Dataset Information

Hemodynamics analysis of the serial stenotic coronary arteries.

ABSTRACT: Coronary arterial stenoses, particularly serial stenoses in a single branch, are responsible for complex hemodynamic properties of the coronary arterial trees, and the uncertain prognosis of invasive intervention. Critical information of the blood flow redistribution in the stenotic arterial segments is required for the adequate treatment planning. Therefore, in this study, an image based non-invasive functional assessment is performed to investigate the hemodynamic significances of serial stenoses. Twenty patient-specific coronary arterial trees with different combinations of stenoses were reconstructed from the computer tomography angiography for the evaluation of the hemodynamics. Our results showed that the computed FFR based on CTA images (FFRCT) pullback curves with wall shear stress (WSS) distribution could provide more effectively examine the physiological significance of the locations of the segmental narrowing and the curvature of the coronary arterial segments. The paper thus provides the diagnostic efficacy of FFRCT pullback curve for noninvasive quantification of the hemodynamics of stenotic coronary arteries with serial lesions, compared to the gold standard invasive FFR, to provide a reliable physiological assessment of significant amount of coronary artery stenosis. Further, we were also able to demonstrate the potential of carrying out virtual revascularization, to enable more precise PCI procedures and improve their outcomes.

SUBMITTER: Liu X

PROVIDER: S-EPMC5679505 | biostudies-literature | 2017 Nov

REPOSITORIES: biostudies-literature

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Hemodynamics analysis of the serial stenotic coronary arteries.

Liu Xin X Peng Changnong C Xia Yufa Y Gao Zhifan Z Xu Pengcheng P Wang Xiaoqing X Xian Zhanchao Z Yin Youbing Y Jiao Liqun L Wang Defeng D Shi Lin L Huang Wenhua W Liu Xin X Zhang Heye H

Biomedical engineering online 20171109 1

Coronary arterial stenoses, particularly serial stenoses in a single branch, are responsible for complex hemodynamic properties of the coronary arterial trees, and the uncertain prognosis of invasive intervention. Critical information of the blood flow redistribution in the stenotic arterial segments is required for the adequate treatment planning. Therefore, in this study, an image based non-invasive functional assessment is performed to investigate the hemodynamic significances of serial steno ...[more]

PMID: 29121932

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Project description:Background / objectivesAutomatic algorithms for stent struts segmentation in optical coherence tomography (OCT) images of coronary arteries have been developed over the years, particularly with application on metallic stents. The aim of this study is three-fold: (1) to develop and to validate a segmentation algorithm for the detection of both lumen contours and polymeric bioresorbable scaffold struts from 8-bit OCT images, (2) to develop a method for automatic OCT pullback quality assessment, and (3) to demonstrate the applicability of the segmentation algorithm for the creation of patient-specific stented coronary artery for local hemodynamics analysis.MethodsThe proposed OCT segmentation algorithm comprises four steps: (1) image pre-processing, (2) lumen segmentation, (3) stent struts segmentation, (4) strut-based lumen correction. This segmentation process is then followed by an automatic OCT pullback image quality assessment. This method classifies the OCT pullback image quality as 'good' or 'poor' based on the number of regions detected by the stent segmentation. The segmentation algorithm was validated against manual segmentation of 1150 images obtained from 23 in vivo OCT pullbacks.ResultsWhen considering the entire set of OCT pullbacks, lumen segmentation showed results comparable with manual segmentation and with previous studies (sensitivity ~97%, specificity ~99%), while stent segmentation showed poorer results compared to manual segmentation (sensitivity ~63%, precision ~83%). The OCT pullback quality assessment algorithm classified 7 pullbacks as 'poor' quality cases. When considering only the 'good' classified cases, the performance indexes of the scaffold segmentation were higher (sensitivity >76%, precision >86%).ConclusionsThis study proposes a segmentation algorithm for the detection of lumen contours and stent struts in low quality OCT images of patients treated with polymeric bioresorbable scaffolds. The segmentation results were successfully used for the reconstruction of one coronary artery model that included a bioresorbable scaffold geometry for computational fluid dynamics analysis.

Project description:BackgroundNonculprit lesions are the major cause of future cardiovascular events. However, the natural course of nonculprit lesions and angiographic predictors of plaque progression are not well-studied. The purpose of our study was to observe the natural course of nonculprit lesions, and to identify predictors of unanticipated future events and angiographic progression in nonculprit lesions.MethodsWe analyzed 640 nonculprit lesions with a length of ≥2 mm and luminal narrowing ≥30% from 320 patients who had two serial angiographic follow-ups; 9 to 13 months post-PCI and 24 months post-PCI. The study endpoints were nonculprit-ischemia driven revascularization (IDR) and the rate of diameter stenosis (DS) progression. Those with progression of DS > 12%/year were defined as 'rapid progressors'.ResultsDuring the median follow-up period of 737 days, 20 lesions in 20 patients (6.3%) required nonculprit-IDR. Independent predictors of nonculprit-IDR were diabetes (hazard ratio [HR] 2.93, 95% confidence interval [CI] 1.072-8.007, p = 0.036) and lesion type B2/C (HR 4.017, 95% CI 1.614-9.997, p = 0.003). The presence of one or both of the two major risk factors was associated with significant DS progression (3.0 ± 6.8% vs. 3.5 ± 6.1% vs. 6.8 ± 9.9% for lesions with 0, 1 and both risk factors, p < 0.001). Among the 640 lesions, 38 lesions (5.9%) in 33 patients were rapid progressors, while risk factors of rapid progressors included lesion type B2/C as a lesion-related risk factor (HR 1.998, 95% CI 1.006-3.791, p = 0.048) and diabetes mellitus as a patient-related risk factor (HR 3.725, 95% CI 1.937-7.538, p < 0.001). Lesions with both risk factors (type B2/C lesions in diabetic patients) were at the highest risk of rapid progression (odds ratio 3.250, 95% CI 1.451-7.282), compared to type A/B1 lesions in non-diabetic patients.ConclusionNonculprit-IDR was not uncommon during the 2-year follow up period in our population. The major risk factors of nonculprit lesion progression were diabetes and lesion type B2/C.Trial registrationRetrospectively registered and approved by the institutional review board of Seoul National University Hospital (No.: 1801-138-918) on February 2nd, 2018.

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Hemodynamics analysis of the serial stenotic coronary arteries.

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Hemodynamics analysis of the serial stenotic coronary arteries.

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