RESUMEN
BACKGROUND AND OBJECTIVE: Intravascular optical coherence tomography (OCT) is an invaluable tool for the detection of pathological features on the arterial wall and the investigation of post-stenting complications. Computational lumen border detection in OCT images is highly advantageous, since it may support rapid morphometric analysis. However, automatic detection is very challenging, since OCT images typically include various artifacts that impact image clarity, including features such as side branches and intraluminal blood presence. This paper presents ARCOCT, a segmentation method for fully-automatic detection of lumen border in OCT images. METHODS: ARCOCT relies on multiple, consecutive processing steps, accounting for image preparation, contour extraction and refinement. In particular, for contour extraction ARCOCT employs the transformation of OCT images based on physical characteristics such as reflectivity and absorption of the tissue and, for contour refinement, local regression using weighted linear least squares and a 2nd degree polynomial model is employed to achieve artifact and small-branch correction as well as smoothness of the artery mesh. Our major focus was to achieve accurate contour delineation in the various types of OCT images, i.e., even in challenging cases with branches and artifacts. RESULTS: ARCOCT has been assessed in a dataset of 1812 images (308 from stented and 1504 from native segments) obtained from 20 patients. ARCOCT was compared against ground-truth manual segmentation performed by experts on the basis of various geometric features (e.g. area, perimeter, radius, diameter, centroid, etc.) and closed contour matching indicators (the Dice index, the Hausdorff distance and the undirected average distance), using standard statistical analysis methods. The proposed method was proven very efficient and close to the ground-truth, exhibiting non statistically-significant differences for most of the examined metrics. CONCLUSIONS: ARCOCT allows accurate and fully-automated lumen border detection in OCT images.
Asunto(s)
Arterias/diagnóstico por imagen , Interpretación de Imagen Asistida por Computador , Tomografía de Coherencia Óptica , Artefactos , Procesamiento Automatizado de Datos , Humanos , Reproducibilidad de los Resultados , StentsRESUMEN
BACKGROUND AND AIMS: The distribution of Low density lipoprotein (LDL) within the arterial wall is helpful in understanding the onset and development of atherosclerosis. The objective of the study is to study the transport and LDL distribution within patient-specific arterial wall using computational analysis under normal and hypertensive conditions. METHODS: Patient specific model of the thoracic aorta is computationally examined. The arterial wall is treated macroscopically as homogeneous (one layered) porous media of variable thickness. The interfacial lumen-arterial wall (endothelium) coupling is achieved by the Kedem-Katchalsky equation. RESULTS: High values of LDL are located at areas where WSS values range from 0.4 N/m2 to 1.5 N/m2 for normal conditions. In this case the Pearson correlation coefficient r between LDL values and WSS is equal to -0.655 denoting a strong negative linear correlation. In the case that hypertension takes place, high LDL values are located at areas where WSS values range from 0.59 N/m2 to 1.7 N/m2 and the corresponding Pearson correlation coefficient r is equal to -0.808 denoting a very strong negative linear correlation. For the same parabolic intake flow velocity profile, the luminal surface concentration of LDL is 0.2-2.1% higher than that of the bulk flow for the normal pressure and 0.4-3.4% higher than that of the bulk flow for the hypertensive pressure. For normal conditions, the concentration of LDL at the endothelium/media interface is considerably lower (almost 20 times) than the LDL concentration value at lumen/endothelium interface. For hypertensive conditions, the LDL concentration at the endothelium/media interface is only 4.5 times lower than the corresponding luminal (endothelium side) concentration. The lumen/endothelium side locations (mainly the concave parts) of low WSS - high LDL concentration values coincide with those of high wall-side LDL concentration. CONCLUSIONS: The transport and LDL distribution is affected by elevated transmural pressure which causes higher LDL concentration. Thus, hypertensive conditions theoretically enhance atherosclerosis.
Asunto(s)
Aorta Torácica , Hipertensión , Lipoproteínas LDL/metabolismo , Modelos Cardiovasculares , Aorta Torácica/metabolismo , Aorta Torácica/patología , Aorta Torácica/fisiopatología , Transporte Biológico Activo , Femenino , Humanos , Hipertensión/metabolismo , Hipertensión/patología , Hipertensión/fisiopatología , MasculinoRESUMEN
AIMS: The association of low endothelial shear stress (ESS) with high-risk plaque (HRP) has not been thoroughly investigated in humans. We investigated the local ESS and lumen remodelling patterns in HRPs using optical coherence tomography (OCT), developed the shear stress score, and explored its association with the prevalence of HRPs and clinical outcomes. METHODS AND RESULTS: A total of 35 coronary arteries from 30 patients with stable angina or acute coronary syndrome (ACS) were reconstructed with three dimensional (3D) OCT. ESS was calculated using computational fluid dynamics and classified into low, moderate, and high in 3-mm-long subsegments. In each subsegment, (i) fibroatheromas (FAs) were classified into HRPs and non-HRPs based on fibrous cap (FC) thickness and lipid pool size, and (ii) lumen remodelling was classified into constrictive, compensatory, and expansive. In each artery the shear stress score was calculated as metric of the extent and severity of low ESS. FAs in low ESS subsegments had thinner FC compared with high ESS (89 ± 84 vs.138 ± 83 µm, P < 0.05). Low ESS subsegments predominantly co-localized with HRPs vs. non-HRPs (29 vs. 9%, P < 0.05) and high ESS subsegments predominantly with non-HRPs (9 vs. 24%, P < 0.05). Compensatory and expansive lumen remodelling were the predominant responses within subsegments with low ESS and HRPs. In non-stenotic FAs, low ESS was associated with HRPs vs. non-HRPs (29 vs. 3%, P < 0.05). Arteries with increased shear stress score had increased frequency of HRPs and were associated with ACS vs. stable angina. CONCLUSION: Local low ESS and expansive lumen remodelling are associated with HRP. Arteries with increased shear stress score have increased frequency of HRPs and propensity to present with ACS.
Asunto(s)
Síndrome Coronario Agudo/diagnóstico por imagen , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Imagenología Tridimensional/métodos , Resistencia al Corte/fisiología , Tomografía de Coherencia Óptica/métodos , Síndrome Coronario Agudo/mortalidad , Síndrome Coronario Agudo/fisiopatología , Anciano , Análisis de Varianza , Enfermedad de la Arteria Coronaria/mortalidad , Enfermedad de la Arteria Coronaria/patología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Variaciones Dependientes del Observador , Placa Aterosclerótica/diagnóstico por imagen , Placa Aterosclerótica/patología , Pronóstico , Medición de Riesgo , Índice de Severidad de la Enfermedad , Análisis de Supervivencia , Resultado del TratamientoRESUMEN
AIMS: To evaluate the incremental value of low endothelial shear stress (ESS) combined with high-resolution magnetic resonance imaging (MRI)- and computed tomography angiography (CTA)-based imaging for the prediction of inflamed plaque. METHODS AND RESULTS: Twelve hereditary hyperlipidaemic rabbits underwent quantitative analysis of plaque in the thoracic aorta with 256-slice CTA and USPIO-enhanced (ultra-small superparamagnetic nanoparticles, P904) 1.5-T MRI at baseline and at 6-month follow-up. Computational fluid dynamics using CTA-based 3D reconstruction of thoracic aortas identified the ESS patterns in the convex and concave curvature subsegments of interest. Subsegments with low baseline ESS exhibited significant increase in wall thickness and plaque inflammation by MRI, in non-calcified plaque burden by CTA, and developed increased plaque size, lipid and inflammatory cell accumulation (high-risk plaque features) at follow-up by histopathology. Multiple regression analysis identified baseline ESS and inflammation by MRI to be independent predictors of plaque progression, while receiver operating curve analysis revealed baseline ESS alone or in combination with inflammation by MRI as the strongest predictor for augmented plaque burden and inflammation (low ESS at baseline: AUC = 0.84, P < 0.001; low ESS and inflammation by molecular MRI at baseline: AUC = 0.89, P < 0.001). CONCLUSION: Low ESS predicts progression of plaque burden and inflammation as assessed by non-invasive USPIO-enhanced MRI. Combined non-invasive assessment of ESS and imaging of inflammation may serve to predict plaque with high-risk features.
Asunto(s)
Angiografía por Tomografía Computarizada/métodos , Endotelio Vascular/patología , Hiperlipidemias/diagnóstico por imagen , Imagen por Resonancia Magnética/métodos , Placa Aterosclerótica/diagnóstico por imagen , Resistencia al Corte , Animales , Aorta/diagnóstico por imagen , Aorta/patología , Biopsia con Aguja , Intervalos de Confianza , Modelos Animales de Enfermedad , Progresión de la Enfermedad , Hiperlipidemias/patología , Inmunohistoquímica , Inflamación/diagnóstico por imagen , Inflamación/patología , Modelos Lineales , Masculino , Imagen Molecular/métodos , Variaciones Dependientes del Observador , Placa Aterosclerótica/patología , Valor Predictivo de las Pruebas , Curva ROC , Conejos , Distribución Aleatoria , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Ultrasonografía IntervencionalRESUMEN
Refractory angina refers to a group of patients with stable coronary atherosclerotic disease and angina symptoms, unresponsive to traditional medical management, while considered to be suboptimal candidates for revascularization procedures. Up to 15% of angina patients are considered to have refractory angina and, taking into account the aging population and the improvements in the treatment of stable coronary artery disease, the incidence of this entity is expected to increase. This review describes traditional and novel pharmacotherapies for symptoms relief and for long-term management of refractory angina. Mechanisms of action and relevant clinical trials are discussed and current recommendations from major European and US cardiovascular societies are reported.
Asunto(s)
Angina de Pecho/tratamiento farmacológico , Fármacos Cardiovasculares/farmacología , Fármacos Cardiovasculares/uso terapéutico , Enfermedad de la Arteria Coronaria/tratamiento farmacológico , Antagonistas Adrenérgicos beta/farmacología , Antagonistas Adrenérgicos beta/uso terapéutico , Angina de Pecho/fisiopatología , Bloqueadores de los Canales de Calcio/farmacología , Bloqueadores de los Canales de Calcio/uso terapéutico , Enfermedad de la Arteria Coronaria/fisiopatología , Fibrinolíticos/farmacología , Fibrinolíticos/uso terapéutico , Humanos , Inhibidores de Hidroximetilglutaril-CoA Reductasas/farmacología , Inhibidores de Hidroximetilglutaril-CoA Reductasas/uso terapéutico , Nicorandil/farmacología , Nicorandil/uso terapéutico , Nitratos/farmacología , Nitratos/uso terapéutico , Ranolazina/farmacología , Ranolazina/uso terapéuticoRESUMEN
BACKGROUND: The temporal variation of the hemodynamic mechanical parameters during cardiac pulse wave is considered as an important atherogenic factor. Applying non-Newtonian blood molecular viscosity simulation is crucial for hemodynamic analysis. Understanding low density lipoprotein (LDL) distribution in relation to flow parameters will possibly spot the prone to atherosclerosis aorta regions. METHODS: The biomechanical parameters tested were averaged wall shear stress (AWSS), oscillatory shear index (OSI) and relative residence time (RRT) in relation to the LDL concentration. Four non-Newtonian molecular viscosity models and the Newtonian one were tested for the normal human aorta under oscillating flow. The analysis was performed via computational fluid dynamic. RESULTS: Tested viscosity blood flow models for the biomechanical parameters yield a consistent aorta pattern. High OSI and low AWSS develop at the concave aorta regions. This is most noticeable in downstream flow region of the left subclavian artery and at concave ascending aorta. Concave aorta regions exhibit high RRT and elevated LDL. For the concave aorta site, the peak LDL value is 35.0% higher than its entrance value. For the convex site, it is 18.0%. High LDL endothelium regions located at the aorta concave site are well predicted with high RRT. CONCLUSIONS: We are in favor of using the non-Newtonian power law model for analysis. It satisfactorily approximates the molecular viscosity, WSS, OSI, RRT and LDL distribution. Concave regions are mostly prone to atherosclerosis. The flow biomechanical factor RRT is a relatively useful tool for identifying the localization of the atheromatic plaques of the normal human aorta.
RESUMEN
Wall stress (WS) is associated with high arterial pressure and affects the localization of atherosclerotic lesions. We sought to non-invasively investigate the distribution of WS along the length of human coronary arteries and investigate its potential effect on atherosclerosis in association with vascular stiffness, local arterial curvature and plaque volume. We reconstructed three-dimensionally 28 coronary arteries from 22 subjects who had undergone coronary computed tomography angiography. Coronary arteries were divided in 2 mm-long segments. WS, vascular stiffness, plaque volume and curvature were calculated in each segment using computational fluid dynamics and morphology measurements. Plaque segments exhibited lower WS compared to their adjacent normal segments. Within plaques, WS was lower in the mid plaque portion compared to the upstream portion. Plaque volume was higher in the mid plaque portion compared to upstream and downstream portions. Low WS was associated with high curvature and both low WS and high curvature were associated with increased plaque volume. The current study demonstrates that WS and plaque volume are not uniform in the longitudinal axis of human coronary plaque. Calculation of WS could serve as a surrogate for the localization of plaque development and the identification of plaques at a more advanced stage of progression.
Asunto(s)
Angiografía Coronaria/métodos , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Vasos Coronarios/diagnóstico por imagen , Tomografía Computarizada Multidetector , Placa Aterosclerótica , Anciano , Fenómenos Biomecánicos , Simulación por Computador , Enfermedad de la Arteria Coronaria/fisiopatología , Circulación Coronaria , Vasos Coronarios/fisiopatología , Estudios Transversales , Progresión de la Enfermedad , Femenino , Humanos , Imagenología Tridimensional , Modelos Lineales , Masculino , Persona de Mediana Edad , Modelos Cardiovasculares , Valor Predictivo de las Pruebas , Interpretación de Imagen Radiográfica Asistida por Computador , Estrés Mecánico , Rigidez VascularRESUMEN
Treatment of coronary bifurcation lesions remains an ongoing challenge for interventional cardiologists. Stenting of coronary bifurcations carries higher risk for in-stent restenosis, stent thrombosis, and recurrent clinical events. This review summarizes the current evidence regarding application and use of biomechanical modeling in the study of stent properties, local flow dynamics, and outcomes after percutaneous coronary interventions in bifurcation lesions. Biomechanical modeling of bifurcation stenting involves computational simulations and in vitro bench testing using subject-specific arterial geometries obtained from in vivo imaging. Biomechanical modeling has the potential to optimize stenting strategies and stent design, thereby reducing adverse outcomes. Large-scale clinical studies are needed to establish the translation of pre-clinical findings to the clinical arena.
Asunto(s)
Angioplastia Coronaria con Balón/instrumentación , Enfermedad de la Arteria Coronaria/terapia , Circulación Coronaria , Vasos Coronarios/fisiopatología , Modelos Cardiovasculares , Stents , Animales , Fenómenos Biomecánicos , Simulación por Computador , Diseño Asistido por Computadora , Enfermedad de la Arteria Coronaria/diagnóstico , Enfermedad de la Arteria Coronaria/fisiopatología , Vasos Coronarios/patología , Humanos , Modelos Anatómicos , Diseño de Prótesis , Terapia Asistida por Computador , 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.
Asunto(s)
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
INTRODUCTION: We sought to assess noninvasively the differences in hemorrheologic and geometric parameters between the left and right coronary artery (RCA). Low endothelial shear stress (ESS), high molecular viscosity (MV), and high wall stress (WS) induce atherosclerosis, while curvature and torsion have lately been implicated in the atherosclerotic process. METHODS: We studied 28 coronary arteries from 22 subjects undergoing coronary computed tomography angiography. We performed 3D reconstruction of the left anterior descending (LAD, n=14), left circumflex (LCx, n=5), and RCA (n=9) arteries. ESS, MV, and WS were calculated for 2-mm segments using computational fluid dynamics. Curvature and torsion were calculated for each segment using morphometric algorithms. RESULTS: A total length of 187 cm of coronary arteries was studied. ESS was higher in the LAD compared to the LCx and RCA (13.76 Pa vs. 3.49 Pa vs. 3.76 Pa, p<0.001); MV was higher in the LCx compared to the LAD and RCA (0.00542 Pa·s vs. 0.00173 Pa·s vs. 0.00240 Pa·s, p<0.001); and WS had higher values in the RCA compared to the LAD and LCx (289.98 mmHg vs. 255.93 mmHg vs. 235.18 mmHg, p<0.001). Curvature was greater in the LCx compared to the LAD and RCA (0.1447 mm-1 vs. 0.1229 mm-1 vs. 0.1234 mm-1, p<0.05), while torsion was found not to differ among the coronary arteries. CONCLUSIONS: Hemorrheologic and geometric parameters differ between the left and right coronary arteries. These factors, either alone or in association with local flow patterns and geometry, may affect the topography of atherosclerosis in the coronary arterial tree.
Asunto(s)
Aterosclerosis/fisiopatología , Vasos Coronarios/anatomía & histología , Vasos Coronarios/fisiología , Anciano , Algoritmos , Presión Arterial/fisiología , Aterosclerosis/diagnóstico por imagen , Viscosidad Sanguínea/fisiología , Angiografía Coronaria/métodos , Vasos Coronarios/diagnóstico por imagen , Vasos Coronarios/fisiopatología , Electrocardiografía/métodos , Femenino , Hemorreología/fisiología , Humanos , Imagenología Tridimensional/métodos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Resistencia al Corte , Estrés MecánicoRESUMEN
Coronary artery bifurcations are susceptible to atherosclerosis as a result of the unique local flow patterns and the subsequent endothelial shear stress (ESS) environment that are conducive to the development of plaques. Along the lateral walls of the main vessel and side branches, a distinct flow pattern is observed with local low and oscillatory ESS, while high ESS develops at the flow divider (carina). Histopathologic studies have shown that the distribution of plaque at bifurcation regions is related to the local ESS patterns. The local ESS profile also influences the outcome of percutaneous coronary interventions in bifurcation lesions. A variety of invasive and non-invasive imaging modalities have enabled 3D reconstruction of coronary bifurcations and thereby detailed local ESS assessment by computational fluid dynamics. Highly effective strategies for treatment and ultimately prevention of atherosclerosis in coronary bifurcations are anticipated with the use of advanced imaging and computational fluid dynamic techniques.
Asunto(s)
Enfermedad de la Arteria Coronaria/diagnóstico , Circulación Coronaria , Vasos Coronarios/patología , Hemodinámica , Placa Aterosclerótica/diagnóstico , Angiografía Coronaria , Vasos Coronarios/diagnóstico por imagen , Humanos , Imagenología Tridimensional , Placa Aterosclerótica/fisiopatología , Tomografía de Coherencia Óptica , Ultrasonografía IntervencionalRESUMEN
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.
Asunto(s)
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
We sought to noninvasively assess the relationship between arterial remodeling, endothelial shear stress (ESS), and wall stiffness in coronary arteries. We studied 28 coronary arteries from 22 patients undergoing coronary computed tomography angiography (CCTA). The ESS was calculated in 2-mm long segments using computational fluid dynamics. Local remodeling, plaque dimensions, and local wall stiffness were assessed in each segment. The ESS was lower in the regions of excessive expansive remodeling versus compensatory expansive versus inadequate expansive versus constrictive remodeling. Areas of decreased wall stiffness more frequently exhibited excessive expansive remodeling. Plaque volume was higher in segments showing excessive expansive and inadequate remodeling than segments with constrictive remodeling. In conclusion, CCTA enables the noninvasive assessment of coronary hemodynamics and arterial/plaque morphology. Excessive expansive remodeling is associated with high-risk plaque features, such as low ESS, decreased plaque stiffness, and increased plaque volume. This methodology may be useful in the risk assessment of individual coronary lesions.
Asunto(s)
Angiografía Coronaria/métodos , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Circulación Coronaria , Vasos Coronarios/diagnóstico por imagen , Endotelio Vascular/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Rigidez Vascular , Anciano , Simulación por Computador , Enfermedad de la Arteria Coronaria/patología , Enfermedad de la Arteria Coronaria/fisiopatología , Vasos Coronarios/patología , Vasos Coronarios/fisiopatología , Estudios Transversales , Elasticidad , Endotelio Vascular/patología , Endotelio Vascular/fisiopatología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Modelos Cardiovasculares , Proyectos Piloto , Placa Aterosclerótica , Valor Predictivo de las Pruebas , Pronóstico , Interpretación de Imagen Radiográfica Asistida por Computador , Medición de Riesgo , Factores de Riesgo , Estrés MecánicoRESUMEN
There is an ongoing research and clinical interest in the development of reliable and easily accessible software for the 3D reconstruction of coronary arteries. In this work, we present the architecture and validation of IVUSAngio Tool, an application which performs fast and accurate 3D reconstruction of the coronary arteries by using intravascular ultrasound (IVUS) and biplane angiography data. The 3D reconstruction is based on the fusion of the detected arterial boundaries in IVUS images with the 3D IVUS catheter path derived from the biplane angiography. The IVUSAngio Tool suite integrates all the intermediate processing and computational steps and provides a user-friendly interface. It also offers additional functionality, such as automatic selection of the end-diastolic IVUS images, semi-automatic and automatic IVUS segmentation, vascular morphometric measurements, graphical visualization of the 3D model and export in a format compatible with other computer-aided design applications. Our software was applied and validated in 31 human coronary arteries yielding quite promising results. Collectively, the use of IVUSAngio Tool significantly reduces the total processing time for 3D coronary reconstruction. IVUSAngio Tool is distributed as free software, publicly available to download and use.