Coronary Cineangiogram Research Articles

AN AUTOMATED FRAMEWORK FOR CORONARY ANALYSIS FROM CORONARY CINE ANGIOGRAMS USING MACHINE LEARNING AND IMAGE ANALYSIS TECHNIQUES

Cardiovascular disease (CVD) is one of the critical diseases and the most common cause of morbidity and mortality worldwide. Therefore, early detection and prediction of such a disease is extremely essential for a healthy life. Cardiac imaging plays an important role in the diagnosis of cardiovascular disease but its role has been limited to visual assessment of heart structure and its function. However, with the advanced techniques and tools of big data and machine learning, it become easier to clinician to diagnose the CVD. Stenosis with in the Coronary Arteries (CA) are often determined by using the Coronary Cine Angiogram (CCA). It comes under the invasive image modality. CCA is the effective method to detect and predict the stenosis. In this paper a coronary analysis automation method is proposed in disease diagnosis. The proposed method includes pre-processing, segmentation, identifying vessel path and statistical analysis.

Visual alignment of arteries in coronary cine-angiogram using global motion stabilisation approach

Coronary cine-angiogram (CCA) is an invasive medical image modality, which is used to detect stenosis in coronary arteries (CA). Global motion that occurs due to the heart beat is a major obstruction to visually track correlated arterial flow within CCAs. This study devises a novel method to align the main CA visualised among the CCA frames using global motion stabilisation. In order to stabilise the global motion artifact, motion vectors are calculated through improved template matching technique, which is introduced in this study to match a given CA template with the CCA frame that contains deformed CA tree. The accuracy of the proposed content alignment method was reported as 97.45 %. The content aligned global motion stabilised CCA is produced as the output of this study and those CCAs can be used to further enhance the angiography image modality, to determine the functional significance of CA to assess the severity level of the detected stenosis.

Hierarchical Region Based Template Matching Technique for Global Motion Reduction of Coronary Cineangiograms

 Abstract—The Coronary Cineangiogram (CCA) is an invasive medical image modality which is used to determine the stenosis in the Coronary Arteries. The global motion occurring due to the heart beat makes great disturbance to obtain the visual alignment among the vessel structure shown in the CCA frames. Therefore, the recorded vessel structure's position in CCA varies within the frame sequence. This paper describes a hierarchical region based template matching technique to reconstruct the CCA by reducing the global motion artifacts. This proposed motion reduction technique is efficient and it reconstructs the CCA by reducing the background motion as desired. Experimental results of this method have shown its' ability to maintain the visual alignment of the internal blood flow among the frames.

A case of hypertrophic cardiomyopathy with mid-ventricular obstruction (MVO) — Dramatic long-term improvement with a DDD pacemaker as assessed by diastolic paradoxical jet flow velocity

A 68-year-old woman complaining of exertional chest and back pain was referred to our hospital for a preoperative evaluation for gastric cancer. She had been treated with a β-blocker since 2002 after being diagnosed with hypertrophic obstructive cardiomyopathy (HOCM) at another hospital. The frequency of her chest and back pain episodes during stair climbing and rapid walking had increased in the previous year. Based on the studies below, a permanent DDD pacemaker with an AV delay of 80 ms was implanted at a heart rate setting of 60/min. Surgery for gastric cancer was performed uneventfully 2 months later. Continuous-waveDoppler imaging (Fig.1A)demonstratedbloodflow from the apex to the base of the left ventricle during early systole (white arrowheads) followed by high-speed blood flowduring diastole, forming biphasicwaves. The latter part of thewave is generally known as diastolic paradoxical jet flow (yellowarrows). The blood flow from the base to the apex showed triphasic waves, in which E-waves [E], A-waves [A], and high-speed bloodflow [H]were observed in the diastolic, presystolic, and early systolic phases, respectively. Color Doppler imaging of the apical four-chamber view (Fig. 1B) revealed so-called diastolic paradoxical jet flow from the apex to the base of the left ventricle (shown in blue) during diastole, with the vortex flows forming a mosaic pattern. Furthermore, as her main complaint was chest and back pain during stair climbing and rapid walking, a hemodynamic assessment was performed during exertion. After the administration of isoproterenol, the patient's heart rate increased to 110/min, and chest pain developed. In addition, her diastolic paradoxical jet flow velocity was elevated to 544 cm/s (Fig. 1C, yellow arrows), and the maximal pressure gradient increased to 119 mmHg, as estimated by continuous-wave Doppler imaging. Immediately after the start of pacing in VVI mode at a heart rate of 115/min, her diastolic paradoxical jet flow velocity decreased to less than 200 cm/s (Fig. 1D, yellow arrows). At 20 months after surgery, she is doing well without any complaints. Her diastolic paradoxical jet flow velocity was 159 cm/s at the last follow-up (Fig. 1E, yellow arrows), and her maximal pressure gradient was 10.1 mmHg, as estimated by continuous-wave Doppler imaging. The coronary cine angiogram revealed normal epicardial coronary arteries. A left ventriculogram confirmed mid-ventricular obstruction combined with an apical aneurysm, which seemed to be enlarged compared with that seen in 2002. During cardiac catheterization, simultaneous pressure measurements at the apex and base of the left ventricle demonstrated a maximal pressure gradient of 162 mmHg in the control conditions (Fig. 2, 1). Using an AV sequential pacemaker with electrodes placed in the right atrium and the right ventricle, her maximal pressure gradient was decreased from 162 mmHg to 116 mmHg (Fig. 2,2) and 20 mmHg (Fig. 2, 3) as the atrioventricular (AV) conduction delay was shortened to 120 ms and then to 70 ms, respectively. It should also be noted that the pressure gradient detected between the apex

Lipoprotein(a) is a potential coronary risk factor.

Lipoprotein(a) (Lp(a)) is recognized as a new coronary risk factor, but few studies have quantitatively assessed the relationship of serum Lp(a) levels with other coronary risk factors in many patients undergoing coronary cineangiography. Seventeen coronary risk factors were quantified (i.e., age, gender, hypertension, impaired glucose tolerance, cerebrovascular accident, hyperuricemia, smoking, family history of ischemic heart disease (IHD), history of hyperlipidemia, Lp(a), total cholesterol, high density lipoprotein (HDL)-cholesterol, triglyceride, low density lipoprotein-cholesterol, apolipoproteins(apo)A-I,B, E) to determine their relationship with the numbers of involved coronary vessels using multiple regression test in 1,006 patients who underwent coronary cineangiogram (280 non-IHD patients: 144 men, 136 women; 726 IHD patients: 460 men, 266 women; age 16-84 years, mean 60.5+/-0.3). Multiple regression test indicated R = 0.506 and items that showed high beta weight and significant p level were age, Lp(a), impaired glucose tolerance, total cholesterol, cerebrovascular accidents, HDL-cholesterol, smoking, gender, family history of IHD, and apo-A-I (0.221, p<0.001; 0.174, p<0.001; 0.616, p<0.001; 0.138, p<0.001; 0.122, p<0.001; -0.12, p<0.001; 0.092, p<0.01; 0.091, p<0.01; 0.067, p<0.05; -0.065, p<0.05; respectively). It was concluded that Lp(a) is an independent, potential, and modifiable coronary risk factor, and that reduction of serum Lp(a) is important in the clinical management of patients with IHD.

冠動脈造影像における複数血管重なり部分の個別血管への分離

冠動脈造影像における複数血管重なり部分の個別血管への分離

Limitation of detection and evaluation of coronary arterial stenosis by densitometry.

In coronary cineangiography, both X-ray absorption and light scatter in the image intensifier tend to degrade image quality, and so affect the accuracy of densitometric measurement of vessel diameter. To investigate this problem, we compared the accuracy and precision of the densitometric method and the edge detection method in the automated detection of stenosis in both vessel phantom and clinical studies. In the phantom study, the X-ray penetration was varied by altering the thickness of the model, and the change in the measured diameter obtained by each of the two methods was evaluated simultaneously. A difference of 5 mm in the thickness of the model was found to alter significantly (P < 0.01) measurement of the diameter obtained using the densitometric method, but not that obtained by the edge detection method. In the clinical part of the study, the accuracy of each method in the automated detection of coronary stenosis was evaluated. With respect to the detection of stenosis, the level of disagreement between the assessment of the 3 observers and what was detected by densitometry (22.8%) was 2.9 times higher than the disagreement between the observers' assessment and what was detected using the edge detection method (7.9%). When the background density of the coronary cineangiogram along the axis of the vessel was uneven, many vessel segments which had been evaluated as normal when edge-detection was used were evaluated as stenosed when densitometry was used. This study, then, demonstrates that the Lambert-Beer law does not apply in cases where the thickness of the subject varies in different locations along the axis of the same vessel. We therefore conclude that densitometry is not a reliable means of assessing coronary stenosis in such cases, due to veiling-glare and scatter, and recommend that it not be routinely used in the automated detection of coronary arterial stenosis.

A new approach for the automated definition of path lines in digitized coronary angiograms

For the quantitative analysis of a coronary segment from a coronary (cine)angiogram, an initial path line is required which functions as a model for the subsequent automated contour detection. For on-line applications, a new method for the automated definition of arterial path lines has been developed. Required user-interaction consists of the manual definition of a beginning and an endpoint of the arterial segment to be analyzed. The method is based on a combination of a beam tracer and a box technique. A validation study was performed on 47 non obstructed arteries of various lengths and diameters, and on 56 arterial segments with obstructions (up to 86 percent diameter stenosis). In 89% of the cases an acceptable path line was found after the first iteration; the success score increased to 99%, if a simple manual correction was allowed (2 iterations). The method is extremely fast: the overall average search time for the first iteration was 266 ms, for the second iteration 211 ms. Therefore, it may be concluded that this new technique for the automated definition of arterial path lines is extremely suitable for on-line applications.

Which Cineangiographically Assessed Anatomic Variable Correlates Best With Functional Measurements of Stenosis Severity? A Comparison of Quantitative Analysis of the Coronary Cineangiogram with Measured Coronary Flow Reserve and Exercise/Redistribution Thallium-201 Scintigraphy

The goal of this investigation was to establish which measured anatomic variable of stenotic coronary lesions correlates best with functional severity. Therefore, 38 patients with single vessel disease underwent coronary cineangiography and exercise/redistribution thallium-201 scintigraphy. The computer-based Cardiovascular Angiography Analysis System was used to determine the cross-sectional area at the site of obstruction (OA) and percent diameter stenosis (DS), and to calculate the pressure drop over the stenosis (PD) with use of fluid dynamic equations. Coronary flow reserve was measured radiographically. Myocardial perfusion defects on thallium scintigrams were analyzed quantitatively and by visual interpretation. The relations between coronary flow reserve (CFR) and the three anatomic variables were described by the following equations: 1) CFR = 4.6 - 0.053 DS, r = 0.82; SEE: 0.79, p less than 0.001. 2) CFR = 0.5 + 0.75 OA, r = 0.87; SEE: 0.68, p less than 0.001). 3 CFR = 3.6 - 1.5 log PD, r = 0.90; SEE: 0.62, p less than 0.001. The calculated pressure drop was highly predictive of the thallium scintigraphic results with a sensitivity of 94% and a specificity of 90%. The calculated pressure drop is a better anatomic variable for assessing the functional importance of a stenosis than is percent diameter stenosis or obstruction area. However, the 95% confidence limits of the relation between pressure drop and coronary flow reserve are wide, making the measurement of coronary flow reserve an indispensable addition to quantitative angiography, especially when determining the functional importance of moderately severe coronary artery lesions.

A Study of Regional Myocardial Function by Biplane Coronary Cineangiogram

A Study of Regional Myocardial Function by Biplane Coronary Cineangiogram

Cardiac imaging—Decrease in the left ventricular ejection fraction after exercise

A 67-year-old female with a history of angina was admitted for progressively increasing exertional precordial pain. There was no history of a prior myocardial infarct. A chest x-ray showed slight cardiomegaly. An electrocardiograph (EKG) showed nonspecific ST-T wave changes in the lateral wall. A gated cardiac blood pool scintiscan that used Tc-99m labeled red cells revealed normal ventricular function and a normal sized left ventricle. The resting left ventricular ejection fraction in the supine legs-up position was 63% and normal contractility was seen (Fig. 1). The patient underwent six minutes of supine bicycle ergometric exercise, reaching 85% of the target heart rate. Exercise was terminated because of chest pain. Repeat imaging at peak exercise demonstrates a decrease in the left ventricular ejection fraction (LVEF) to 48% (Fig. 2). The left ventricle enlarged with an increase in the left ventricular end-diastolic volume. Hypokinesis of the septum developed which was not noted on the rest study. Selective coronary cineangiogram demonstrated a 90% narrowing of the left anterior descending coronary artery at its origin and an area of marked narrowing of the marginal branch of the left circumflex. A contrast left ventriculogram showed normal contractility and normal ejection fraction. The patient underwent aortocoronary bypass grafts to the left anterior descending and circumflex coronary arteries. Borer et al ~ first described the left ventricular response to exercise by using multiple gated equilibrium blood pool scintigraphy. In their initial work, all normal patients developed an increase in the LVEF of at least 7%, whereas all the patients with coronary artery disease either had a decrease or no change in LVEF. In addition, regional wall abnormalities were seen in all patients with coronary artery disease. Although initially the fall in LVEF with exercise or development of abnormal areas of contractility were thought specific for coronary artery disease (CAD), more extensive work has shown that many other conditions can cause these findings, including aortic stenosis, 2 aortic regurgitation? mitral regurgitation, 4 mitral valve prolapse, 5 chronic iron overload, 6 and in normal elderly patients] Technical factors in the performance of the studies are also of major importance in obtaining

Graphics methods for tracking three-dimensional heart wall motion

An analysis of heart wall motion requires that specific points on the wall be identified and their movements tracked in three dimensions over several heart beats. A method to reconstruct time-dependent 3D coordinates from any two or more perspective views has been developed. We have used this method to determine accurately the 3D dynamics of bifurcation points of the coronary arteries or surgically implanted markers by tracking their projections in both views of a biplane coronary cineangiogram. The tracking operation is aided by a sophisticated interactive computer system which superimposes an animated graphics display onto the film image. This allows entries to be checked and corrected immediately. The most powerful tool provided by the graphics system is the ability to display the backprojections of positions from one view as auxiliary lines across the other view on which the projection of the point of interest must lie. We provide some examples of cardiac wall motion measures we have made using this system.

Direct myocardial revascularization: A ten year journey: Myths and realities

Direct myocardial revascularization, mostly by saphenous vein graft and mammary-coronary artery anastomosis, is performed routinely in thousands of patients in most cardiovascular centers around the world. However, this procedure remains controversial among cardiologists and cardiovascular surgeons as they strive to determine its proper perspective in the overall treatment of coronary arteriosclerosis. A point of view on the indications for direct myocardial revascularization is presented in this lecture. To clarify the current criteria it is essential and timely to analyze (1) the problems related to the operation (operative mortality, perioperative myocardial infarction, early and late graft occlusion and changes in the coronary vessels; (2) the natural history of coronary arteriosclerosis, which requires a proper classification of ischemic myocardiopathy to compare current medical and surgical treatment; the classification followed in Buenos Aires and prospective studies in progress; (3) the proper utilization of diagnostic procedures, clinical history, exercise electrocardiography, echocardiography, radioisotopes and coronary cineangiography. Although all of these methods are needed in our armamentarium, coronary cineangiography is mandatory and irreplaceable. A tabulation to read the coronary cineangiogram in relation to the ischemic area is presented. Classification by single, double and triple vessel disease is not enough to select patients adequately. After performing direct myocardial revascularization for more than 10 years, I believe that the indication for bypass surgery has been clarified and that enough evidence exists to state that the use of this technique in properly selected patients enhances the quality of life and improves life expectancy.

Discrepancies Between Cineangiographic and Postmortem Findings in Patients with Coronary Artery Disease and Recent Myocardial Revascularization

In 28 consecutive patients who died following coronary artery grafting and within 30 days of a previous coronary cineangiogram, a study was undertaken to compare the findings at autopsy and those at angiography. In five instances, such a comparison could not be made: in one instance, no postmortem examination was obtained, and in four additional cases, the quality of the cineangiographic document (three instances) or the pathological specimen (one instance) did not permit a reliable comparison. In the remaining 23 cases, there were nine specimens in which an appreciable difference (≥ 25%) was noted in the severity of the coronary artery lesions. In four of these nine cases, failure of cineangiography to assess the degree of coronary arterial narrowing led to incomplete myocardial revascularization and contributed, in retrospect, to the surgical failure. Most discrepancies occurred in the left coronary artery system, despite the fact that in all instances, four projections had been obtained of the left coronary artery in the transverse plane. Because of the particular orientation of the initial portion of the left coronary artery and its major divisions, it is recommended that additional projections in the sagittal plane be included to eliminate angiographic superimposition of multiple branches, which often cannot be properly separated in the standard transverse plane.