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Tsugu T, Tanaka K, Nagatomo Y, Belsack D, Devos H, Buls N, Cosyns B, Argacha JF, De Maeseneer M, De Mey J. Impact of coronary bifurcation angle on computed tomography derived fractional flow reserve in coronary vessels with no apparent coronary artery disease. Eur Radiol 2023; 33:1277-1285. [PMID: 36114847 PMCID: PMC9889442 DOI: 10.1007/s00330-022-09125-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 07/04/2022] [Accepted: 08/19/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Computed tomography (CT) derived fractional flow reserve (FFRCT) decreases from the proximal to the distal part due to a variety of factors. The energy loss due to the bifurcation angle may potentially contribute to a progressive decline in FFRCT. However, the association of the bifurcation angle with FFRCT is still not entirely understood. This study aimed to investigate the impact of various bifurcation angles on FFRCT decline below the clinically crucial relevance of 0.80 in vessels with no apparent coronary artery disease (CAD). METHODS A total of 83 patients who underwent both CT angiography including FFRCT and invasive coronary angiography, exhibiting no apparent CAD were evaluated. ΔFFRCT was defined as the change in FFRCT from the proximal to the distal in the left anterior descending artery (LAD) and left circumflex artery (LCX). The bifurcation angle was calculated from three-dimensional volume rendered images. Vessel morphology and plaque characteristics were also assessed. RESULTS ΔFFRCT significantly correlated with the bifurcation angle (LAD angle, r = 0.35, p = 0.001; LCX angle, r = 0.26, p = 0.02) and vessel length (LAD angle, r = 0.30, p = 0.005; LCX angle, r = 0.49, p < 0.0001). In LAD, vessel length was the strongest predictor for distal FFRCT of ≤ 0.80 (β-coefficient = 0.55, p = 0.0003), immediately followed by the bifurcation angle (β-coefficient = 0.24, p = 0.02). The bifurcation angle was a good predictor for a distal FFRCT ≤ 0.80 (LAD angle, cut-off 31.0°, AUC 0.70, sensitivity 74%, specificity 68%; LCX angle, cut-off 52.6°, AUC 0.86, sensitivity 88%, specificity 85%). CONCLUSIONS In vessels with no apparent CAD, vessel length was the most influential factor on FFRCT, directly followed by the bifurcation angle. KEY POINTS • Both LAD and LCX bifurcation angles are factors influencing FFR CT. • Bifurcation angle is one of the predictors of a distal FFRCT of ≤ 0.80 and an optimal cut-off value of 31.0° for the LAD and 52.6° for the LCX. • Bifurcation angle should be taken into consideration when interpreting numerical values of FFRCT.
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Affiliation(s)
- Toshimitsu Tsugu
- Department of Radiology, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Jette, Brussels, Belgium
| | - Kaoru Tanaka
- Department of Radiology, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Jette, Brussels, Belgium
| | - Yuji Nagatomo
- Department of Cardiology, National Defense Medical College Hospital, Tokorozawa, Japan
| | - Dries Belsack
- Department of Radiology, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Jette, Brussels, Belgium
| | - Hannes Devos
- Department of Radiology, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Jette, Brussels, Belgium
| | - Nico Buls
- Department of Radiology, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Jette, Brussels, Belgium
| | - Bernard Cosyns
- Cardiology, Centrum voor Hart-en Vaatziekten, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Jean-François Argacha
- Cardiology, Centrum voor Hart-en Vaatziekten, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Michel De Maeseneer
- Department of Radiology, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Jette, Brussels, Belgium
| | - Johan De Mey
- Department of Radiology, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Jette, Brussels, Belgium
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Murasato Y, Meno K, Mori T, Tanenaka K. Impact of coronary bifurcation angle on the pathogenesis of atherosclerosis and clinical outcome of coronary bifurcation intervention–A scoping review. PLoS One 2022; 17:e0273157. [PMID: 35976920 PMCID: PMC9385039 DOI: 10.1371/journal.pone.0273157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 08/03/2022] [Indexed: 12/03/2022] Open
Abstract
Background A coronary bifurcation stenting is still a challenging issue due to frequent restenosis and stent thrombosis even with drug-eluting stents. The bifurcation angle (BA) between a main vessel and a side branch is one of the crucial determinants of coronary flow and shear stress that affect the plaque distribution. Previous bench and clinical studies have evaluated the impact of the BA between the proximal main vessel and the side branch (Angle A) and the BA between the distal main vessel and the side branch (Angle B) on the clinical outcomes of bifurcation stenting. However, the impact has not yet been fully elucidated due to a lack of statistical power or different manner of the assessment of BA. Objectives To analyze the published studies on coronary artery BA, the modalities used for assessment, and the impact of BA on interventions and attempt to define the pre-procedural protocols. Data sources A scoping review was performed using the Joanna Briggs Institute Methodology. A total of 52 relevant references were selected from PubMed, Cochrane Library, and CINAHL databases and categorized into three topic areas. Results and conclusions A wider Angle A is associated with the increased likelihood of carina shift and a wider Angle B, with that of side branch occlusion. A wider Angle B promotes stent malapposition and deformation in the side branch ostium and has been reported as an independent predictor of major adverse cardiac events after bifurcation stenting; however, improvement of the drug-eluting stent, refinement of the stenting technique, and accurate 3-dimensional assessment may attenuate the adverse clinical impact of a wider BA. Implications of key findings Assessment of the BA is necessary to predict the effect of bifurcation intervention procedure on the stent configuration and coronary flow at the bifurcated vessels. This will help to optimize stent selection and the stenting technique.
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Affiliation(s)
- Yoshinobu Murasato
- Department of Cardiology, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
- * E-mail:
| | - Kyohei Meno
- Department of Cardiology, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Takahiro Mori
- Department of Cardiology, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Katsuhiko Tanenaka
- Department of Cardiology, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
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Cao Y, Mintz GS, Matsumura M, Zhang W, Lin Y, Wang X, Fujino A, Lee T, Murai T, Hoshino M, Usui E, Kanaji Y, Yonetsu T, Kakuta T, Maehara A. The Relation Between Optical Coherence Tomography-Detected Layered Pattern and Acute Side Branch Occlusion after Provisional Stenting of Coronary Bifurcation Lesions. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2019; 20:1007-1013. [PMID: 30683562 DOI: 10.1016/j.carrev.2018.12.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 12/12/2018] [Accepted: 12/21/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND/PURPOSE Layered pattern (presumed to be healed plaque after a thrombotic event) can be observed by optical coherence tomography (OCT). We sought to assess the ability of OCT-detected plaque composition to predict acute side branch (SB) occlusion after provisional bifurcation stenting. METHODS This is a retrospective observational study using pre-intervention OCT in the main vessel to predict Thrombolysis in Myocardial Infarction (TIMI) flow grade ≤1 in a SB (diameter ≥ 1.5 mm) after provisional bifurcation stenting. OCT-detected layered pattern was defined as plaque with a superficial layer that had a different optical intensity and a clear demarcation from underlying tissue. RESULTS Overall, 207 patients with stable coronary disease were included. SB occlusion occurred in 26/207 (12.6%) bifurcation lesions. Operators decided not to perform additional treatment, and TIMI flow did not improve to ≥2 in cases with SB occlusion. The prevalence of OCT-detected layered pattern was more common in lesions with versus without SB occlusion (88.5% versus 33.7%, p < 0.0001); OCT-detected layered pattern was more often located on the same side of the SB (73.9% versus 21.3%, p < 0.0001) circumferentially compared to lesions without SB occlusion. Multivariable analysis showed that OCT-detected layered pattern was an independent predictor of SB occlusion (odds ratio 18.8, 95% confidence interval 5.1-68.8, p < 0.0001) along with true bifurcation lesion and wider angiographic bifurcation angle. CONCLUSIONS The presence of an OCT-detected layered pattern near its ostium was a strong predictor of SB occlusion after provisional bifurcation stenting.
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Affiliation(s)
- Yang Cao
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA; NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY, USA; Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Gary S Mintz
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA
| | - Mitsuaki Matsumura
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA
| | - Wenbin Zhang
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA; NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY, USA; Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Yongqing Lin
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA; NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY, USA
| | - Xiao Wang
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA; NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY, USA
| | - Akiko Fujino
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA; NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY, USA
| | - Tetsumin Lee
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA; NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY, USA
| | | | | | | | | | | | | | - Akiko Maehara
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA; NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY, USA.
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Intravascular ultrasound-guided drug-eluting stent implantation is associated with improved clinical outcomes in patients with unstable angina and complex coronary artery true bifurcation lesions. Int J Cardiovasc Imaging 2018; 34:1685-1696. [PMID: 29981016 DOI: 10.1007/s10554-018-1393-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 06/04/2018] [Indexed: 12/11/2022]
Abstract
Stenting coronary artery bifurcation lesion is associated with suboptimal clinical results. Clinical improvement by intravascular ultrasound (IVUS) guided bifurcation stenting is controversial because small-side-branch (SB), low-risk patients and false bifurcations were included in previous studies that had no exact IVUS criteria for optimal stent expansion. We sought determine whether IVUS guidance is superior to angiography guidance for patients with true and complex bifurcation lesions. Between July 2006 and July 2012, 1465 patients with unstable angina and Medina 1,1,1 or 0,1,1 coronary bifurcation lesions were prospectively studied. 310 patients in the IVUS guidance (defined as stent symmetry index > 0.7, stent expansion index > 0.9, well apposition, and no Type B/C dissection) group were paired with 620 patients in the angiography group by propensity score-matching. The primary endpoint was the rate of composite major adverse cardiac events (MACE) (cardiac death, myocardial infarction (MI), or clinically-driven target vessel revascularization) at 1-year and at the end of study after indexed procedure. Use of IVUS guidance was mainly driven by stenting technique selection and identification of lesions' specificities. IVUS criteria for optimal stent expansion were achieved in 82.9% of patients which contribute to IVUS group data assessment and the rest did not meet optimal criteria. MACE occurred in 10.0% of patients at 1-year follow-up and 15.2% at the 7-year follow-up in the IVUS group, significantly different from 15.0% (p = 0.036) and 22.4% (p = 0.01) in the angiography group, respectively. Compared to angiography guidance, IVUS guidance also resulted in a lower 7-year cardiac death rate (6.5 versus 1.3%, p = 0.002) and MI (8.4 versus 2.3%, P < 0.001). Any revascularization was also statistically lower in the IVUS group through whole study period, compared to the angiography group. Lower MACE rates were observed in IVUS guidance group in a 7-year follow-up compared with angiography guidance alone.
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Morbiducci U, Kok AM, Kwak BR, Stone PH, Steinman DA, Wentzel JJ. Atherosclerosis at arterial bifurcations: evidence for the role of haemodynamics and geometry. Thromb Haemost 2018; 115:484-92. [DOI: 10.1160/th15-07-0597] [Citation(s) in RCA: 131] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 11/13/2015] [Indexed: 11/05/2022]
Abstract
SummaryAtherosclerotic plaques are found at distinct locations in the arterial system, despite the exposure to systemic risk factors of the entire vascular tree. From the study of arterial bifurcation regions, emerges ample evidence that haemodynamics are involved in the local onset and progression of the atherosclerotic disease. This observed co-localisation of disturbed flow regions and lesion prevalence at geometrically predisposed districts such as arterial bifurcations has led to the formulation of a ‘haemodynamic hypothesis’, that in this review is grounded to the most current research concerning localising factors of vascular disease. In particular, this review focuses on carotid and coronary bifurcations because of their primary relevance to stroke and heart attack. We highlight reported relationships between atherosclerotic plaque location, progression and composition, and fluid forces at vessel’s wall, in particular shear stress and its ‘easier-tomeasure’ surrogates, i.e. vascular geometric attributes (because geometry shapes the flow) and intravascular flow features (because they mediate disturbed shear stress), in order to give more insight in plaque initiation and destabilisation. Analogous to Virchow’s triad for thrombosis, atherosclerosis must be thought of as subject to a triad of, and especially interactions among, haemodynamic forces, systemic risk factors, and the biological response of the wall.
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Cui Y, Zeng W, Yu J, Lu J, Hu Y, Diao N, Liang B, Han P, Shi H. Quantification of left coronary bifurcation angles and plaques by coronary computed tomography angiography for prediction of significant coronary stenosis: A preliminary study with dual-source CT. PLoS One 2017; 12:e0174352. [PMID: 28346530 PMCID: PMC5367806 DOI: 10.1371/journal.pone.0174352] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 03/07/2017] [Indexed: 11/26/2022] Open
Abstract
Purpose To evaluate the diagnostic performance of left coronary bifurcation angles and plaque characteristics for prediction of coronary stenosis by dual-source CT. Methods 106 patients suspected of coronary artery disease undergoing both coronary computed tomography angiography (CCTA) and invasive coronary angiography (CAG) within three months were included. Left coronary bifurcation angles including the angles between the left anterior descending artery and left circumflex artery (LAD-LCx), left main coronary artery and left anterior descending artery (LM-LAD), left main coronary artery and left circumflex artery (LM-LCx) were measured on CT images. CCTA plaque parameters were calculated by plaque analysis software. Coronary stenosis ≥ 50% by CAG was defined as significant. Results 106 patients with 318 left coronary bifurcation angles and 126 vessels were analyzed. The bifurcation angle of LAD-LCx was significantly larger in left coronary stenosis ≥ 50% than stenosis < 50%, and significantly wider in the non-calcified plaque group than calcified. Multivariable analyses showed the bifurcation angle of LAD-LCx was an independent predictor for significant left coronary stenosis (OR = 1.423, P = 0.002). In ROC curve analysis, LAD-LCx predicted significant left coronary stenosis with a sensitivity of 66.7%, specificity of 78.4%, positive predictive value of 85.2% and negative predictive value of 55.8%. The lipid plaque volume improved the diagnostic performance of CCTA diameter stenosis (AUC: 0.854 vs. 0.900, P = 0.045) in significant coronary stenosis. Conclusions The bifurcation angle of LAD-LCx could predict significant left coronary stenosis. Wider LAD-LCx is related to non-calcified lesions. Lipid plaque volume could improve the diagnostic performance of CCTA for coronary stenosis prediction.
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Affiliation(s)
- Yue Cui
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wenjuan Zeng
- Department of Clinical Laboratory, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jie Yu
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jing Lu
- Department of Nuclear Medicine, Zhongshan Hospital, Xiamen University, Xiamen, Fujian, China
| | - Yuannan Hu
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Nan Diao
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Bo Liang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ping Han
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Heshui Shi
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- * E-mail:
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Mohammadi H, Cartier R, Mongrain R. The impact of the aortic valve impairment on the distant coronary arteries hemodynamics: a fluid-structure interaction study. Med Biol Eng Comput 2017; 55:1859-1872. [PMID: 28316038 DOI: 10.1007/s11517-017-1636-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 03/13/2017] [Indexed: 12/30/2022]
Abstract
Atherosclerosis is still the leading cause of death in the developed world. Although its initiation and progression is a complex multifactorial process, it is well known that blood flow-induced wall shear stress (WSS) is an important factor involved in early atherosclerotic plaque initiation. In recent clinical studies, it was established that the regional pathologies of the aortic valve can be involved in the formation of atherosclerotic plaques. However, the impact of hemodynamic effects is not yet fully elucidated for disease initiation and progression. In this study, our developed 3D global fluid-structure interaction model of the aortic root incorporating coronary arteries is used to investigate the possible interaction between coronary arteries and aortic valve pathologies. The coronary hemodynamics was examined and quantified for different degrees of aortic stenosis varying from nonexistent to severe. For the simulated healthy model, the calculated WSS varied between 0.41 and 1.34 Pa which is in the atheroprotective range. However, for moderate and severe aortic stenoses, wide regions of the coronary structures, especially the proximal sections around the first bifurcation, were exposed to lower values of WSS and therefore they were prone to atherosclerosis even in the case of healthy coronary arteries.
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Affiliation(s)
- Hossein Mohammadi
- Mechanical Engineering Department, McGill University, Montreal, QC, H3A 0C3, Canada
| | - Raymond Cartier
- Department of Cardiovascular Surgery, Montreal Heart Institute, Montreal, QC, H1T 1C8, Canada
| | - Rosaire Mongrain
- Mechanical Engineering Department, McGill University, Montreal, QC, H3A 0C3, Canada.
- Department of Cardiovascular Surgery, Montreal Heart Institute, Montreal, QC, H1T 1C8, Canada.
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Dugas CM, Schussler JM. Advanced technology in interventional cardiology: A roadmap for the future of precision coronary interventions. Trends Cardiovasc Med 2016; 26:466-73. [DOI: 10.1016/j.tcm.2016.02.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Revised: 02/14/2016] [Accepted: 02/17/2016] [Indexed: 01/17/2023]
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Coronary computed tomography angiography investigation of the association between left main coronary artery bifurcation angle and risk factors of coronary artery disease. Int J Cardiovasc Imaging 2016; 32 Suppl 1:129-37. [DOI: 10.1007/s10554-016-0884-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 03/24/2016] [Indexed: 10/22/2022]
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10
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Coronary CT angiography in calcified coronary plaques: Comparison of diagnostic accuracy between bifurcation angle measurement and coronary lumen assessment for diagnosing significant coronary stenosis. Int J Cardiol 2015; 203:78-86. [PMID: 26495804 DOI: 10.1016/j.ijcard.2015.10.079] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 09/21/2015] [Accepted: 10/12/2015] [Indexed: 11/20/2022]
Abstract
BACKGROUND To investigate the diagnostic value of coronary CT angiography (CCTA) by bifurcation angle measurement in the assessment of calcified plaques compared to conventional coronary lumen analysis. METHODS Fifty-three patients with calcified plaques identified on CCTA in the left coronary artery were included in the study. Minimal lumen diameter (MLD) and bifurcation angle between the left anterior descending (LAD) and left circumflex (LCx) arteries were measured and compared between CCTA and invasive coronary angiography (ICA), while the areas under the curves (AUCs) by receiver-operating characteristic curve analysis (ROC) were compared between CCTA and ICA with regard to the diagnostic value of using bifurcation angle as a criterion. RESULTS On a per-vessel assessment, the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) and 95% confidence interval (CI) with the use of bifurcation angle for determining coronary stenosis were 100% (86%, 100%), 79% (59%, 92%), 81% (62%, 92%), and 100% (85%, 100%) for CCTA, and 100% (86%, 100%), 82% (63%, 94%), 83% (65%, 94%), and 100% (85%, 100%) for ICA, respectively. While the sensitivity and NPV remained unchanged, the specificity and PPV of CCTA by MLD were 33% (21%, 47%) and 43% (31%, 56%). The AUCs by ROC curve analysis for CCTA and ICA bifurcation angle measurements demonstrated no significant difference (p>0.05, 0.79 vs 0.86, and 0.70 vs 0.68 at the LAD and LCx assessment, respectively). CONCLUSION Coronary CT angiography by bifurcation angle measurement shows significant improvement in the diagnosis of calcified plaques with diagnostic value comparable to invasive coronary angiography.
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ZHANG DONG, DOU KEFEI. Coronary Bifurcation Intervention: What Role Do Bifurcation Angles Play? J Interv Cardiol 2015; 28:236-48. [DOI: 10.1111/joic.12203] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Affiliation(s)
- DONG ZHANG
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Cardiovascular Institute; Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College; Beijing 100037 China
| | - KEFEI DOU
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Cardiovascular Institute; Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College; Beijing 100037 China
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12
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Insights into the spatial distribution of lipid-rich plaques in relation to coronary artery bifurcations. Coron Artery Dis 2015; 26:133-41. [DOI: 10.1097/mca.0000000000000188] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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13
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Zhang D, Xu B, Yin D, Li Y, He Y, You S, Qiao S, Wu Y, Yan H, Yang Y, Gao R, Dou K. How bifurcation angle impacts the fate of side branch after main vessel stenting: a retrospective analysis of 1,200 consecutive bifurcation lesions in a single center. Catheter Cardiovasc Interv 2015; 85 Suppl 1:706-15. [PMID: 25631776 DOI: 10.1002/ccd.25858] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 01/07/2015] [Indexed: 11/07/2022]
Abstract
OBJECTIVES We aimed to investigate the effect of bifurcation angle (BA) on side branch (SB) occlusion after main vessel (MV) stenting. BACKGROUND BA is thought to impact the risk of SB occlusion in coronary bifurcation patients undergoing percutaneous coronary intervention (PCI). METHODS A total of 1,171 consecutive patients with 1,200 bifurcation lesions undergoing one stent or provisional two stent techniques were studied. The lesions were divided into low angle and high angle groups using the median BA (52°). Multivariate logistic regression analysis was performed to identify independent predictors of SB occlusion. RESULTS SB occlusion occurred in 88 (7.33%) of 1,200 bifurcation lesions treated with the one stent technique or MV stenting first strategy. The rate of SB occlusion was significantly higher in the high angle group (63/600, 10.5%) than the low angle group (25/600, 4.2%) (P < 0.001). The rate of SB occlusion increased significantly across quartiles of BA as follows: from 3.63% in the first quartile of BA, to 4.71% in quartile II, to 8.14% in quartile III to 12.97% in quartile IV (P < 0.001). Multivariable analysis showed that high angle was an independent predictor of SB occlusion (odds ratio: 1.026, 95% confidence intervals: 1.014-1.037, P < 0.001). Plaque distribution at the same side of SB, MV Thrombolysis in Myocardial Infarction flow grade before stenting, pre-procedural diameter stenosis of bifurcation core, diameter ratio between MV/SB and diameter stenosis of SB before MV stenting were also independent predictors of SB occlusion. CONCLUSIONS High BA was an independent predictor of SB occlusion after MV stenting. The occlusion risk of SB with a high BA should not be ignored.
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Affiliation(s)
- Dong Zhang
- State Key Laboratory of Cardiovascular Disease, Department of Cardiology, Cardiovascular Institute, Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100037, China
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Park JJ, Chun EJ, Cho YS, Oh IY, Yoon CH, Suh JW, Choi SI, Youn TJ, Koo BK, Chae IH, Choi DJ. Potential Predictors of Side-Branch Occlusion in Bifurcation Lesions after Percutaneous Coronary Intervention: A Coronary CT Angiography Study. Radiology 2014; 271:711-20. [DOI: 10.1148/radiol.14131959] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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15
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Papadopoulou SL, Girasis C, Gijsen FJ, Rossi A, Ottema J, van der Giessen AG, Schuurbiers JC, Garcia-Garcia HM, de Feyter PJ, Wentzel JJ. A CT-based medina classification in coronary bifurcations: Does the lumen assessment provide sufficient information? Catheter Cardiovasc Interv 2014; 84:445-52. [DOI: 10.1002/ccd.25496] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Revised: 01/16/2014] [Accepted: 03/12/2014] [Indexed: 11/11/2022]
Affiliation(s)
- Stella-Lida Papadopoulou
- Department of Cardiology; Thoraxcenter, Erasmus MC; 3000 CA Rotterdam The Netherlands
- Department of Radiology; Erasmus MC; 3000 CA Rotterdam The Netherlands
| | - Chrysafios Girasis
- Department of Cardiology; Thoraxcenter, Erasmus MC; 3000 CA Rotterdam The Netherlands
| | - Frank J. Gijsen
- Department of Biomedical Engineering; Thoraxcenter, Erasmus MC; 3000 CA Rotterdam The Netherlands
| | - Alexia Rossi
- Department of Cardiology; Thoraxcenter, Erasmus MC; 3000 CA Rotterdam The Netherlands
- Department of Radiology; Erasmus MC; 3000 CA Rotterdam The Netherlands
| | - Jade Ottema
- Department of Biomedical Engineering; Thoraxcenter, Erasmus MC; 3000 CA Rotterdam The Netherlands
| | - Alina G. van der Giessen
- Department of Biomedical Engineering; Thoraxcenter, Erasmus MC; 3000 CA Rotterdam The Netherlands
| | - Johan C. Schuurbiers
- Department of Biomedical Engineering; Thoraxcenter, Erasmus MC; 3000 CA Rotterdam The Netherlands
| | | | - Pim J. de Feyter
- Department of Cardiology; Thoraxcenter, Erasmus MC; 3000 CA Rotterdam The Netherlands
- Department of Radiology; Erasmus MC; 3000 CA Rotterdam The Netherlands
| | - Jolanda J. Wentzel
- Department of Biomedical Engineering; Thoraxcenter, Erasmus MC; 3000 CA Rotterdam The Netherlands
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de Araujo Goncalves P, Campos CAM, Serruys PW, Garcia-Garcia HM. Computed tomography angiography for the interventional cardiologist. Eur Heart J Cardiovasc Imaging 2014; 15:842-54. [DOI: 10.1093/ehjci/jeu053] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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Coronary CT angiography in coronary artery disease: correlation between virtual intravascular endoscopic appearances and left bifurcation angulation and coronary plaques. BIOMED RESEARCH INTERNATIONAL 2013; 2013:732059. [PMID: 24455719 PMCID: PMC3888717 DOI: 10.1155/2013/732059] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Revised: 09/19/2013] [Accepted: 10/04/2013] [Indexed: 11/17/2022]
Abstract
The aim of this study is to investigate the relationship between intraluminal appearances of coronary plaques and left coronary bifurcation angle and plaque components using coronary CT virtual intravascular endoscopy (VIE). Fifty patients suspected of coronary artery disease undergoing coronary CT angiography were included in the study. The left bifurcation angle in patients with diseased left coronary artery which was measured as 94.3° ± 16.5 is significantly larger than that in patients with normal left coronary artery, which was measured as 76.5° ± 15.9 (P < 0.001). Irregular VIE appearances were found in 10 out of 11 patients with mixed plaques in the left anterior descending (LAD) and left circumflex (LCx), while, in 29 patients with calcified plaques in the LAD and LCx, irregular VIE appearances were only noticed in 5 patients. Using 80° as a cut-off value to determine coronary artery disease, smooth VIE appearances were found in 95% of patients (18/19) with left bifurcation angle of less than 80°, while irregular VIE appearances were observed in nearly 50% of patients (15/31) with left bifurcation angle of more than 80°. This preliminary study shows that VIE appearances of the coronary lumen are directly related to the types of plaques.
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Edvardsen T, Plein S, Saraste A, Knuuti J, Maurer G, Lancellotti P. The year 2012 in the European Heart Journal-Cardiovascular Imaging: Part I. Eur Heart J Cardiovasc Imaging 2013; 14:509-14. [PMID: 23671232 DOI: 10.1093/ehjci/jet069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
The new multi-modality cardiovascular imaging journal, European Heart Journal - Cardiovascular Imaging, was started in 2012. During its first year, the new Journal has published an impressive collection of cardiovascular studies utilizing all cardiovascular imaging modalities. We will summarize the most important studies from its first year in two articles. The present 'Part I' of the review will focus on studies in myocardial function, myocardial ischaemia, and emerging techniques in cardiovascular imaging.
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Affiliation(s)
- Thor Edvardsen
- Department of Cardiology, Oslo University Hospital, Rikshospitalet and University of Oslo, Oslo, Norway
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