ROLE OF INTRA CORONARY IMAGING AND PHYSIOLOGY IN DIAGNOSIS AND MANAGEMENT OF CORONARY ARTERY DISEASE

Authors

  • Yasir Parviz New York Presbyterian Hospital and Columbia University, New York, NY; USA
  • Kokab Awan Queen’s University, Kingston, ON, Canada
  • Sethumadhavan Vijayan South Yorkshire Cardiothoracic Centre, Northern General Hospital, Sheffield, UK
  • Ayyaz Sultan Wrightington Wigan and Leigh NHS Foundation Trust, UK
  • Javaid Iqbal South Yorkshire Cardiothoracic Centre, Northern General Hospital, Sheffield, UK

Abstract

Coronary artery disease (CAD) is the leading cause of death in the Indo-Pakistan subcontinent as well as globally. Coronary angiography is considered the gold standard test for the diagnosis of CAD. Therefore, an accurate interpretation of coronary angiography is of paramount importance in decision-making to treat patients with CAD. Coronary angiography has the inherent limitation of being a two-dimensional X-Ray lumenogram of a complex three-dimensional vascular structure. Visual assessment of angiogram can lead to both inter- and intra-observer variability in the assessment of the severity and extent of the disease which can lead to differences in management strategies. This issue becomes even more relevant when assessing left main stem (LMS), bifurcations, diffuse coronary artery disease or situations involving complex coronary morphology. Interventional cardiology has been revolutionised by recent advances in techniques, and innovative technologies in the catheterisation laboratory. Today, a modern catheterisation laboratory is equipped with adjunctive technologies, such as Quantitative Coronary Angiography (QCA), Fractional Flow Reserve (FFR), Intra-Vascular Ultra-Sonography (IVUS), and Optical Coherence Tomography (OCT), to help clinicians make a well-informed decision based on detailed anatomical and physiological assessment of a coronary artery rather than judgement based solely on visual assessment. In this article, we have briefly described the utility and evidence behind these adjunctive modalities and have provided examples of clinical cases to highlight their use in aiding physicians to make a well-informed treatment decision.

Author Biographies

Yasir Parviz, New York Presbyterian Hospital and Columbia University, New York, NY; USA

New York Presbyterian Hospital and Columbia University, New York, NY; USA

Kokab Awan, Queen’s University, Kingston, ON, Canada

Queen’s University, Kingston, ON, Canada

Sethumadhavan Vijayan, South Yorkshire Cardiothoracic Centre, Northern General Hospital, Sheffield, UK

South Yorkshire Cardiothoracic Centre, Northern General Hospital, Sheffield, UK

Ayyaz Sultan, Wrightington Wigan and Leigh NHS Foundation Trust, UK

Wrightington Wigan and Leigh NHS Foundation Trust, UK  

Javaid Iqbal, South Yorkshire Cardiothoracic Centre, Northern General Hospital, Sheffield, UK

South Yorkshire Cardiothoracic Centre, Northern General Hospital, Sheffield, UK

References

Shapiro TA, Herrmann HC. Coronary angiography and interventional cardiology. Curr Opin Radiol 1992;4(4):55–64.

Proudfit WL, Shirey EK, Sones FM Jr. Selective cine coronary arteriography. Correlation with clinical findings in 1,000 patients. Circulation 1966;33(6):901–10.

Leape LL, Park RE, Bashore TM, Harrison JK, Davidson CJ, Brook RH. Effect of variability in the interpretation of coronary angiograms on the appropriateness of use of coronary revascularization procedures. Am Heart J 2000;139(1 Pt 1):106–13.

Bashore TM, Balter S, Barac A, Byrne JG, Cavendish JJ, Chambers CE, et al. 2012 American College of Cardiology Foundation/Society for Cardiovascular Angiography and Interventions expert consensus document on cardiac catheterization laboratory standards update: A report of the American College of Cardiology Foundation Task Force on Expert Consensus documents developed in collaboration with the Society of Thoracic Surgeons and Society for Vascular Medicine. J Am Coll Cardiol 2012;59(24):2221–305.

Iqbal J, Serruys PW, Taggart DP. Optimal revascularization for complex coronary artery disease. Nat Rev Cardiol 2013;10(11):635–47.

Jensen LO, Thayssen P, Mintz GS, Egede R, Maeng M, Junker A, et al. Comparison of intravascular ultrasound and angiographic assessment of coronary reference segment size in patients with type 2 diabetes mellitus. Am J Cardiol 2008;101(5):590–5.

Tobis J, Azarbal B, Slavin L. Assessment of intermediate severity coronary lesions in the catheterization laboratory. J Am Coll Cardiol 2007;49(8):839–48.

Girasis C, Onuma Y, Schuurbiers JC, Morel MA, van Es GA, van Geuns RJ, et al. Validity and variability in visual assessment of stenosis severity in phantom bifurcation lesions: a survey in experts during the fifth meeting of the European Bifurcation Club. Catheter Cardiovasc Interv 2012;79(3):361–8.

Fleming RM, Fleming DM, Gaede R. Training physicians and health care providers to accurately read coronary arteriograms. A training program. Angiology 1996;47(4):349–59.

Marcus ML, Skorton DJ, Johnson MR, Collins SM, Harrison DG, Kerber RE. Visual estimates of percent diameter coronary stenosis: "a battered gold standard". J Am Coll Cardiol 1988;11(4):882–5.

Fleming RM, Harrington GM. Quantitative coronary arteriography and its assessment of atherosclerosis. Part II. Calculating stenosis flow reserve from percent diameter stenosis. Angiology 1994;45(10):835–40.

Feldman RL, Nichols WW, Pepine CJ, Conti CR. Hemodynamic significance of the length of a coronary arterial narrowing. Am J Cardiol 1978;41(5):865–71.

Tuinenburg JC, Koning G, Hekking E, Zwinderman AH, Becker T, Simon R, et al. American College of Cardiology/European Society of Cardiolgoy International Study of Angiographic Data Compression Phase II: the effects of varying JPEG data compression levels on the quantitative assessment of the degree of stenosis in digital coronary angiography. Joint Photographic Experts Group. J Am Coll Cardiol 2000;35(5):1380–7.

Gottsauner-Wolf M, Sochor H, Moertl D, Gwechenberger M, Stockenhuber F, Probst P. Assessing coronary stenosis. Quantitative coronary angiography versus visual estimation from cine-film or pharmacological stress perfusion images. Eur Heart J 1996;17(8):1167–74.

Arnett EN, Isner JM, Redwood DR, Kent KM, Baker WP, Ackerstein H, et al. Coronary artery narrowing in coronary heart disease: comparison of cineangiographic and necropsy findings. Ann Intern Med 1979;91(3):350–6.

Dietz WA, Tobis JM, Isner JM. Failure of angiography to accurately depict the extent of coronary artery narrowing in three fatal cases of percutaneous transluminal coronary angioplasty. J Am Coll Cardiol 1992;19(6):1261–70.

Nissen SE, Gurley JC, Grines CL, Booth DC, McClure R, Berk M, et al. Intravascular ultrasound assessment of lumen size and wall morphology in normal subjects and patients with coronary artery disease. Circulation 1991;84(3):1087–99.

Grundeken MJ, Ishibashi Y, Généreux P, LaSalle L, Iqbal J, Wykrzykowska JJ, et al. Inter-core lab variability in analyzing quantitative coronary angiography for bifurcation lesions: a post-hoc analysis of a randomized trial. JACC Cardiovasc Interv 2015;8(2):305–14.

Ambrose JA. Prognostic implications of lesion irregularity on coronary angiography. J Am Coll Cardiol 1991;18(3):675–6.

Omoto R. Intracardiac scanning of the heart with the aid of ultrasonic intravenous probe. Jpn Heart J 1967;8(6):569–81.

Leesar MA, Masden R, Jasti V. Physiological and intravascular ultrasound assessment of an ambiguous left main coronary artery stenosis. Catheter Cardiovasc Interv 2004;62(3):349–57.

Klein AJ, Hudson PA, Kim MS, Cleveland JC Jr, Messenger JC. Spontaneous left main coronary artery dissection and the role of intravascular ultrasonography. J Ultrasound Med 2010;29(6):981–8.

Abizaid AS, Mintz GS, Abizaid A, Mehran R, Lansky AJ, Pichard AD, et al. One-year follow-up after intravascular ultrasound assessment of moderate left main coronary artery disease in patients with ambiguous angiograms. J Am Coll Cardiol 1999;34(3):707–15.

Witzenbichler B, Maehara A, Weisz G, Neumann FJ, Rinaldi MJ, Metzger DC, et al. Relationship between intravascular ultrasound guidance and clinical outcomes after drug-eluting stents: the assessment of dual antiplatelet therapy with drug-eluting stents (ADAPT-DES) study. Circulation 2014;129(4):463–70.

Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B, et al. 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions. J Am Coll Cardiol 2011;58(24):e44–122.

Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B, et al. 2011 ACCF/AHA/SCAI guideline for percutaneous coronary intervention: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions. Catheter Cardiovasc Interv 2013;82(4):E266–355.

Ali ZA, Karimi Galougahi K, Nazif T, Maehara A, Hardy MA, Cohen DJ, et al. Imaging- and physiology-guided percutaneous coronary intervention without contrast administration in advanced renal failure: a feasibility, safety, and outcome study. Eur Heart J 2016;37(40):3090–5.

Parviz Y, Fall KN, Ali ZA. Using sound advice-intravascular ultrasound as a diagnostic tool. J Thorac Dis 2016;8(10):E1395–7.

Mueller C, Hodgson JM, Schindler C, Perruchoud AP, Roskamm H, Buettner HJ. Cost-effectiveness of intracoronary ultrasound for percutaneous coronary interventions. Am J Cardiol 2003;91(2):143–7.

Brezinski ME, Tearney GJ, Bouma BE, Izatt JA, Hee MR, Swanson EA, et al. Optical coherence tomography for optical biopsy. Properties and demonstration of vascular pathology. Circulation 1996;93(6):1206–13.

Tenekecioglu E, Albuquerque FN, Sotomi Y, Zeng Y, Suwannasom P, Tateishi H, et al. Intracoronary optical coherence tomography: Clinical and research applications and intravascular imaging software overview. Catheter Cardiovasc Interv 2017;89(4):679–89.

Giavarini A, Kilic ID, Redondo Diéguez A, Longo G, Vandormael I, Pareek N , et al. Intracoronary Imaging. Heart 2017;103(9):708–25.

Ali ZA, Maehara A, Généreux P, Shlofmitz RA, Fabbiocchi F, Nazif TM, et al. Optical coherence tomography compared with intravascular ultrasound and with angiography to guide coronary stent implantation (ILUMIEN III: OPTIMIZE PCI): a randomised controlled trial. Lancet 2016;388(10060):2618–28.

Campos CM, Garcia-Garcia HM, Iqbal J, Muramatsu T, Nakatani S, Dijkstra J, et al. Serial volumetric assessment of coronary fibroatheroma by optical frequency domain imaging: insights from the TROFI trial. Eur Heart J Cardiovasc Imaging 2017.

Guo N, Maehara A, Mintz GS, He Y, Xu K, Wu X, et al. Incidence, mechanisms, predictors, and clinical impact of acute and late stent malapposition after primary intervention in patients with acute myocardial infarction: an intravascular ultrasound substudy of the Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction (HORIZONS-AMI) trial. Circulation 2010;122(11):1077–84.

Prati F, Cera M, Ramazzotti V, Imola F, Giudice R, Albertucci M. Safety and feasibility of a new non-occlusive technique for facilitated intracoronary optical coherence tomography (OCT) acquisition in various clinical and anatomical scenarios. EuroIntervention 2007;3(3):365–70.

Pijls NH, De Bruyne B, Peels K, Van Der Voort PH, Bonnier HJ, Bartunek J Koolen JJ, et al. Measurement of fractional flow reserve to assess the functional severity of coronary-artery stenoses. N Engl J Med 1996;334(26):1703–8.

De Bruyne B, Fearon WF, Pijls NH, Barbato E, Tonino P, Piroth Z, et al. Fractional flow reserve-guided PCI for stable coronary artery disease. N Engl J Med 2014;371(13):1208–17.

De Bruyne B, Pijls NH, Kalesan B, Barbato E, Tonino PA, Piroth Z, et al. Fractional flow reserve-guided PCI versus medical therapy in stable coronary disease. N Engl J Med 2012;367(11):991–1001.

Tonino PA, De Bruyne B, Pijls NH, Siebert U, Ikeno F, van' t Veer M, et al. Fractional flow reserve versus angiography for guiding percutaneous coronary intervention. N Engl J Med 2009;360(3):213–24.

Tonino PA, Fearon WF, De Bruyne B, Oldroyd KG, Leesar MA, Ver Lee PN, et al. Angiographic versus functional severity of coronary artery stenoses in the FAME study fractional flow reserve versus angiography in multivessel evaluation. J Am Coll Cardiol 2010;55(25):2816–21.

Fearon WF, Tonino PA, De Bruyne B, Siebert U, Pijls NH. Rationale and design of the Fractional Flow Reserve versus Angiography for Multivessel Evaluation (FAME) study. Am Heart J 2007;154(4):632–6.

Messenger JC, Ho KK, Young CH, Slattery LE, Draoui JC, Curtis JP, et al. The National Cardiovascular Data Registry (NCDR) Data Quality Brief: the NCDR Data Quality Program in 2012. J Am Coll Cardiol 2012;60(16):1484–8.

Fearon WF, Shilane D, Pijls NH, Boothroyd DB, Tonino PA, Barbato E, et al. Cost-effectiveness of percutaneous coronary intervention in patients with stable coronary artery disease and abnormal fractional flow reserve. Circulation 2013;128(12):1335–40.

Published

2017-07-11

Issue

Vol. 29 No. 3 (2017): JOURNAL OF AYUB MEDICAL COLLEGE, ABBOTTABAD

Section

COMMENTARY

License

Journal of Ayub Medical College, Abbottabad is an OPEN ACCESS JOURNAL which means that all content is FREELY available without charge to all users whether registered with the journal or not. The work published by J Ayub Med Coll Abbottabad is licensed and distributed under the creative commons License  CC BY ND Attribution-NoDerivs. Material printed in this journal is OPEN to access, and are FREE for use in academic and research work with proper citation. J Ayub Med Coll Abbottabad accepts only original material for publication with the understanding that except for abstracts, no part of the data has been published or will be submitted for publication elsewhere before appearing in J Ayub Med Coll Abbottabad. The Editorial Board of J Ayub Med Coll Abbottabad makes every effort to ensure the accuracy and authenticity of material printed in J Ayub Med Coll Abbottabad. However, conclusions and statements expressed are views of the authors and do not reflect the opinion/policy of J Ayub Med Coll Abbottabad or the Editorial Board.

USERS are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles, or use them for any other lawful purpose, without asking prior permission from the publisher or the author. This is in accordance with the BOAI definition of open access.

AUTHORS retain the rights of free downloading/unlimited e-print of full text and sharing/disseminating the article without any restriction, by any means including twitter, scholarly collaboration networks such as ResearchGate, Academia.eu, and social media sites such as Twitter, LinkedIn, Google Scholar and any other professional or academic networking site.