Interpretation Of Coronary Angiograms Research Articles

MORPHOMETRIC ANALYSIS OF CORONARY ARTERIES IN HARYANVI POPULATION

Objective: The present study aimed to record the length of coronary arteries was carried out for better anatomical knowledge about the branches of coronary arteries and its variation is essential for cardiologists and interpretation of coronary angiograms by radiologists. Methods: The study group was comprised 60 human cadaveric hearts retrieved from the dead bodies of the age group 18–50 years brought for medicolegal autopsy. Results: In 60 heart specimen’s length of right coronary artery (RCA)-I (34.4–128.8 mm, 81.5±18.1), RCA-II (6.2–43.4 mm, 20.3±9.9), RCA-III (9.6–69 mm, 38.2±18.7), length of left coronary artery (3.4–19 mm, 12.6±3.74 mm), length of left circumflex artery (31.9–144.5 mm, 79.2±26.2 mm), and length of left anterior descending artery (33.4–154.4 mm, 105.3±27 mm). Conclusion: The name and nature of a coronary artery or a branch define that vessel’s vascularization pattern or territory, rather than its origin. Better anatomical knowledge about the branches of the coronary artery and its variation is essential for cardiologists and interpretation of coronary angiograms by radiologists.

Culprit Arteries in Patients with Inferior Wall Myocardial Infarction (IWMI) With St Segment Depression in Lead AVR

ACS is an imbalance between the myocardial oxygen demand and consumption of oxygen by the heart. While coronary plaque rupture, which results in STEMI, is almost always the cause of this mismatch development of thrombus blocking a coronary artery. Objective: To determine the frequency of culprit arteries in patients with inferior wall myocardial infarction (IWMI) with ST Segment depression in Lead AVR. Methods: This cross sectional  study was conducted at Department of Adult Cardiology, NICVD, Karachi, Pakistan from November 4, 2020 to May 3, 2021.  All patients who fulfilled the inclusion criteria were enrolled and consent was taken. All patients were initially stabilized and then were prepared for coronary angiography. Interpretation of coronary angiogram was done to assess the culprit arteries i.e. LCX, RCA. Data were collected in proforma. Results. Out of 317 patients, 233 (73.5%) were male while 84 (26.5%) were female with mean age of 51.4±12.4 years. Left circumflex coronary artery was found in 184 (58%) patients. Right coronary artery was found in 133 (42%) patients. Conclusions: This study concludes that  LCX artery is more likely to be culprit in patients with inferior wall myocardial infarction and ST-segment depression in lead AVR. STEMI patients with IWMI should be worked up for the presence of culprit arteries to ensure adequate treatment

In-Hosptal Outcome and Angiographic Findings in Acute Inferior Myocardial Infarction with ST-Segment Elevation in Posterior Chest Leads ( V7, V8, V9 ) Following Thrombolytic Therapy

Background: Electrocardiographic diagnosis of a posterior wall myocardial infarction is difficult to accomplish by the standard 12-lead ECG. Early detection of posterior wall involvement in an inferior myocardial infarction is of paramount importance for the therapeutic outcome. The aim of this study is to assess the role of ST segment elevation in posterior wall leads (V7, V8, V9) on the admission ECG of acute inferior myocardial infarction, for the diagnosis of posterior wall myocardial infarction and the identification of infarct related artery as well as in-hospital outcome following thrombolysis.Methods: A total of 90 patients with acute inferior MI were enrolled by purposive sampling. On the basis of ST segment elevation in posterior leads (V7,V8,V9), study subjects were categorized into two groups: 45 patients of acute inferior MI with ST segment elevation in posterior leads as group I and 45 patients of acute inferior MI without ST segment elevation in posterior leads as group II. Coronary angiography was done during index hospital admission. Interpretation of coronary angiogram was done by visual estimation by two cardiologists to assess the severity of coronary artery disease. Severity of coronary stenosis was graded according to the number of major epicardial vessel with significant stenosis by vessel score and Friesinger score. After CAG, patients were evaluated for in hospital adverse outcome like heart block, cardiogenic shock, arrhythmia, and death.Results: Patients of PMI and non PMI groups were similar in terms of age and sex. Smoking and dyslipidemia (p=0.05) were significantly higher in PMI group. Mean RBS and Troponin-I difference were significantly (p<0.05) higher in group I. Majority of patients had ejection fraction 45-55% in both groups. Patients in group I showed more normal LVEF, than group II, which was statistically significant. This study provided the evidence that the ST segment elevation in posterior leads associated with more left circumflex (LCX) and posterior left ventricular brass (PLVB) involvement. Majority of the patients had vessel score 2, Friesinger score 5-10 in group I and vessel score 1, Friesinger score 1-4 in group II.Conclusion: ST segment elevation in posterior chest leads (V7, V8, V9) were associated with more in-hospital adverse outcome than those who had inferior MI alone. This group of patients had more PLVB involvement. Recording of posterior precordial leads appear to be beneficial for risk stratification and to locate the site of lesion in patients admitted with acute inferior myocardial infarction. Since it is inexpensive method, it may be used in any hospital.Bangladesh Heart Journal 2016; 31(2) : 58-64

Angiographic profile of coronary arteries in Keralite population

Abstract Background and aims: The incidence of Coronary Artery Disease (CAD) has reached alanning proportions in India. The pathological hall mark of CAD is myocardial ischemia resulting from the atherosclerotic narrowing of coronary arteries. In this era of advanced interventions and cardiac surgery, a thorough knowledge of normal and variant anatomy of coronary arteries is of prime significance and of great use both to the clinicians and anatomists. Materials and methods: One hundred coronary angiograms of patients free of disease were studied in detail in different profiles. The data obtained was quantified according to their frequencies. The relation between the length of left main coronary artery and coronary artery dominance was statistically analyzed using the 'Chi Square test for Trend'. Results: This study highlighted some interesting findings such as the origin of Sino- atrial nodal artery from the second segment of right coronary artery in 3% of cases, double right marginal artery in 4% cases. Other variations such as Mouchet's posterior recurrent interventricular artery, origin of circumflex artery from the right coronary artery and abnormal communication between the terminal parts of right coronary artery and circumflex artery were each noticed in 1 % of cases. Conclusions: Coronary arteries and their branches are prone to variations in their course and morphology. Prior knowledge about this is important for the interpretation of coronary angiograms and surgical myocardial revascularization. The present work on normal and variant pattern of coronary arteries will help in gathering momentum to the already advancing research work in this field.

Prolonged QTc Dispersion Correlates with Coronary Artery Disease in Acute ST Elevated Myocardial Infarction (STEMI)

Background: It has been found that there is strong association of QT dispersion and QT dispersion ratio with extent and severity of coronary artery disease. Qualitative importance of QTc dispersion on the base line ECG in patients with MI is recognized clinically but quantification of this phenomenon is less commonly used in clinical practice, which might be a better independent risk predictor of this group of patients. Methods: A total of 100 patients were selected, Study populations sub-divided into two groups on the basis of QTc dispersion. In group I (comparison group): QTc dispersion is <60 milliseconds (msec) in group II (study group) : QTc dispersion e”60milliseconds(msec). 50 patients in each group. QT dispersion was calculated on standard resting 12 lead ECGs. QT interval was measured from the beginning of the inscription of the QRS complex to the point at which the T wave returned to the isoelectric line. Angiographic severity of coronary artery disease was assessed by- Vessel score, Friesinger score and Leaman score. Interpretation of coronary angiogram was reviewed by at least two cardiologists. . Results: The mean vessel score for group I patients was 1.16±0.68 and that of group II patients was 2.30±0.64 and the mean difference was statistically significant (p<0.05). Patients those had single vessel involvement had mean QTc dispersion 57.05, patients those had double vessel disease mean QTc dispersion was 102.00 and patients those had triple vessel involvement had mean QTc dispersion 177.60. There was a strong positive correlation with the QTc dispersion and increasing number of vessel involvement (Pearson’s correlation coefficient). The mean Friesinger score for group I patients was 4.84±2.56 and that of group II patients was 9.80±2.60. The mean difference was significantly (p<0.05) higher in group II patients. There was a strong positive correlation between the QTc dispersion and Leaman score (Pearson’s correlation coefficient). In group I patients 56% had insignificant coronary artery disease and 44% had significant coronary artery disease defined by Friesinger index (n=100). In group II patients 6% had Insignificant coronary artery disease & had 94% significant coronary artery disease. Conclusion: QTc dispersion>60 ms had independent predictive value for the severity of coronary artery disease. The greater the QTc dispersion the higher the number of coronary artery involvement. We observed that there is a positive correlation between prolonged QT dispersion and coronary artery disease severity in terms of Vessel score, Friesinger score, Leaman score. DOI: http://dx.doi.org/10.3329/cardio.v5i2.14322 Cardiovasc. j. 2013; 5(2): 173-181

American College of Cardiology/ European Society of Cardiology international study of angiographic data compression phase I. The effects of lossy data compression on recognition of diagnostic features in digital coronary angiography

This study intended to determine the effect of varying degrees of lossy Joint Photographic Experts Group (JPEG) compression on detection of coronary angiographic features. Background Compression of digital coronary angiograms facilitates playback of images and decreases cost. There are little data on the effect of compression on the accuracy of coronary angiography. At six centers, 71 angiographers each reviewed a set of 100 angiographic sequences. The 100 sequences were divided into four, 25-sequence subsets. Each subset of 25 was displayed either as original images or at one of three compression ratios (CRs) (6:1, 10:1 or 16:1). The effect of lossy compression on the sensitivity and specificity for detection of diagnostic features was determined. The effect of compression on subjective measures of image quality graded by the angiographers was also examined. Lossy compression at a ratio of 16:1 decreased the sensitivity for the detection of diagnostic features (76% vs. 80%P=0.004). The largest effect was in the detection of calcification (52% vs. 63% at 16:1 compression vs. original images, P<0.001). Subjective indicators of image quality indicated a reduction in confidence in interpretation at CRs of 10:1 and 16:1. With increased ratios of lossy compression, a degradation of digital coronary angiograms occurs that results in decreased diagnostic accuracy. The sensitivity for detection of common diagnostic features was decreased, and subjective assessment of image quality was impaired. Caution is warranted in the interpretation of coronary angiograms that have been subjected to lossy JPEG compression beyond a ratio of 6:1.

American College of Cardiology/ European Society of Cardiology international study of angiographic data compression phase I: The effects of lossy data compression on recognition of diagnostic features in digital coronary angiography

OBJECTIVESThis study intended to determine the effect of varying degrees of lossy Joint Photographic Experts Group (JPEG) compression on detection of coronary angiographic features.BACKGROUNDCompression of digital coronary angiograms facilitates playback of images and decreases cost. There are little data on the effect of compression on the accuracy of coronary angiography.METHODSAt six centers, 71 angiographers each reviewed a set of 100 angiographic sequences. The 100 sequences were divided into four, 25-sequence subsets. Each subset of 25 was displayed either as original images or at one of three compression ratios (CRs) (6:1, 10:1 or 16:1). The effect of lossy compression on the sensitivity and specificity for detection of diagnostic features was determined. The effect of compression on subjective measures of image quality graded by the angiographers was also examined.RESULTSLossy compression at a ratio of 16:1 decreased the sensitivity for the detection of diagnostic features (76% vs. 80% p = 0.004). The largest effect was in the detection of calcification (52% vs. 63% at 16:1 compression vs. original images, p < 0.001). Subjective indicators of image quality indicated a reduction in confidence in interpretation at CRs of 10:1 and 16:1.CONCLUSIONSWith increased ratios of lossy compression, a degradation of digital coronary angiograms occurs that results in decreased diagnostic accuracy. The sensitivity for detection of common diagnostic features was decreased, and subjective assessment of image quality was impaired. Caution is warranted in the interpretation of coronary angiograms that have been subjected to lossy JPEG compression beyond a ratio of 6:1.

Effect of variability in the interpretation of coronary angiograms on the appropriateness of use of coronary revascularization procedures

Effect of variability in the interpretation of coronary angiograms on the appropriateness of use of coronary revascularization procedures

Effect of variability in the interpretation of coronary angiograms on the appropriateness of use of coronary revascularization procedures

Background Evidence from numerous studies of coronary angiography show differences between observers’ assessments of 15% to 45%. The implication of this variation is serious: If readings are erroneous, some patients will undergo revascularization procedures unnecessarily and others will be denied an essential treatment. We evaluated the variation in interpretation of angiograms and its potential effect on appropriateness of use of revascularization procedures. Methods and Results Angiograms of 308 randomly selected patients previously studied for appropriateness of angiography, coronary artery bypass grafting (CABG), and percutaneous transluminal coronary angioplasty (PTCA) were interpreted by a blinded panel of 3 experienced angiographers and compared with the original interpretations. The potential effect on differences on the appropriateness of revascularization was assessed by use of the RAND criteria. Technical deficiencies were found in 52% of cases. Panel readings tended to show less significant disease (none in 16% of vessels previously read as showing significant disease), less severity of stenosis (43% lower, 6% higher), and lower extent of disease (23% less, 6% more). The classification of CABG changed from necessary/appropriate to uncertain/inappropriate for 17% to 33% of cases when individual ratings were replaced by panel readings. Conclusions The general level of technical quality of coronary angiography is unsatisfactory. Variation in the interpretation of angiograms was substantial in all measures and tended to be higher in individual than in panel readings. The effect was to lead to a potential overestimation of appropriateness of use of CABG by 17% and of PTCA by 10%. These findings indicate the need for increased attention to the technical quality of studies and an independent second reading for angiograms before recommending revascularization. (Am Heart J 2000;139:106-13.)

Inter-observer reliability in the interpretation of coronary angiograms.

The interpretation of coronary angiograms is indispensable in determining procedure in coronary surgery. The aim of this study was to measure the overall reliability of a group of surgeons in the interpretation of coronary angiograms, surgical procedure and the evaluation of operative risk. Ten coronary angiograms were interpreted by eight cardiac surgeons at four different medical centers. Evaluation of coding discrepancies, in this case of multiple raters applying an ordinal-scale classification scheme (0, 1, 2) with no expert yardstick available for coding, was explored by a two-way random factor analysis of variance. Reliability was substantial for the assessment of stenosis irrespective of the artery (intraclass correlation coefficient (ICC) ranging from 0.92 to 1), and good for the distal part of the artery (ICC ranging from 0.83 to 0.86) as well as for the collateral provision (ICC ranging from 0.75 to 0.94). Agreement between surgeons was good with respect to the number of bypasses to be performed (ICC = 0.88). The number of bypass per patient varied from 2.6 to 3.2 depending on the surgeon. Agreement as to whether or not to bypass was substantial for the right coronary artery (ICC = 0.92), good for the marginal artery (ICC = 0.87) and fair for the left anterior descending artery (ICC = 0.60) and the circumflex artery (ICC = 0.60). There was a higher rate of agreement concerning inferior wall motion (ICC = 0.98) than of the anterior wall motion (ICC = 0.78). Agreement was substantial for ejection fraction (ICC = 0.93), operative risk (ICC = 0.93) and the type of coronary tree (ICC = 0.85). With respect to the overall set of items, no one surgeon disagreed significantly with the rest of the group. Some disagreement regarding anatomy suitable for revascularization exists between surgeons. Surgical assessment of risk is similar. Cardiac surgeons quickly learn to assess risk in a similar manner, even though they might not always graft the same anatomic vessels or assess regional wall motion similarly.

A new look at coronary angiograms: plaque morphology as a help to diagnosis and to evaluate outcome.

Characterization of plaque morphology can provide useful information beyond those generally yielded by the more traditional methods of interpretation of coronary angiograms based on assessment of severity of stenoses and number of diseased vessels. Focus on the culprit coronary lesion in acute myocardial infarction and in unstable angina allows recognition of the complex plaque and of presence of endoluminal thrombi that are closely associated to the mechanisms of the disease. Response to treatment in these clinical situations, and the healing process can be assessed by repeated opacifications of the lesion. The presence of a residual thrombus is associated with a worse clinical outcome and also a higher risk of complication if coronary angioplasty is performed. The prognostic information derived from the morphologic analysis extends to the chronic phase of the disease. The extent score of disease, defined as the sum of coronary artery segments showing a narrowing of any severity marks more severe disease and predicts future progression. Severity of stenosis is also a predictor. More severe lesions will occlude more frequently but most often without clinical consequences. Occlusion of less severe stenosis, on the other hand, leads to acute myocardial infarction or to the other manifestations of acute coronary syndromes. Other morphologic features are also associated with a higher risk of myocardial infarction. These include a geometry favoring blood flow separation and turbulence such as acute inflow and outflow angles of the stenosis and presence of a division within its vicinity. This new look at coronary angiograms may help orient therapy. Patients with angina and a significant stenosis will profit from a corrective intervention. Others with a high extent score should receive a comprehensive program for control of risk factors. Patients with a lesion of borderline significance at risk of activation should be closely monitored, and when clinical symptoms evolve, receive more intensive antithrombotic therapy. Quantification of the morphologic characteristics of the plaque, coupled to new techniques for endovascular imaging should lead in the future to better diagnostic and better risk stratification.

Variability of quantitative digital subtraction coronary angiography before and after percutaneous transluminal coronary angioplasty

Quantitative coronary angiography has been proposed as a means of reducing observer variability in the interpretation of coronary angiograms, especially before and after percutaneous transluminal coronary angioplasty (PTCA). Analysis of 13 consecutively acquired biplane digital subtraction angiograms before and after PTCA was undertaken to determine intra- and interobserver variability of absolute lesion diameter, relative videodensitometric cross-sectional area, automated percent diameter stenosis and visual percent diameter stenosis using a new fully automated quantitative computer program. The reliability of single-view measurements was also assessed. Both before and after PTCA, measures of absolute diameter showed less interobserver variability than densitometry, percent automated diameter stenosis stenosis and percent visual diameter stenosis measurements (before, r = 0.95, 0.83, 0.86, 0.70; after, 0.95, 0.88, 0.81, 0.62, respectively). Relative videodensitometric cross-sectional area correlated poorly with images from the orthogonal view (r = 0.46). These data suggest that quantitative angiography reduces variability from visual estimates; of all quantitative angiographic measurements, the highest interobserver reproducibility is achieved using absolute lesion diameter both before and after PTCA, probably because no operator interaction is needed to identify a “normal” segment. Unselected, single-view quantitative arteriography is poorly reproducible using videodensitometry. Therefore, automated determination of absolute lesion diameter in at least 2 projections provides the most reproducible evaluation of coronary lesions both before and after PTCA.

Coronary angiograms and myocardial scintigraphy

To the Editor.— We read the work by Galbraith et al (240:2053, 1978) concerning interobserver variability in the interpretation of coronary angiograms. These authors correlated the findings on premortem coronary angiograms of 20 patients with the postmortem pathological findings in fresh, unfixed heart specimens from the same patients. The authors used as a criterion for "substantial" lesions a reduction in lumen diameter of a given vessel of 50% or greater angiographically, or 75% reduction in cross-sectional area pathologically. Their basic results indicate that while minimal interobserver variability was present, there was considerable overall inaccuracy in the interpretation of coronary angiograms, with false-positive misinterpretations being the most common (about twice the false-negative rate). Within the context of their study, in which they set forth specific criteria for correlation of angiographic and pathological findings, the results are straightforward and of utmost validity. However, we wish to point out that in the clinical

Coronary Angiograms and Myocardial Scintigraphy

To the Editor.— We read the work by Galbraith et al (240:2053, 1978) concerning interobserver variability in the interpretation of coronary angiograms. These authors correlated the findings on premortem coronary angiograms of 20 patients with the postmortem pathological findings in fresh, unfixed heart specimens from the same patients. The authors used as a criterion for substantial lesions a reduction in lumen diameter of a given vessel of 50% or greater angiographically, or 75% reduction in cross-sectional area pathologically. Their basic results indicate that while minimal interobserver variability was present, there was considerable overall inaccuracy in the interpretation of coronary angiograms, with false-positive misinterpretations being the most common (about twice the false-negative rate). Within the context of their study, in which they set forth specific criteria for correlation of angiographic and pathological findings, the results are straightforward and of utmost validity. However, we wish to point out that in the clinical

Reproducibility of a consensus panel in the interpretation of coronary angiograms

This report describes the consistency of coronary angiogram evaluation by a four man panel of experts rendering “consensus opinion.” The panel evaluated films from 38 patients at two grading sessions separated by an interval of seven months. Fourteen patients' films were selected at random for duplicate evaluation. These contained 186 lesion sites. The panel was 95 per cent consistent in designating significant stenosis (≥ 70 per cent). “Consensus” panel reading appears more consistent than “group opinion” panel reading. The over-all standard deviation of the difference in panel reading was 14 per cent. The panel was most consistent in evaluating the right coronary artery, proximal LAD, and proximal circumflex. In the left main segment two of fourteen duplicate evaluations showed major discrepancy.