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Cusma, Jack; Fortin, Donald; Spero, Laurence; Groshong, Bennett; Bashore, Thomas
doi: 10.1007/BF01137898pmid: 7876656
The clinical application of quantitative methods for coronary arteriography remains limited, due in large part to the absence of a suitable replacement for cinefilm as the procedure record. The extension to the clinical environment of the validated objective methods which have found such widespread acceptance in clinical research studies is difficult to implement if the time-consuming and variable process for digitization of selected cinefilm frames is required. In addition, the complete integration of the angiographic procedure record with other patient records and procedures stored in a digital data format requires that the angiographic data eventually be converted to a digital format as well. Replacement of cinefilm requires that the media chosen for the task provide at least the same capabilities and preferably improved functions as those provided by cinefilm as a display, transport, and archival media. The demanding set of requirements imposed on the replacement options include high capacity, high acquisition rate, high transfer rate, application in a distributed environment, portability between institutions, and low expense. A true digital solution should also provide immediate access to the results of the angiographic procedure, transfer of image data over digital networks, multiple-user viewing capability, and quantitative analysis on a routine basis for all patients. In fact, a single media may not provide all the capabilities listed above but, rather, different media may need to be used for specialized tasks, i.e. the solution for archival may not be the same that will be employed as the portable patient record. Separation of the archival function from the acquisition/display and portable transfer functions increases the likelihood that cinefilm can be replaced in the imminent future by reducing the demands on a single media. Among the archival options available today are: (1) magnetic disks; (2) analog laser optical disks; (3) digital laser optical disks; (4) digital file-based magnetic tape; (5) digital video magnetic tape. In evaluating each of these alternatives, an accounting is required of how each meets the archival requirements along with an approximate breakdown of cost and readiness for implementation as a clinical solution today.
Brand, Marcel; Miltenburg, Addy; Boer, Menko; Wieken, L.; Feyter, Pim; Simoons, Maarten
doi: 10.1007/BF01137899pmid: 7876657
Patients with unstable angina, refractory to intensive medical therapy, are at high risk for developing thrombotic complications, such as recurrent ischemia, myocardial infarction and coronary occlusion during coronary angioplasty. As both platelet aggregation and/or thrombus formation play an important role in this ongoing ischemic process, a monoclonal platelet GPIIb/IIIa receptor antibody (c7E3) or thrombolytic therapy (alteplase) might be able to modify the clinical course and underlying coronary lesion morphology. To evaluate whether alteplase or c7E3 could influence the incidence of complications, we randomized 36 and 60 patients, respectively to alteplase or placebo, or c7E3 or placebo. All patients exhibited dynamic ECG changes and recurrent pain attacks, despite maximal tolerated medical therapy. Patients were randomized in both studies after initial angiography had demonstrated a culprit lesion amenable for angioplasty. After study drug infusion quantitative angiography was repeated and angioplasty performed. Recurrent ischemia during study drug infusion occured in 5, 6, 9 and 16 patients from the alteplase, placebo, c7E3 and placebo group, respectively. Major events defined as death, myocardial infarction or urgent intervention occurred in 7, 3, 1 and 7 patients, respectively. Two patients died: one in the alteplase group and one in the placebo group from the c7E3 study. The first patient due to retroperitoneal hemorrhage, the second as a result of recurrent infarction. Qualitative angiography showed resolution of clots in the c7E3 group only, while the same group of patients showed in 20% an improvement in TIMI flow grade, without deterioration in any patient from this group. Quantitative angiography showed a significant improvement in percentage diameter stenosis in the c7E3 group, which was not observed in all three other groups, although differences between groups were not significant. Alteplase infusion in patients with refractory unstable angina did not change the clinical course, nor the coronary morphology, c7E3 on the other hand, both improved the clinical course and the coronary lesion morphology and rheology in the same category of patients.
Ouzan, J.; Wilson, D.; Pérualt, C.; Metz, D.; Torossian, F.; Gibold, C.; Loboguerrero, A.; Carre, E.; Liehn, J.; Elaerts, J.
doi: 10.1007/BF01137900pmid: 7876658
111 In-antimyosin antibodies are capable of visualizing acute myocardial infarction (MI). Because of slow blood clearance, images are usually recorded 24 or 48 h postinjection. This pilot study was aimed at validating a blood pool subtraction technique, which makes it possible to visualize MI 6 h postinjection. Twenty-five patients with proven MI (16 anterior, 9 inferior) were imaged 10 minutes, 6 and 24 h after an injection of 110 MBq 111 In-labelled antimyosin antibodies, with a mean delay of two weeks after infarction. Three planar views were obtained each time. Using software which performs geometric registration, grey level normalization and subtraction of images, the blood pool image (obtained 10 minutes postinjection) was subtracted from the 6 hour image. The resulting image was the blood pool corrected 6 h image. The 24 h images and the blood pool corrected 6 h images were interpreted blindly and the number of correct, incorrect and indeterminate MI localizations were tabulated. The number of correct localizations was 19/25 for the standard 24 h images and 22/25 for the blood pool corrected 6 h images. With this blood pool subtraction method it was possible to visualize MI 6 h postinjection. Theoretically, this method could be applied six hours after myocardial infarction.
Zotz, Rainer; Genth, Sabine; Erbel, Raimund; Dieterich, Hans; Meyer, Jürgen
doi: 10.1007/BF01137901pmid: 7876659
To test the hypothesis that left heart opacification is dependent on pulmonary artery pressure, we analyzed consecutively 12 patients with normal and 8 patients with abnormal pulmonary artery pressure with a new lung capillary stable echo contrast agent. Patients underwent contrast echocardiographic examination within 6 hours before right and left heart catheterization with 200 mg/ml and 400 mg/ml SHU 508A intravenously. The mean pulmonary artery pressure was 15.4 mmHg in the patients with normal pulmonary artery pressures and 46.4 mmHg in the patients with pulmonary hypertension (p< 0.000). Echocardiograms were video-intensitometrically analyzed for intensity maximum (MAX), half-time of video-intensity decay (T1/2), area under the intensity curve (AUC) in the right and left ventricle and transit time from left to right heart (TT). Patients with normal pulmonary artery pressure showed sufficient left heart opacification, in the left ventricle MAX was 37±15 IU, AUC measured 653±463 IUxs and Tl/2 was 4.4±2.6 s, while patients with elevated pulmonary artery pressure showed no significant left heart opacification. In the left ventricle MAX was 8±10 IU (p=0.006), AUC measured 66±108 (p=0.003) and T1/2 was 2.0±2.0 s (p=0.041). TT was significantly increased in patients with elevated pulmonary artery pressure (11.8±4.6 s versus 6.5±2.8 s in patients with normal pulmonary artery pressure, p=0.005). Thus, elevated pulmonary pressure has a significant impact on left heart opacification, which may be used for diagnostic purposes.
Dumay, Adrie; Gerbrands, Jan; Reiber, Johan
doi: 10.1007/BF01137902pmid: 7876660
For clinical decision-making and documentation purposes we have developed techniques to extract, label and analyze the coronary vasculature from arteriograms in an automated, quantitative manner. Advanced image processing techniques were applied to extract and analyze the vasculatures from non-subtracted arteriograms while artificial intelligence techniques were employed to assign anatomical labels. Lumen diameters of 11 phantom vessels were assessed with an accuracy of 0.27±0.19 mm (d true = 0.45 + 0.92d measured ; r> 0.99) and 0.21±0.15 mm (d true =0.42+0.91d measured ; r> 0.99), from cine and digital images, respectively. We collected a total of 15 routinely acquired cine-arteriograms showing 74 vessel segments with 18 stenoses (severity larger than 30% assessed quantitatively), and 53 digital arteriograms showing 236 vessel segments with 69 stenoses. From the cine arteriograms we extracted 64 (86%) of the vessel segments without manual correction and 196 (83%) from the digital arteriograms. Repeated analysis (3 times) of the arteriograms by the same operator resulted in a standard deviation of the mean segment diameters (precision) of 0.064 mm for the cine-images and 0.020 mm for the digital images, while the standard deviations in the measurement of the minimal luminal diameter of the observed stenoses were 0.020 mm and 0.019 mm, respectively. The LAD artery, the septal and diagonal branches were correctly identified automatically in 86% of the segments. From these evaluations we conclude that our automated approach provides reliable tools for the assessment of multi-vessel disease, both in an offand on-line environment.
Joseph, Abraham; Talley, J.; Shih, Andrew; Crum, Tracy; Vogel, Robert; Kupersmith, Joel
doi: 10.1007/BF01137903pmid: 7876661
To assess by serial quantitative angiography, the significance of clinical and angiographic variables that affect the progression of coronary artery disease (CAD). Progression of disease by sequential angiography is unpredictable and the role of clinical risk factors controversial. Various intervention trials have demonstrated less progression and even regression in hyperlipidemic patients. Correlates of progression have included a younger age, unstable angina, and greater involvement of the coronary arteries, with few studies looking at angiographic features of individual lesions. Serial angiograms on 74 patients were analyzed by computer assisted quantitative angiography using absolute measurements. A total of 99 diseased segments were analyzed for progression defined as an absolute reduction of 20% in luminal cross-sectional area. A preliminary correlation coefficient was calculated for each of the clinical and angiographic variables to detect any association with progression, and the odds ratio determined.
Georgia, Michael; Chimowitz, Marc; Hepner, Anne; Armstrong, William
doi: 10.1007/BF01137904pmid: 7876662
We describe the clinical and echocardiographic findings in eight patients with right atrial spontaneous echo contrast who were identified from 648 consecutive patients undergoing transesophageal echocardiography. Common findings in these patients were right atrial enlargement (8 patients), tricuspid regurgitation (7 patients), atrial fibrillation or flutter (6 patients), elevated right ventricular pressure (5 patients), moderate or severe mitral valve disease (5 patients), and right to left interatrial shunts (3 patients). Right heart catheterization in three patients showed markedly elevated right atrial, right ventricular, and pulmonary artery pressures. Two patients had thromboembolic events — one patient had recurrent pulmonary emboli, and another patient with an atrial septal aneurysm had recurrent transient ischemic attacks. Right atrial echo contrast is an uncommon finding at echocardiography that is associated with severe right heart dysfunction. It may also be associated with paradoxical or pulmonary embolism.
Dendale, Paul; Beeck, Bartop; Ridder, Filip; Claessens, Frank; Osteaux, Michel; Block, Pierre
doi: 10.1007/BF01137905pmid: 7876663
Hepatocellular carcinoma is the most common primary malignant liver tumor occuring in more than 1 million cases a year all over the world. Vascular invasion is known to occur in 30% of patients at initial presentation [1]. An extension of the tumor into the right atrium is well described in the literature [2], with surgical resection as the only procedure available. But the diagnosis is often difficult before death. We report a case in which magnetic resonance imaging of liver and heart shows the extension of this tumor into the right atrium
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