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AIMS: The aim of this study was to assess the safety and diagnostic efficacy of frequency-domain optical coherence tomography (FD-OCT) in identifying functional severity of the left main coronary artery (LM) stenosis determined by fractional flow reserve (FFR). METHODS AND RESULTS: 101 patients with LM lesion (20-70% diameter stenosis angiographically) underwent FFR measurement and FD-OCT imaging of the LM. The following parameters were measured by FD-OCT in the LM: reference lumen area (RLA), reference lumen diameter (RLD), minimum lumen area (MLA), minimum lumen diameter (MLD), % lumen area stenosis, and % diameter stenosis. The LM lesions were analyzable by FD-OCT in 88/101 (87.1%) patients. FFR at maximum hyperemia was ≤0.80 in 39/88 (44.3%) patients. FFR values were correlated significantly with FD-OCT-derived LM lumen parameters. An MLA cutoff value of 5.38 mm2 had the highest sensitivity and specificity of 82% and 81%, respectively, followed by an MLD of 2.43 mm (sensitivity 77%, specificity 72%) and AS of 60% (sensitivity 72%, specificity 72%) for predicting FFR <0.80. CONCLUSIONS: FD-OCT is a safe and feasible imaging technique for the assessment of LM stenosis. An FD-OCT-derived MLA of ≤5.38 mm2 strongly predicts the functional severity of an LM lesion.
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Estenosis Coronaria , Reserva del Flujo Fraccional Miocárdico , Hiperemia , Estenosis Coronaria/diagnóstico por imagen , Vasos Coronarios/diagnóstico por imagen , Humanos , Tomografía de Coherencia ÓpticaRESUMEN
BACKGROUND: Permanent pacemaker implantation is accompanied by minor myocardial damage, indicated by elevated serum levels of cardiac biomarkers. Aim of this prospective study was to comparably investigate the lead fixation type effect on the extent of myocardial injury and inflammation following pacemaker implantation, and to assess the possible clinical implications. METHODS: Cardiac troponin I (cTnI) and C-reactive protein (CRP) were measured at baseline, 6 and 24h after implantation in 101 patients, categorized into the active and passive lead fixation group. Patients were followed up for clinical adverse events or abnormal pacing parameters at 24h, 7 and 30 days post-procedure. RESULTS: cTnI increased at 6h post-procedure (p<0.05) in 23.8% of patients, and returned to baseline after 24h. The passive group demonstrated significantly higher cTnI at 6h compared to the active group (p=0.006). CRP increased significantly at 6h, and maintained an upward trend after 24h (p<0.01) in both groups. The active group demonstrated significantly higher CRP at 6h compared to the passive group. We did not identify an association of positive biomarkers with adverse events. CONCLUSION: cTnI and CRP can increase early after permanent pacemaker implantation, indicating mechanical myocardial injury and inflammation. The extent of these biomarkers elevation depends on the lead fixation type, and is not related to worse short-term prognosis.
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We present the case of a patient with non-ST-elevated myocardial infarction due to very late stent thrombosis 2 years after a sirolimus-eluting stent implantation (SES). Optical coherence tomography (OCT) imaging identified vessel wall destruction of the whole stented coronary segment with multiple cavity formations along the entire stent length, severe strut malapposition and thrombi. The patient was treated successfully with the implantation of a bare metal stent (BMS). Follow-up OCT imaging at 12 months revealed the improvement of vascular healing with complete re-endothelialization of the distal parts of the new BMS, while the stent body remained partly uncovered, suggesting vascular toxicity due to the old SES.
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Reestenosis Coronaria/diagnóstico por imagen , Stents Liberadores de Fármacos/efectos adversos , Tomografía de Coherencia Óptica/métodos , Adulto , Reestenosis Coronaria/etiología , Humanos , Masculino , Infarto del Miocardio sin Elevación del ST/etiología , Sirolimus/administración & dosificación , Stents , Resultado del TratamientoRESUMEN
BACKGROUND: Geometrically-correct 3D OCT is a new imaging modality with the potential to investigate the association of local hemodynamic microenvironment with OCT-derived high-risk features. We aimed to describe the methodology of 3D OCT and investigate the accuracy, inter- and intra-observer agreement of 3D OCT in reconstructing coronary arteries and calculating ESS, using 3D IVUS and 3D QCA as references. METHODS-RESULTS: 35 coronary artery segments derived from 30 patients were reconstructed in 3D space using 3D OCT. 3D OCT was validated against 3D IVUS and 3D QCA. The agreement in artery reconstruction among 3D OCT, 3D IVUS and 3D QCA was assessed in 3-mm-long subsegments using lumen morphometry and ESS parameters. The inter- and intra-observer agreement of 3D OCT, 3D IVUS and 3D QCA were assessed in a representative sample of 61 subsegments (n = 5 arteries). The data processing times for each reconstruction methodology were also calculated. There was a very high agreement between 3D OCT vs. 3D IVUS and 3D OCT vs. 3D QCA in terms of total reconstructed artery length and volume, as well as in terms of segmental morphometric and ESS metrics with mean differences close to zero and narrow limits of agreement (Bland-Altman analysis). 3D OCT exhibited excellent inter- and intra-observer agreement. The analysis time with 3D OCT was significantly lower compared to 3D IVUS. CONCLUSIONS: Geometrically-correct 3D OCT is a feasible, accurate and reproducible 3D reconstruction technique that can perform reliable ESS calculations in coronary arteries.
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Angiografía Coronaria/métodos , Enfermedad de la Arteria Coronaria/diagnóstico , Vasos Coronarios , Endotelio Vascular , Imagenología Tridimensional/métodos , Tomografía de Coherencia Óptica/métodos , Ultrasonografía Intervencional/métodos , Algoritmos , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Enfermedad de la Arteria Coronaria/patología , Enfermedad de la Arteria Coronaria/fisiopatología , Circulación Coronaria , Vasos Coronarios/diagnóstico por imagen , Vasos Coronarios/patología , Vasos Coronarios/fisiopatología , Endotelio Vascular/diagnóstico por imagen , Endotelio Vascular/patología , Endotelio Vascular/fisiopatología , Estudios de Factibilidad , Grecia , Humanos , Japón , Variaciones Dependientes del Observador , Valor Predictivo de las Pruebas , Interpretación de Imagen Radiográfica Asistida por Computador , Reproducibilidad de los Resultados , Estrés MecánicoRESUMEN
AIMS: The purpose of the present study was to assess the incidence, predictors and long term prognosis of stent edge dissections identified by (OCT) after the implantation of bare metal (BMS) and drug eluting stents (DES). METHODS AND RESULTS: We studied 74 patients who underwent percutaneous coronary intervention (PCI) because of an acute coronary syndrome. Edge dissections were found in 29 of 74 patients (39.1%). Independent predictors of edge dissections were: the presence of ST-elevation myocardial infarction (STEMI) (P = 0.005, odds ratio 11.78; 95% Cl 2.06-67.10), the small reference lumen diameter (P = 0.009, odds ratio 0.11; 95% Cl 0.02-0.58) and the short stents implanted (P = 0.013, odds ratio 0.83; 95% Cl 0.72-0.96). During a follow-up period of 25.6 ± 9.4 months 11 patients presented with at least one major adverse cardiac event. Event free survival was significantly decreased in patients with edge dissection with a flap thickness >0.31 mm compared to patients with thinner flap or without any dissection (P < 0.001). CONCLUSIONS: OCT frequently detects edge dissections, usually related to STEMI presentation and to PCI technique. Deep vessel wall injury at stent edges with a dissection flap thickness more than 0.31mm carries an adverse clinical impact on long-term clinical outcome.
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Síndrome Coronario Agudo/terapia , Vasos Coronarios/patología , Infarto del Miocardio/terapia , Intervención Coronaria Percutánea/efectos adversos , Intervención Coronaria Percutánea/instrumentación , Stents , Tomografía de Coherencia Óptica , Síndrome Coronario Agudo/patología , Anciano , Área Bajo la Curva , Distribución de Chi-Cuadrado , Supervivencia sin Enfermedad , Femenino , Humanos , Estimación de Kaplan-Meier , Modelos Logísticos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Infarto del Miocardio/patología , Oportunidad Relativa , Valor Predictivo de las Pruebas , Estudios Prospectivos , Diseño de Prótesis , Curva ROC , Factores de Riesgo , Factores de Tiempo , Resultado del TratamientoRESUMEN
OBJECTIVES: The analysis of intracoronary optical coherence tomography (OCT) images is based on manual identification of the lumen contours and relevant structures. However, manual image segmentation is a cumbersome and time-consuming process, subject to significant intra- and inter-observer variability. This study aims to present and validate a fully-automated method for segmentation of intracoronary OCT images. METHODS: We studied 20 coronary arteries (mean length=39.7±10.0 mm) from 20 patients who underwent a clinically-indicated cardiac catheterization. The OCT images (n=1812) were segmented manually, as well as with a fully-automated approach. A semi-automated variation of the fully-automated algorithm was also applied. Using certain lumen size and lumen shape characteristics, the fully- and semi-automated segmentation algorithms were validated over manual segmentation, which was considered as the gold standard. RESULTS: Linear regression and Bland-Altman analysis demonstrated that both the fully-automated and semi-automated segmentation had a very high agreement with the manual segmentation, with the semi-automated approach being slightly more accurate than the fully-automated method. The fully-automated and semi-automated OCT segmentation reduced the analysis time by more than 97% and 86%, respectively, compared to manual segmentation. CONCLUSIONS: In the current work we validated a fully-automated OCT segmentation algorithm, as well as a semi-automated variation of it in an extensive "real-life" dataset of OCT images. The study showed that our algorithm can perform rapid and reliable segmentation of OCT images.
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Algoritmos , Cateterismo Cardíaco/métodos , Enfermedad de la Arteria Coronaria/diagnóstico , Vasos Coronarios/patología , Interpretación de Imagen Asistida por Computador , Tomografía de Coherencia Óptica/métodos , Femenino , Humanos , Imagenología Tridimensional , Masculino , Persona de Mediana Edad , Curva ROC , Reproducibilidad de los Resultados , Factores de TiempoRESUMEN
The time course of complete arterial healing after drug eluting stent implantation is unknown. We present a case of incomplete endothelialization and late stent malapposition identified by optical coherence tomography 8 years after a sirolimus-eluting stent implantation, which was not related with any adverse clinical event.
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Angioplastia Coronaria con Balón/instrumentación , Fármacos Cardiovasculares/administración & dosificación , Enfermedad de la Arteria Coronaria/terapia , Vasos Coronarios/patología , Stents Liberadores de Fármacos , Sirolimus/administración & dosificación , Tomografía de Coherencia Óptica , Cicatrización de Heridas , Anciano , Angioplastia Coronaria con Balón/efectos adversos , Angiografía Coronaria , Humanos , Masculino , Neointima/patología , Diseño de Prótesis , Factores de Tiempo , Resultado del TratamientoRESUMEN
BACKGROUND: OCT with its unique image resolution is the ideal method to detect culprit lesion characteristics in different clinical presentations. The identification of inflammatory markers related to plaque characteristics may be of clinical importance. METHODS: Thirty-two patients with acute coronary syndromes (ACS) and fourteen patients with stable angina pectoris (SAP) were enrolled in this study. Culprit lesion morphology was assessed by optical coherence tomography (OCT) in patients with ACS and SAP. The possible relations between serum levels of high sensitivity-C reactive protein (hs-CRP) and interleukin-18 (IL-18) with plaque characteristics were investigated in those patients. RESULTS: Plaque rupture and thin-cap fibroatheroma (TCFA) were detected more frequently in ACS patients compared with SAP patients, (78.6% vs. 14.3%, p<0.001, 92.9% vs. 14.3%, p<0.001, respectively). Higher levels of serum hs-CRP and IL-18 were found in patients with plaque rupture vs. those with no plaque rupture (median value: 19.2mg/L vs. 1.6 mg/L, p<0.001 and 219.5 pg/ml vs. 127.5 pg/ml, p=0.001 respectively), and TCFA vs. those without TCFA (median value: 15.2mg/L vs. 1.6 mg/L, p=0.004 and 209.0 pg/ml vs.153.2 pg/ml, p=0.03 respectively). Serum hs-CRP was the only independent predictor of plaque rupture (p=0.02, odds ratio 1.1, 95% confidence interval 1.0 to 1.2). A cut-off value of hs-CRP>4.5mg/L could detect ruptured plaque with a sensitivity of 91.7% and a specificity of 77.8%. CONCLUSIONS: OCT detected plaque rupture and TCFA more frequent in ACS patients compared with SAP. Elevated hs-CRP and IL-18 were positively related to plaque instability and rupture.
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Síndrome Coronario Agudo/sangre , Síndrome Coronario Agudo/patología , Angina Estable/patología , Proteína C-Reactiva/análisis , Interleucina-18/sangre , Placa Aterosclerótica/sangre , Placa Aterosclerótica/patología , Tomografía de Coherencia Óptica , Anciano , Biomarcadores/sangre , Femenino , Humanos , Inflamación/sangre , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Estudios ProspectivosRESUMEN
Optical coherence tomography (OCT) is an optical analogue of intravascular ultrasound that has recently been proposed as a high-resolution imaging method for plaque characterization. Histology-controlled studies have shown that OCT can evaluate the characteristics of culprit lesions, such as fibrous cap thickness, fibrous cap macrophage density, lipid core and intracoronary thrombus. We describe a case where OCT was used to evaluate the culprit lesion morphology in a patient with acute myocardial infarction. The patient was treated with stent implantation. OCT was also used to confirm good stent apposition.
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Enfermedad de la Arteria Coronaria/diagnóstico , Placa Aterosclerótica/diagnóstico , Tomografía de Coherencia Óptica , Anciano , Enfermedad de la Arteria Coronaria/complicaciones , Enfermedad de la Arteria Coronaria/terapia , Humanos , Masculino , Placa Aterosclerótica/complicaciones , Placa Aterosclerótica/terapiaRESUMEN
OBJECTIVES: This study investigated the association between morphological characteristics of culprit atheromatic lesions as assessed by optical coherence tomography and Thrombolysis In Myocardial Infarction (TIMI) flow grade after thrombolysis in patients with ST-segment elevation myocardial infarction (STEMI). BACKGROUND: Although several variables have been found to predict coronary flow after thrombolysis in patients with STEMI, the impact of culprit lesion morphology has not been studied. METHODS: Fifty-five patients with STEMI from 3 tertiary centers that were treated with thrombolysis and underwent optical coherence tomography examination in the culprit lesion between 24 and 48 h after thrombolysis were included in the study. Patients were categorized on the basis of TIMI flow grade into patients with TIMI flow grade 3 versus TIMI flow grade < or =2. RESULTS: Patients with TIMI flow grade < or =2 had plaques with more lipid quadrants than patients with TIMI flow grade 3 (p < 0.001), and presented with greater incidence of plaque rupture (p = 0.001). Mean minimal cap thickness was greater in patients with patent arteries than in patients with impaired flow (87 +/- 26 microm vs. 48 +/- 18 microm, p < 0.0001). Minimal cap thickness was independently associated with TIMI flow grade. CONCLUSIONS: The morphological characteristics of the culprit atheromatic lesion in patients with STEMI are associated with coronary flow after thrombolysis. The lipid content, the existence of rupture, and mainly the thickness of the fibrous cap are associated with the outcome of thrombolysis.
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Enfermedad de la Arteria Coronaria/patología , Circulación Coronaria/efectos de los fármacos , Trombosis Coronaria/patología , Fibrinolíticos/uso terapéutico , Infarto del Miocardio/patología , Terapia Trombolítica , Activador de Tejido Plasminógeno/uso terapéutico , Tomografía de Coherencia Óptica , Anciano , Distribución de Chi-Cuadrado , Angiografía Coronaria , Enfermedad de la Arteria Coronaria/tratamiento farmacológico , Enfermedad de la Arteria Coronaria/fisiopatología , Trombosis Coronaria/tratamiento farmacológico , Trombosis Coronaria/fisiopatología , Femenino , Fibrosis , Grecia , Humanos , Lípidos/análisis , Modelos Logísticos , Masculino , Persona de Mediana Edad , Infarto del Miocardio/tratamiento farmacológico , Infarto del Miocardio/fisiopatología , Valor Predictivo de las Pruebas , Estudios Prospectivos , Rotura , Tenecteplasa , Resultado del TratamientoRESUMEN
Late stent malapposition may play a role in stent thrombosis, but the results of several intravascular ultrasound and few optical coherence tomography (OCT) studies are still controversial. We present a case of late acquired stent malapposition after drug eluting stent implantation, identified by follow-up OCT examination at 12 months, which was not related with any adverse clinical event.
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Angioplastia Coronaria con Balón/métodos , Enfermedad de la Arteria Coronaria/terapia , Stents Liberadores de Fármacos/efectos adversos , Tomografía de Coherencia Óptica , Anciano , Angiografía Coronaria , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Femenino , Humanos , Masculino , Persona de Mediana Edad , Diseño de Prótesis , Túnica ÍntimaRESUMEN
Despite advances in the treatment of patients with acute coronary syndromes, there has been no significant decrease in the incidence of cardiogenic shock, while its mortality remains frustratingly high. Shock is a progressive state of hypotension (systolic blood pressure < 90 mm Hg) lasting at least 30 minutes, which leads to systemic hypoperfusion. It is more common in patients with ST-segment elevation myocardial infarction than in patients with other acute coronary syndromes. Revascularization is associated with better outcomes than intensive medical therapy, especially in patients < 75 years of age with cardiogenic shock. Adjunctive therapies include inotropes, vasopressor therapy, intra-aortic balloon pump counterpulsation, and IIb/IIIa blockade to prevent no-reflow phenomenon during primary percutaneous transluminal coronary angioplasty. Other adjunctive therapies which are investigated are improved mechanical support devices, and as medical therapy for myocyte protection nicorandil, glucose/insulin/potassium infusions and direct inhibition of Na+/H+ exchanger.
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Enfermedad Coronaria/complicaciones , Choque Cardiogénico/terapia , Cardiotónicos/uso terapéutico , Enfermedad Coronaria/mortalidad , Enfermedad Coronaria/terapia , Humanos , Contrapulsador Intraaórtico , Revascularización Miocárdica , Inhibidores de Agregación Plaquetaria/uso terapéutico , Complejo GPIIb-IIIa de Glicoproteína Plaquetaria/antagonistas & inhibidores , Choque Cardiogénico/etiología , Choque Cardiogénico/mortalidad , Tasa de Supervivencia , Síndrome , Resultado del Tratamiento , Vasoconstrictores/uso terapéuticoRESUMEN
We describe a case of successful direct coronary stenting of two tight lesions, one at the site of the left internal mammary artery (LIMA) graft anastomosis with left anterior descending coronary artery and the other at the site of the anastomosis between the right internal mammary artery (RIMA) graft and the right coronary artery. To our knowledge, this is the first reported case of successful direct stent implantation through the LIMA and RIMA.