures were performed in 7 (35%) patients, and no adverse cardiovascular events were noted in all these patients during 6 months of follow-up. Conclusions: In patients with coronary stenosis of intermediate severity, FFR appears to be a useful index of the functional severity of the stenosis and the need for coronary revascularization

Using the combination of traditional risk factors and quantitative coronary angiography (QCA )in predicting the risk of individuals with subclinical artherosclerosis / 中华流行病学杂志

Objective To determine whether the combination of traditional risk factors and quantitative coronary angiography (QCA) assessment could provide accurate prognostic information on a population-based study including 1137 adults with subclinical artherosclerosis and with coronary risk factors. Methods Participants underwent coronary angiography examination before the minimal stenotic diameters, segment diameters, percent stenosis, plaque areas. Other parameters were analyzed by the computer-assisted Coronary Angiography Analysis System. The Framingham Risk Score for each participant was assessed. During the 1 year follow-up period, all kinds of endpoint cardiovascular events were screened. Endpoint events were defined as death from coronary heart disease, nonfatal myocardial infarction (MI) or unstable angina pectoris. Results During the 1 year of follow-up period, a total of 124 participants developed an endpoint event, which was significantly associated with the Framingham Risk Score, calcium of plaques and the plaque areas (all Ps＜0.05).The QCA score incorporated with the QCA parameters was related to the endpoint events. The Framingham Risk Score was combined with QCA score through logistic regression for prediction of end-point events. Data from the ROC analysis showed the accuracy of this prediction algorithm was superior to the accuracy when variables themselves were used. The event-free survival rate was inferior to the control group in participates under high risk, when being screened with this prediction algorithm (P＜0.05). Conclusion The risk of cardiovascular attack in subclinical artherosclerosis individual seemed to be associated with the Framingham Risk Score, calcium of plaques and the plaque areas. When the traditional risk factors (the Framingham Risk Score) were combined with QCA, the new method could provide more prognostic information on those adults with subclinical artherosclerosis.

Comparative analysis between three dimentional reconstruction coronary angiography with CardiOp-B system and conventional quantitative coronary angiography / 上海第二医科大学学报

Objective To investigate the accuracy of three-dimensional reconstruction coronary angiography with CardiOp-B system in the evaluation of coronary artery stenosis, and make comparison with conventional quantitative coronary angiography(QCA). Methods The imaging data of 33 patients (39 vessel segments) who underwent coronary angiography and received interventional therapy were collected. The vessel diameter, vessel area, diameter of reference vessel rate of stenosed area and lesion length detected by three-dimensional reconstruction coronary angiography and QCA were compared. Results There was no significant difference in the detected minimal vessel diameter, minimal vessel area, diameter of reference vessel, rate of stenosed area and lesion length between three-dimensional reconstruction coronary angiography and QCA in these 39 vessel segments (P > 0.05), while the lesion length detected by three-dimensional reconstruction coronary angiography was significantly longer than that detected by QCA(P < 0.05). Conclusion Three-dimentional reconstruction of coronary angiography with CardiOp-B system demonstrates higher accuracy in the quantitative analysis of coronary artery stenosis compared with conventional QCA.