730 research outputs found
Deep learning analysis of the myocardium in coronary CT angiography for identification of patients with functionally significant coronary artery stenosis
In patients with coronary artery stenoses of intermediate severity, the
functional significance needs to be determined. Fractional flow reserve (FFR)
measurement, performed during invasive coronary angiography (ICA), is most
often used in clinical practice. To reduce the number of ICA procedures, we
present a method for automatic identification of patients with functionally
significant coronary artery stenoses, employing deep learning analysis of the
left ventricle (LV) myocardium in rest coronary CT angiography (CCTA). The
study includes consecutively acquired CCTA scans of 166 patients with FFR
measurements. To identify patients with a functionally significant coronary
artery stenosis, analysis is performed in several stages. First, the LV
myocardium is segmented using a multiscale convolutional neural network (CNN).
To characterize the segmented LV myocardium, it is subsequently encoded using
unsupervised convolutional autoencoder (CAE). Thereafter, patients are
classified according to the presence of functionally significant stenosis using
an SVM classifier based on the extracted and clustered encodings. Quantitative
evaluation of LV myocardium segmentation in 20 images resulted in an average
Dice coefficient of 0.91 and an average mean absolute distance between the
segmented and reference LV boundaries of 0.7 mm. Classification of patients was
evaluated in the remaining 126 CCTA scans in 50 10-fold cross-validation
experiments and resulted in an area under the receiver operating characteristic
curve of 0.74 +- 0.02. At sensitivity levels 0.60, 0.70 and 0.80, the
corresponding specificity was 0.77, 0.71 and 0.59, respectively. The results
demonstrate that automatic analysis of the LV myocardium in a single CCTA scan
acquired at rest, without assessment of the anatomy of the coronary arteries,
can be used to identify patients with functionally significant coronary artery
stenosis.Comment: This paper was submitted in April 2017 and accepted in November 2017
for publication in Medical Image Analysis. Please cite as: Zreik et al.,
Medical Image Analysis, 2018, vol. 44, pp. 72-8
Reply to 'Percutaneous coronary intervention timing and coronary physiology in transcatheter aortic valve implantation patients'
Reply to the letter of Soliman et al. regarding 'Randomised comparison of a balloon-expandable and self-expandable valve with quantitative assessment of aortic regurgitation using magnetic resonance imaging'
Serial Morphological and Functional Assessment of Drug-Eluting Balloon for In-Stent Restenotic Lesions Mechanisms of Action Evaluated With Angiography, Optical Coherence Tomography, and Fractional Flow Reserve
ObjectivesThis study sought to elucidate the underlying mechanism through which drug-eluting balloons (DEB) restore coronary blood flow, by assessing the coronary vessel before, immediately after, and at 6-month follow-up with angiography, optical coherence tomography (OCT), and fractional flow reserve (FFR).BackgroundIn-stent restenosis (ISR) treatment remains challenging. Drug-eluting balloons have been shown to be a valid treatment option in several studies. These studies focused on efficiency of the device, whereas the mechanisms of action of DEB in ISR treatment have not been investigated.MethodsIn this prospective, single-center observational study, patients with ISR were treated with a second-generation DEB. Serial angiographic, OCT, and FFR measurements were performed before and after the procedure, as well as at 6-month follow-up.ResultsTwenty-five patients were assigned to DEB treatment, with an angiographic and device success of 100% and 92%, respectively. Late luminal loss was 0.01 ± 0.43 mm. Median percent changes [interquartile range] between pre-and post-procedure, and post-procedure and follow-up were, respectively: lumen volume 75.1% increase [43.7 to 115.0], and 8% increase [−14.0 to 25.8]; stent volume 23.7% increase [15.5 to 40.0], and −1.2% decrease [−6.9 to 5.9]; and neointimal volume −14.4% decrease [−29.2 to −9.5], and −15.8% decrease [−38.1 to 28.3]. The FFR gradient along the treated stent (difference in FFR between the distal and the proximal stent edge) was 0.37 ± 0.18 pre-procedure, 0.06 ± 0.04 post-procedure, and 0.05 ± 0.05 at follow-up. In all post-procedural OCT images, intrastent dissections were seen, which were sealed at follow-up OCT.ConclusionsDEB restore coronary blood flow by means of a short-term mechanical effect, causing an increase in lumen and stent volumes and compression of neointimal hyperplasia (with intra-stent dissections). Due to the local drug effect, patency persists and may even improve at follow-up, with further increase in lumen volume, decrease in neointimal volume, and complete sealing of neointimal dissections
Case report: Dobutamine stress intracoronary physiology and imaging to examine the functional and dynamic properties of an apparent malignant intra-arterial right coronary artery
Background: We present a case concerning a 64-year-old female with complaints of palpitations, chest pain, and an anomalous right coronary artery (RCA) from the opposite sinus (R-ACAOS) with a suspected malignant trajectory on computed tomography. She was referred to our clinic for a second opinion to re-assess the suggested treatment of coronary surgery. Case summary: A coronary angiogram was performed demonstrating a RCA with a tapered ostium typical for an inter-arterial course. Dobutamine and adenosine stress test during simultaneous intracoronary flow, pressure, and ultrasound assessment, was performed to determine the functional significance. After 120 mcg adenosine, intracoronary baseline flow velocity increased from 14 cm/s to a peak flow velocity of 37 cm/s, demonstrating a sufficient coronary flow velocity reserve (CFVR) of 2.6. No intracoronary pressure drop during maximal hyperaemia was found. After maximum dobutamine stress, CFVR was measured 2.5. Fractional flow reserve measured 0.99. Cross-sectional area measurement through intravascular ultrasound demonstrated a diameter reduction from 14.6 mm2 to 8.5 mm2. Therefore, we concluded this aberrant trajectory was not of any functional relevance and should be considered non-malignant. Discussion: There are several anatomic coronary anomalies which may contribute to coronary compression during exercise and are therefore correlated with sudden cardiac death. Right coronary artery from the opposite sinus is correlated with a low mortality rate of 0.2% in comparison to left-ACAOS at 6.3% over 20 years in participants of competitive sport. Therefore, strong evidence of ischaemia must be present before opting for surgery. Our pragmatic approach provided in our opinion enough evidence for a conservative treatment strategy
Muscular Performance and Neuromuscular Fatigue are not Sex-Dependent During Low-Load Fatiguing Bilateral Leg Extension Exercise
Purpose. This study examined the sex-related differences in muscular performance and neuromuscular (electromyographic [EMG] and mechanomyographic [MMG] amplitude [AMP] and mean power frequency [MPF]) responses during fatiguing leg extension repetitions performed at the critical load (CL). Methods. Eleven men and nine women completed one-repetition maximum (1RM) testing, repetitions to failure at 50, 60, 70, and 80% 1RM to determine CL, and repetitions to failure at CL, on separate days. The EMG and MMG, AMP and MPF signals and number of repetitions completed were recorded. Results. There were no sex-dependent responses in the %1RM that corresponded to, the number of repetitions completed at, or the neuromuscular responses during repetitions performed to failure at CL. There were time-dependent responses in EMG AMP from 25-100% of total repetitions completed, respectively. The EMG MPF and MMG MPF demonstrated fatigue-induced decreases from 50-100% and at 100% of total repetitions completed, respectively. There was no change over time for MMG AMP. Conclusions. These findings indicated men and women responded similarly to leg extension exercise performed at the CL. Further, sex-dependent responses to fatiguing exercise may be related to the amount of active muscle mass engaged in exercise and the corresponding afferent feedback that influences peripheral fatigue and central drive during fatiguing tasks
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