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Coronary Artery Disease: HELP
Articles by Johan H. C. Reiber
Based on 57 articles published since 2010
(Why 57 articles?)
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Between 2010 and 2020, J. H. Reiber wrote the following 57 articles about Coronary Artery Disease.
 
+ Citations + Abstracts
Pages: 1 · 2 · 3
1 Editorial QCA editorial. 2011

Costa, Ricardo A / Reiber, Johan H C. · ·Int J Cardiovasc Imaging · Pubmed #21455674.

ABSTRACT: -- No abstract --

2 Editorial Introduction to QCA, IVUS and OCT in interventional cardiology. 2011

Reiber, Johan H C. · ·Int J Cardiovasc Imaging · Pubmed #21337024.

ABSTRACT: -- No abstract --

3 Review Invasive assessment of coronary artery disease. 2018

Pyxaras, Stylianos A / Wijns, William / Reiber, Johan H C / Bax, Jeroen J. ·Cardiology Department, Coburg-Clinic, Ketschendorfer Str. 33, 96450, Coburg, Germany. steliospyxaras@gmail.com. · The Lambe Institute for Translational Medicine and Curam, National University of Ireland, Galway and Saolta University Healthcare Group, Galway, Ireland. · Division of Image Processing, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands. · Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands. ·J Nucl Cardiol · Pubmed #28849416.

ABSTRACT: Coronary artery disease is associated to high mortality and morbidity rates and an accurate diagnostic assessment during heart catheterization has a fundamental role in prognostic stratification and treatment choices. Coronary angiography has been integrated by intravascular imaging modalities, namely intravascular ultrasound and optical coherence tomography, which allow the precise quantification of the atherosclerotic burden of coronary arteries. The hemodynamic relevance of a given coronary stenosis can be assessed using stress or resting indexes: fractional flow reserve and instantaneous wave-free ratio are both coronary flow surrogates, used to guide percutaneous coronary interventions. This review summarizes the current state-of-the-art of invasive diagnostic methods during heart catheterization and highlights the potential role that an integration of anatomical and functional information enables.

4 Review Biomechanical Modeling to Improve Coronary Artery Bifurcation Stenting: Expert Review Document on Techniques and Clinical Implementation. 2015

Antoniadis, Antonios P / Mortier, Peter / Kassab, Ghassan / Dubini, Gabriele / Foin, Nicolas / Murasato, Yoshinobu / Giannopoulos, Andreas A / Tu, Shengxian / Iwasaki, Kiyotaka / Hikichi, Yutaka / Migliavacca, Francesco / Chiastra, Claudio / Wentzel, Jolanda J / Gijsen, Frank / Reiber, Johan H C / Barlis, Peter / Serruys, Patrick W / Bhatt, Deepak L / Stankovic, Goran / Edelman, Elazer R / Giannoglou, George D / Louvard, Yves / Chatzizisis, Yiannis S. ·Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Cardiovascular Engineering and Atherosclerosis Laboratory, AHEPA University Hospital, Aristotle University Medical School, Thessaloniki, Greece; Cardiovascular Department, Guy's and St Thomas' National Health Service Foundation Trust, London, United Kingdom. · FEops, Ghent, Belgium; IBiTech-bioMMeda, Ghent University, Ghent, Belgium. · California Medical Innovations Institute, San Diego, California. · Laboratory of Biological Structure Mechanics (LaBS), Department of Chemistry, Materials and Chemical Engineering "Giulio Natta," Politecnico di Milano, Milan, Italy. · National Heart Centre Singapore, Singapore. · Department of Cardiology and Clinical Research Institute, Kyushu Medical Center, Fukuoka, Japan. · Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Cardiovascular Engineering and Atherosclerosis Laboratory, AHEPA University Hospital, Aristotle University Medical School, Thessaloniki, Greece. · Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China. · Graduate School of Advanced Science and Engineering, Waseda University, Tokyo, Japan. · Cardiovascular Division, Department of Internal Medicine, Saga University, Saga, Japan. · Laboratory of Biological Structure Mechanics (LaBS), Department of Chemistry, Materials and Chemical Engineering "Giulio Natta," Politecnico di Milano, Milan, Italy; Biomechanics Laboratory, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands. · Biomechanics Laboratory, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands. · Division of Image Processing, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands. · Melbourne Medical School and Melbourne School of Engineering, The University of Melbourne, Melbourne, Australia. · International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London, London, United Kingdom. · Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. · Department of Cardiology, Clinical Center of Serbia, and Medical Faculty, University of Belgrade, Belgrade, Serbia. · Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, Massachusetts. · Cardiovascular Engineering and Atherosclerosis Laboratory, AHEPA University Hospital, Aristotle University Medical School, Thessaloniki, Greece. · Institut Cardiovasculaire Paris Sud, Massy, France. · Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Cardiovascular Engineering and Atherosclerosis Laboratory, AHEPA University Hospital, Aristotle University Medical School, Thessaloniki, Greece. Electronic address: ychatzizisis@icloud.com. ·JACC Cardiovasc Interv · Pubmed #26315731.

ABSTRACT: 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.

5 Review Cardiac MR perfusion image processing techniques: a survey. 2012

Gupta, Vikas / Kirişli, Hortense A / Hendriks, Emile A / van der Geest, Rob J / van de Giessen, Martijn / Niessen, Wiro / Reiber, Johan H C / Lelieveldt, Boudewijn P F. ·Division of Image Processing, Department of Radiology, Leiden University Medical Center, 2300 RC Leiden, The Netherlands. ·Med Image Anal · Pubmed #22297264.

ABSTRACT: First-pass cardiac MR perfusion (CMRP) imaging has undergone rapid technical advancements in recent years. Although the efficacy of CMRP imaging in the assessment of coronary artery diseases (CAD) has been proven, its clinical use is still limited. This limitation stems, in part, from manual interaction required to quantitatively analyze the large amount of data. This process is tedious, time-consuming, and prone to operator bias. Furthermore, acquisition and patient related image artifacts reduce the accuracy of quantitative perfusion assessment. With the advent of semi- and fully automatic image processing methods, not only the challenges posed by these artifacts have been overcome to a large extent, but a significant reduction has also been achieved in analysis time and operator bias. Despite an extensive literature on such image processing methods, to date, no survey has been performed to discuss this dynamic field. The purpose of this article is to provide an overview of the current state of the field with a categorical study, along with a future perspective on the clinical acceptance of image processing methods in the diagnosis of CAD.

6 Review QCA, IVUS and OCT in interventional cardiology in 2011. 2011

Reiber, Johan H C / Tu, Shengxian / Tuinenburg, Joan C / Koning, Gerhard / Janssen, Johannes P / Dijkstra, Jouke. ·Division of Image Processing (LKEB), Department of Radiology, Leiden University Medical Center (LUMC), Leiden, The Netherlands. ·Cardiovasc Diagn Ther · Pubmed #24282685.

ABSTRACT: Over the past 30 years, quantitative coronary arteriography (QCA) has been used extensively as an objective and reproducible tool in clinical research to assess changes in vessel dimensions as a result of interventions, but also as a tool to provide evidence to the interventionalist prior to and after an intervention and at follow-up when necessary. With the increasing complexities of bifurcation stenting, corresponding analytical tools for bifurcation analysis have been developed with extensive reporting schemes. Although intravascular ultrasound (IVUS) has been around for a long time as well, more recent radiofrequency analysis provides additional information about the vessel wall composition; likewise optical coherence tomography (OCT) provides detailed information about the positions of the stent struts and the quality of the stent placement. Combining the information from the X-ray lumenogram and the intravascular imaging devices is mentally a challenging task for the interventionalist. To support the registration of these intravascular images with the X-ray images, 3D QCA has been developed and registered with the IVUS or OCT images, so that at every position along the vessel of interest the luminal data and the vessel wall data by IVUS or the stent strut data by OCT can be combined. From the 3D QCA the selection of the optimal angiographic views can also be facilitated. It is the intention of this overview paper to provide an extensive description of the techniques that we have developed and validated over the past 30 years.

7 Review Dedicated bifurcation analysis: basic principles. 2011

Tuinenburg, Joan C / Koning, Gerhard / Rareş, Andrei / Janssen, Johannes P / Lansky, Alexandra J / Reiber, Johan H C. ·Division of Image Processing, LKEB, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands. J.C.Tuinenburg@lumc.nl ·Int J Cardiovasc Imaging · Pubmed #21327913.

ABSTRACT: Over the last several years significant interest has arisen in bifurcation stenting, in particular stimulated by the European Bifurcation Club. Traditional straight vessel analysis by QCA does not satisfy the requirements for such complex morphologies anymore. To come up with practical solutions, we have developed two models, a Y-shape and a T-shape model, suitable for bifurcation QCA analysis depending on the specific anatomy of the coronary bifurcation. The principles of these models are described in this paper, as well as the results of validation studies carried out on clinical materials. It can be concluded that the accuracy, precision and applicability of these new bifurcation analyses are conform the general guidelines that have been set many years ago for conventional QCA-analyses.

8 Clinical Trial Impact of the Everolimus-eluting Bioresorbable Scaffold in Coronary Atherosclerosis. 2016

Campos, Carlos M / Garcia-Garcia, Hector M / Muramatsu, Takashi / de Araujo Gonçalves, Pedro / Onuma, Yoshinobu / Dudek, Dariusz / Thuesen, Leif / Webster, Mark W I / Kitslaar, Pieter / Veldhof, Susan / Reiber, Johan H C / Nieman, Koen / Ormiston, John A / Serruys, Patrick W. ·Department of Cardiology, Erasmus University Medical Centre, Thoraxcenter, Rotterdam, The Netherlands; Heart Institute (InCor), University of São Paulo Medical School, Sao Paulo, Brazil; Department of Interventional Cardiology, Hospital Israelita Albert Einstein, Sao Paulo, Brazil. · Department of Cardiology, Erasmus University Medical Centre, Thoraxcenter, Rotterdam, The Netherlands. Electronic address: hect2701@gmail.com. · Department of Cardiology, Erasmus University Medical Centre, Thoraxcenter, Rotterdam, The Netherlands; Department of Cardiology, Fujita Health University Hospital, Toyoake, Japan. · Cardiology Department, Hospital de Santa Cruz, CHLO, Lisbon, Portugal; Hospital da Luz, Cardiovascular Center, ESS, Lisbon, Portugal; CEDOC, Chronic Diseases Research Center, FCM-NOVA, Lisbon, Portugal. · Department of Cardiology, Erasmus University Medical Centre, Thoraxcenter, Rotterdam, The Netherlands. · Jagiellonian University, Krakow, Poland. · Department of Cardiology, Aarhus University Hospital, Skejby, Denmark. · Auckland City Hospital, Auckland, New Zealand. · Medis Medical Imaging Systems, B.V., Leiden, The Netherlands; Division of Image Processing, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands. · Abbott Vascular, Diegem, Belgium. · Department of Cardiology, Erasmus University Medical Centre, Thoraxcenter, Rotterdam, The Netherlands; Department of Radiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands. · International Centre for Circulatory Health, NHLI, Imperial College London, London, United Kingdom. ·Rev Esp Cardiol (Engl Ed) · Pubmed #26739828.

ABSTRACT: INTRODUCTION AND OBJECTIVES: The Absorb bioresorbable vascular scaffold has been shown to decrease total plaque areas in the treated segment. However, it is unknown whether plaque size is modified in scaffolded segments only or whether the modification extends to other coronary segments. METHODS: Absorb Cohort A is a single-arm, prospective study, with safety and imaging endpoints, in which 30 patients underwent percutaneous coronary intervention with the first generation Absorb bioresorbable vascular scaffold. Noninvasive multislice computed tomography imaging was performed in 18 patients at 18 months and 5 years of follow-up. The present study was an intrapatient comparison of matched segments (normalized by the segment length) of the scaffolded region with nonintervened segments for lumen volume, vessel volume, plaque volume, plaque burden, and percent change in plaque atheroma volume. RESULTS: All 18 scaffolded segments could be analyzed. In the nonintervened segments, 1 of 72 segments had a motion artifact and was excluded. Serial comparison showed that the scaffolded segments showed no significant change in the mean plaque burden, total atheroma volume, total lumen volume, or vessel volume between 18 months and 5 years. Conversely, the untreated segments showed a significant increase in plaque burden (2.7 ± 6.5%; P < .01) and normalized plaque volumes (8.0 ± 22.8mm(3); P < .01). This resulted in a significant difference in plaque burden between scaffolded and nonintervened segments (P = .03). CONCLUSIONS: In this small series, the Absorb bioresorbable vascular scaffold showed the potential to provide an additional benefit to pharmacological therapy in locally reducing progression of percent plaque burden. These findings need to be confirmed in larger studies.

9 Clinical Trial Detection of coronary plaques using MR coronary vessel wall imaging: validation of findings with intravascular ultrasound. 2013

Gerretsen, Suzanne / Kessels, Alfons G / Nelemans, Patty J / Dijkstra, Jouke / Reiber, Johan H C / van der Geest, Rob J / Katoh, Marcus / Waltenberger, Johannes / van Engelshoven, Jos M A / Botnar, Rene M / Kooi, M Eline / Leiner, Tim. ·Department of Radiology, Maastricht University Medical Centre, P. Debyelaan 25, 6229HX, Maastricht, The Netherlands. ·Eur Radiol · Pubmed #22782568.

ABSTRACT: OBJECTIVES: Compared with X-ray coronary angiography (CAG), magnetic resonance imaging of the coronary vessel wall (MR-CVW) may provide more information about plaque burden and coronary remodelling. We compared MR-CVW with intravascular ultrasound (IVUS), the standard of reference for coronary vessel wall imaging, with regard to plaque detection and wall thickness measurements. METHODS: In this study 17 patients with chest pain, who had been referred for CAG, were included. Patients underwent IVUS and MR-CVW imaging of the right coronary artery (RCA). Subsequently, the coronary vessel wall was analysed for the presence and location of coronary plaques. RESULTS: Fifty-two matching RCA regions of interest were available for comparison. There was good agreement between IVUS and MR-CVW for qualitative assessment of presence of disease, with a sensitivity of 94% and specificity of 76%. Wall thickness measurements demonstrated a significant difference between mean wall thickness on IVUS and MR-CVW (0.48 vs 1.24 mm, P < 0.001), but great heterogeneity between wall thickness measurements, resulting in a low correlation between IVUS and MR-CVW. CONCLUSIONS: MR-CVW has high sensitivity for the detection of coronary vessel wall thickening in the RCA compared with IVUS. However, the use of MRI for accurate absolute wall thickness measurements is not supported when a longitudinal acquisition orientation is used.

10 Article Comparative effectiveness of coronary artery stenosis and atherosclerotic plaque burden assessment for predicting 30-day revascularization and 2-year major adverse cardiac events. 2020

Kishi, Satoru / Magalhães, Tiago A / Cerci, Rodrigo J / Zimmermann, Elke / Matheson, Matthew B / Vavere, Andrea / Tanami, Yutaka / Kitslaar, Pieter H / George, Richard T / Brinker, Jeffrey / Miller, Julie M / Clouse, Melvin E / Lemos, Pedro A / Niinuma, Hiroyuki / Reiber, Johan H C / Kofoed, Klaus F / Rochitte, Carlos E / Rybicki, Frank J / Di Carli, Marcelo F / Cox, Christopher / Lima, Joao A C / Arbab-Zadeh, Armin. ·Department of Medicine/ Diabetology, Mitsui Memorial Hospital, Tokyo, Japan. · Federal University of Paraná, Hospital de Clínicas (CHC-UFPR), Curitiba, Brazil. · Quanta Diagnostico Nuclear, Curitiba, Brazil. · Department of Radiology, Charité, Berlin, Germany. · Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA. · Department of Medicine, Johns Hopkins University, Baltimore, USA. · Department of Radiology, Keio University, Tokyo, Japan. · Leiden University Medical Center/Medis Medical Imaging Systems, Leiden, The Netherlands. · iDepartment of Radiology, Beth Israel Deaconess Medical Center, Boston, USA. · Heart Institute (InCor), University of Sao Paulo, São Paulo, Brazil. · Hospital Israelita Albert Einstein, Sao Paulo, SP, Brazil. · Department of Medicine, Division of Cardiology, St. Luke's Hospital, Tokyo, Japan. · Department of Medicine, Division of Cardiology, Rigshospitalet, Copenhagen, Denmark. · Department of Radiology, University of Cincinnati, Cincinnati, USA. · Department of Radiology, Brigham and Women's Hosptial, Boston, MA, USA. · Department of Medicine, Johns Hopkins University, Baltimore, USA. azadeh1@jhmi.edu. · Johns Hopkins Hospital, 600 N. Wolfe Street, Halsted 562, Baltimore, MD, 21287-0409, USA. azadeh1@jhmi.edu. ·Int J Cardiovasc Imaging · Pubmed #32361925.

ABSTRACT: PURPOSE: To provide comparative prognostic information of coronary atherosclerotic plaque volume and stenosis assessment in patients with suspected coronary artery disease (CAD). METHODS: We followed 372 patients with suspected or known CAD enrolled in the CORE320 study for 2 years after baseline 320-detector row cardiac CT scanning and invasive quantitative coronary angiography (QCA). CT images were analyzed for coronary calcium scanning (CACS), semi-automatically derived total percent atheroma volume (PAV), segment stenosis score (SSS), in addition to traditional stenosis assessment (≥ 50%) by CT and QCA for (1) 30-day revascularization and (2) major adverse cardiac events (MACE). Area under the receiver operating characteristic curve (AUC) was used to compare accuracy of risk prediction. RESULTS: Sixty percent of patients had obstructive CAD by QCA with 23% undergoing 30-day revascularization and 9% experiencing MACE at 2 years. Most late events (20/32) were revascularization procedures. Prediction of 30-day revascularization was modest (AUC range 0.67-0.78) but improved after excluding patients with known CAD (AUC range 0.73-0.86, p < 0.05 for all). Similarly, prediction of MACE improved after excluding patients with known CAD (AUC range 0.58-0.73 vs. 0.63-0.77). CT metrics of atherosclerosis burden performed overall similarly but stenosis assessment was superior for predicting 30-day revascularization. CONCLUSIONS: Angiographic and coronary atherosclerotic plaque metrics perform only modestly well for predicting 30-day revascularization and 2-year MACE in high risk patients but improve after excluding patients with known CAD. Atherosclerotic plaque metrics did not yield incremental value over stenosis assessment for predicting events that predominantly consisted of revascularization procedures. CLINICAL TRIAL REGISTRATION: NCT00934037.

11 Article Fractional flow reserve in clinical practice: from wire-based invasive measurement to image-based computation. 2019

Tu, Shengxian / Westra, Jelmer / Adjedj, Julien / Ding, Daixin / Liang, Fuyou / Xu, Bo / Holm, Niels Ramsing / Reiber, Johan H C / Wijns, William. ·School of Biomedical Engineering, Shanghai Jiao Tong University, No. 1954 Hua Shan Road, Shanghai 200030, China. · Department of Cardiology, Aarhus University Hospital, Skejby, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark. · Cardiology Department, Arnault Tzanck Institute, 171 Rue du Commandant Gaston Cahuzac, 06700 Saint-Laurent-du-Var, France. · Cardiology Department, CHUV, Rue du Bugnon 46, 1011 Lausanne, Switzerland. · School of Naval Architecture, Ocean and Civil Engineering, Shanghai Jiao Tong University, 800 Dongchuan Road, Shanghai 200240, China. · Institute for Personalized Medicine, Sechenov University, 8-2 Trubetskaya st., Moscow 119991, Russia. · Catheterization Laboratories, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, National Clinical Research Center for Cardiovascular Diseases, A 167, Beilishi Road, Xicheng District, Beijing 100037, China. · Division of Image Processing, Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands. · The Lambe Institute for Translational Medicine and Curam, National University of Ireland Galway, University Road, Galway H91 TK3, Ireland. ·Eur Heart J · Pubmed #31886479.

ABSTRACT: Fractional flow reserve (FFR) and instantaneous wave-free ratio are the present standard diagnostic methods for invasive assessment of the functional significance of epicardial coronary stenosis. Despite the overall trend towards more physiology-guided revascularization, there remains a gap between guideline recommendations and the clinical adoption of functional evaluation of stenosis severity. A number of image-based approaches have been proposed to compute FFR without the use of pressure wire and induced hyperaemia. In order to better understand these emerging technologies, we sought to highlight the principles, diagnostic performance, clinical applications, practical aspects, and current challenges of computational physiology in the catheterization laboratory. Computational FFR has the potential to expand and facilitate the use of physiology for diagnosis, procedural guidance, and evaluation of therapies, with anticipated impact on resource utilization and patient outcomes.

12 Article Referral of patients for fractional flow reserve using quantitative flow ratio. 2019

Smit, Jeff M / Koning, Gerhard / van Rosendael, Alexander R / El Mahdiui, Mohammed / Mertens, Bart J / Schalij, Martin J / Jukema, J Wouter / Delgado, Victoria / Reiber, Johan H C / Bax, Jeroen J / Scholte, Arthur J. ·Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, ZA Leiden, The Netherlands. · Medis Medical Imaging Systems B.V., Schuttersveld 9, XG Leiden, The Netherlands. · Department of Medical Statistics, Leiden University Medical Center, Albinusdreef 2, ZA Leiden, The Netherlands. · Department of Radiology, Leiden University Medical Center, Albinusdreef 2, ZA Leiden, The Netherlands. ·Eur Heart J Cardiovasc Imaging · Pubmed #30535361.

ABSTRACT: AIMS: Quantitative flow ratio (QFR) is a recently developed technique to calculate fractional flow reserve (FFR) based on 3D quantitative coronary angiography and computational fluid dynamics, obviating the need for a pressure-wire and hyperaemia induction. QFR might be used to guide patient selection for FFR and subsequent percutaneous coronary intervention (PCI) referral in hospitals not capable to perform FFR and PCI. We aimed to investigate the feasibility to use QFR to appropriately select patients for FFR referral. METHODS AND RESULTS: Patients who underwent invasive coronary angiography in a hospital where FFR and PCI could not be performed and were referred to our hospital for invasive FFR measurement, were included. Angiogram images from the referring hospitals were retrospectively collected for QFR analysis. Based on QFR cut-off values of 0.77 and 0.86, our patient cohort was reclassified to 'no referral' (QFR ≥0.86), referral for 'FFR' (QFR 0.78-0.85), or 'direct PCI' (QFR ≤0.77). In total, 290 patients were included. Overall accuracy of QFR to detect an invasive FFR of ≤0.80 was 86%. Based on a QFR cut-off value of 0.86, a 50% reduction in patient referral for FFR could be obtained, while only 5% of these patients had an invasive FFR of ≤0.80 (thus, these patients were incorrectly reclassified to the 'no referral' group). Furthermore, 22% of the patients that still need to be referred could undergo direct PCI, based on a QFR cut-off value of 0.77. CONCLUSION: QFR is feasible to use for the selection of patients for FFR referral.

13 Article Angiography-Derived Fractional Flow Reserve in the SYNTAX II Trial: Feasibility, Diagnostic Performance of Quantitative Flow Ratio, and Clinical Prognostic Value of Functional SYNTAX Score Derived From Quantitative Flow Ratio in Patients With 3-Vessel Disease. 2019

Asano, Taku / Katagiri, Yuki / Chang, Chun Chin / Kogame, Norihiro / Chichareon, Ply / Takahashi, Kuniaki / Modolo, Rodrigo / Tenekecioglu, Erhan / Collet, Carlos / Jonker, Hans / Appleby, Clare / Zaman, Azfar / van Mieghem, Nicolas / Uren, Neal / Zueco, Javier / Piek, Jan J / Reiber, Johan H C / Farooq, Vasim / Escaned, Javier / Banning, Adrian P / Serruys, Patrick W / Onuma, Yoshinobu. ·Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Department of Cardiology, St. Luke's International Hospital, Tokyo, Japan. · Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands. · ThoraxCenter, Erasmus Medical Center, Rotterdam, the Netherlands. · Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Department of Cardiology, Universitair Ziekenhuis Brussels, Brussels, Belgium. · Cardialysis, Rotterdam, the Netherlands. · Department of Cardiology, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom. · Department of Cardiology, Freeman Hospital Newcastle, Newcastle upon Tyne, United Kingdom. · Department of Cardiology, The Royal Infirmary of Edinburgh, Edinburgh, United Kingdom. · Department of Cardiology, Hospital Universitario Valdecilla, Cantabria, Spain. · Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands. · Manchester Heart Centre, Manchester Royal Infirmary, Central Manchester University Hospitals, Manchester, United Kingdom. · Hospital Clinico San Carlos IDISSC and Universidad Complutense de Madrid, Madrid, Spain. · Department of Cardiology, John Radcliffe Hospital, Cardiology, Oxford, United Kingdom. · ThoraxCenter, Erasmus Medical Center, Rotterdam, the Netherlands. Electronic address: patrick.w.j.c.serruys@gmail.com. · ThoraxCenter, Erasmus Medical Center, Rotterdam, the Netherlands; Department of Cardiology, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom. ·JACC Cardiovasc Interv · Pubmed #30409759.

ABSTRACT: OBJECTIVES: The aims of the present study were to investigate the applicability of quantitative flow ratio (QFR) in patients with 3-vessel disease and to demonstrate the impact of functional SYNTAX (Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery) score derived from QFR (fSS BACKGROUND: The applicability of QFR in patients with 3-vessel disease and the feasibility of fSS METHODS: All lesions interrogated using instantaneous wave-free ratio and/or fractional flow reserve in the SYNTAX II trial were retrospectively screened and analyzed for QFR. The diagnostic performance of QFR was investigated using hybrid wire-derived pressure assessment (instantaneous wave-free ratio and fractional flow reserve), used in the trial as a reference. Patients with analyzable QFR in 3 vessels were stratified according to fSS RESULTS: QFRs were analyzable in 71.0% of lesions (836 lesions). The diagnostic performance of QFR to predict binary wire-based ischemia was substantial (area under the curve 0.81, accuracy 73.8%), with a positive predictive value of 85.9%. Independent predictors of diagnostic discordance were lesions in side branches, involvement of bifurcation or trifurcation, and small vessel. According to the 2-year patient-oriented composite endpoint, fSS CONCLUSIONS: QFR demonstrated substantial applicability in patients with 3-vessel disease. The fSS

14 Article Comparative Effectiveness of CT-Derived Atherosclerotic Plaque Metrics for Predicting Myocardial Ischemia. 2019

Bakhshi, Hooman / Meyghani, Zahra / Kishi, Satoru / Magalhães, Tiago A / Vavere, Andrea / Kitslaar, Pieter H / George, Richard T / Niinuma, Hiroyuki / Reiber, Johan H C / Betoko, Aisha / Matheson, Matthew / Rochitte, Carlos E / Di Carli, Marcelo F / Cox, Christopher / Lima, João A C / Arbab-Zadeh, Armin. ·Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, Maryland. · Universidade Federal do Paraná, Curitiba, Brazil; Heart Institute (InCor), University of São Paulo, São Paulo, Brazil. · MedImmune, Gaithersburg, Maryland. · Department of Radiology, Leiden University/Medical Imaging Systems, Leiden, the Netherlands. · Division of Cardiology, St. Luke's International Hospital, Tokyo, Japan. · Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland. · Heart Institute (InCor), University of São Paulo, São Paulo, Brazil. · Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts. · Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, Maryland. Electronic address: azadeh1@jhmi.edu. ·JACC Cardiovasc Imaging · Pubmed #30031705.

ABSTRACT: OBJECTIVES: This study sought to investigate the performance of various cardiac computed tomography (CT)-derived atherosclerotic plaque metrics for predicting provocable myocardial ischemia. BACKGROUND: The association of coronary arterial diameter stenosis with myocardial ischemia is only modest, but cardiac CT provides several other, readily available atherosclerosis metrics, which may have incremental value. METHODS: The study analyzed 873 nonstented coronary arteries and their myocardial perfusion territories in 356 patients (mean 62 years of age) enrolled in the CORE320 (Coronary Artery Evaluation using 320-row Multidetector Computed Tomography Angiography and Myocardial Perfusion) study. Myocardial perfusion defects in static CT perfusion imaging were graded at rest and after adenosine in 13 myocardial segments using a 4-point scale. The summed difference score was calculated by subtracting the summed rest score from the summed stress score. Reversible ischemia was defined as summed difference score ≥1. In a sensitivity analysis, results were also provided using single-photon emission computed tomography (SPECT) as the reference standard. Vessel based predictor variables included maximum percent diameter stenosis, lesion length, coronary calcium score, maximum cross-sectional calcium arc, percent atheroma volume (PAV), low-attenuation atheroma volume, positive (external) vascular remodeling, and subjective impression of "vulnerable plaque." The study used logistic regression models to assess the association of plaque metrics with myocardial ischemia. RESULTS: In univariate analysis, all plaque metrics were associated with reversible ischemia. In the adjusted logistic model, only maximum percent diameter stenosis (1.26; 95% confidence interval: 1.15 to 1.38) remained an independent predictor. With SPECT as outcome variable, PAV and "vulnerable" plaque remained predictive after adjustment. In vessels with intermediate stenosis (40% to 70%), no single metric had clinically meaningful incremental value. CONCLUSIONS: Various plaque metrics obtained by cardiac CT predict provocable myocardial ischemia by CT perfusion imaging through their association with maximum percent stenosis, while none had significant incremental value. With SPECT as reference standard, PAV and "vulnerable plaque" remained predictors of ischemia after adjustment but the predictive value added to stenosis assessment alone was small.

15 Article Evaluation of Coronary Artery Stenosis by Quantitative Flow Ratio During Invasive Coronary Angiography: The WIFI II Study (Wire-Free Functional Imaging II). 2018

Westra, Jelmer / Tu, Shengxian / Winther, Simon / Nissen, Louise / Vestergaard, Mai-Britt / Andersen, Birgitte Krogsgaard / Holck, Emil Nielsen / Fox Maule, Camilla / Johansen, Jane Kirk / Andreasen, Lene Nyhus / Simonsen, Jo Krogsgaard / Zhang, Yimin / Kristensen, Steen Dalby / Maeng, Michael / Kaltoft, Anne / Terkelsen, Christian Juhl / Krusell, Lars Romer / Jakobsen, Lars / Reiber, Johan H C / Lassen, Jens Flensted / Bøttcher, Morten / Bøtker, Hans Erik / Christiansen, Evald Høj / Holm, Niels Ramsing. ·From the Department of Cardiology, Aarhus University Hospital, Skejby, Denmark (J.W., S.W., M.-B.V., B.K.A., E.N.H., C.F.M., L.N.A., J.K.S., S.D.K., M.M., A.K., C.J.T., L.R.K., L.J., J.F.L., H.E.B., E.H.C., N.R.H.) · Med-X Research Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, China (S.T., Y.Z.) · Department of Cardiology, Hospitalsenheden Vest, Regionshospitalet Herning, Denmark (L.N., M.B.) · Department of Cardiology, Hospitalsenheden Midt, Regionshospitalet Silkeborg, Denmark (J.K.J.) · and Department of Radiology, Leiden University Medical Center, The Netherlands (J.H.C.R.). ·Circ Cardiovasc Imaging · Pubmed #29555835.

ABSTRACT: BACKGROUND: Quantitative flow ratio (QFR) is a novel diagnostic modality for functional testing of coronary artery stenosis without the use of pressure wires and induction of hyperemia. QFR is based on computation of standard invasive coronary angiographic imaging. The purpose of WIFI II (Wire-Free Functional Imaging II) was to evaluate the feasibility and diagnostic performance of QFR in unselected consecutive patients. METHODS AND RESULTS: WIFI II was a predefined substudy to the Dan-NICAD study (Danish Study of Non-Invasive Diagnostic Testing in Coronary Artery Disease), referring 362 consecutive patients with suspected coronary artery disease on coronary computed tomographic angiography for diagnostic invasive coronary angiography. Fractional flow reserve (FFR) was measured in all segments with 30% to 90% diameter stenosis. Blinded observers calculated QFR (Medis Medical Imaging bv, The Netherlands) for comparison with FFR. FFR was measured in 292 lesions from 191 patients. Ten (5%) and 9 patients (5%) were excluded because of FFR and angiographic core laboratory criteria, respectively. QFR was successfully computed in 240 out of 255 lesions (94%) with a mean diameter stenosis of 50±12%. Mean difference between FFR and QFR was 0.01±0.08. QFR correctly classified 83% of the lesions using FFR with cutoff at 0.80 as reference standard. The area under the receiver operating characteristic curve was 0.86 (95% confidence interval, 0.81-0.91) with a sensitivity, specificity, negative predictive value, and positive predictive value of 77%, 86%, 75%, and 87%, respectively. A QFR-FFR hybrid approach based on the present results enables wire-free and adenosine-free procedures in 68% of cases. CONCLUSIONS: Functional lesion evaluation by QFR assessment showed good agreement and diagnostic accuracy compared with FFR. Studies comparing clinical outcome after QFR- and FFR-based diagnostic strategies are required. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier: NCT02264717.

16 Article Quantification of disturbed coronary flow by disturbed vorticity index and relation with fractional flow reserve. 2018

Chu, Miao / von Birgelen, Clemens / Li, Yingguang / Westra, Jelmer / Yang, Junqing / Holm, Niels R / Reiber, Johan H C / Wijns, William / Tu, Shengxian. ·Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China; Shanghai Med-X Engineering Research Center, Shanghai Jiao Tong University, Shanghai, China. · Department of Cardiology, Thoraxcentrum Twente, MST, Enschede, The Netherlands. · Division of Image Processing, Leiden University Medical Center, The Netherlands. · Department of Cardiology, Aarhus University Hospital, Skejby, Denmark. · Department of Cardiology, Guangdong General Hospital, Guangzhou, China. · The Lambe Institute for Translational Medicine and Curam, National University of Ireland, Galway, and Saolta University Healthcare Group, Galway, Ireland. · Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China; Shanghai Med-X Engineering Research Center, Shanghai Jiao Tong University, Shanghai, China. Electronic address: sxtu@sjtu.edu.cn. ·Atherosclerosis · Pubmed #29501225.

ABSTRACT: BACKGROUND AND AIMS: The relation between FFR and local coronary flow patterns is incompletely understood. We aimed at developing a novel hemodynamic index to quantify disturbed coronary flow, and to investigate its relationship with lesion-associated pressure-drop, and fractional flow reserve (FFR). METHODS: Three-dimensional angiographic reconstruction and computational fluid dynamics were applied to simulate pulsatile coronary flow. Disturbed vorticity index (DVI) was derived to quantify the stenosis-induced flow disturbance. The relation between DVI and pressure-drop was assessed in 9 virtual obstruction models. Furthermore, we evaluated the correlation between DVI, FFR, hyperemic flow velocity, and anatomic parameters in 84 intermediate lesions from 73 patients. RESULTS: In virtual models, DVI increased with increasing flow rate, stenosis severity, and lesion complexity. The correlation between DVI and pressure-drop across all models was excellent (determination coefficient R CONCLUSIONS: DVI, a novel index to quantify disturbed flow, was related to pressure-drop in virtual obstruction models and showed a strong inverse relation with FFR in intermediate lesions in vivo. It supports the prognostic value of FFR and may provide additional information about sources of energy loss when measuring FFR.

17 Article Quantitative Flow Ratio Identifies Nonculprit Coronary Lesions Requiring Revascularization in Patients With ST-Segment-Elevation Myocardial Infarction and Multivessel Disease. 2018

Spitaleri, Giosafat / Tebaldi, Matteo / Biscaglia, Simone / Westra, Jelmer / Brugaletta, Salvatore / Erriquez, Andrea / Passarini, Giulia / Brieda, Alessandro / Leone, Antonio Maria / Picchi, Andrea / Ielasi, Alfonso / Girolamo, Domenico Di / Trani, Carlo / Ferrari, Roberto / Reiber, Johan H C / Valgimigli, Marco / Sabatè, Manel / Campo, Gianluca. ·From the Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona (FE), Italy (G.S., M.T., S.B., A.E., G.P., A.B., R.F., G.C.) · Department of Cardiology, Aarhus University Hospital, Skejby, Denmark (J.W.) · University Hospital Clínic, Cardiovascular Clinic Institute, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain (S.B., M.S.) · Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy (A.M.L., C.T.) · Division of Cardiology, Misericordia Hospital, Grosseto, Italy (A.P.) · Bolognini Hospital, Seriate (BG), Italy (A.I.) · Cardiologia Interventistica, A.O. Sant'Anna e San Sebastiano, Caserta, Italy (D.D.G.) · Maria Cecilia Hospital, GVM Care and Research, E.S: Health Science Foundation, Cotignola, Italy (R.F., G.C.) · Department of Radiology, Leiden University Medical Center, the Netherlands (J.H.C.R.) · and University Hospital of Bern, Inselspital, Switzerland (M.V.). ·Circ Cardiovasc Interv · Pubmed #29449325.

ABSTRACT: BACKGROUND: The nonculprit lesion (NCL) management in ST-segment-elevation myocardial infarction patients with multivessel disease is debated. We sought to assess whether quantitative flow ratio (QFR), a noninvasive tool to identify potentially flow-limiting lesions, may be reliable in this scenario. METHODS AND RESULTS: The present proof-of-concept study is based on a 3-step process: (1) identification of the QFR reproducibility in NCLs assessment (cohort A, n=31); (2) prospective validation of QFR diagnostic accuracy in respect to fractional flow reserve (cohort B, n=45); and (3) investigation of long-term clinical outcomes of NCLs stratified according to QFR (cohort C, n=110). A blinded core laboratory computed QFR values for all NCLs. Cohort A showed a good correlation and agreement between QFR values at index (acute) and at staged (subacute, 3-4 days later) procedures ( CONCLUSIONS: In a limited and selected study population, our study showed that QFR computation may be a safe and reliable tool to guide coronary revascularization of NCLs in ST-segment-elevation myocardial infarction patients.

18 Article In-stent fractional flow reserve variations and related optical coherence tomography findings: the FFR-OCT co-registration study. 2018

Pyxaras, Stylianos A / Adriaenssens, Tom / Barbato, Emanuele / Ughi, Giovanni Jacopo / Di Serafino, Luigi / De Vroey, Frederic / Toth, Gabor / Tu, Shengxian / Reiber, Johan H C / Bax, Jeroen J / Wijns, William. ·Cardiovascular Research Center Aalst, OLV Clinic, Aalst, Belgium. · I Medizinische Klinik, Landshut-Achdorf Hospital, Landshut, Germany. · Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium. · Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium. · University Heart Center Graz, Graz, Austria. · Division of Image Processing, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands. · School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China. · Department of Cardiology, Heart & Lung Center, Leiden University Medical Center, Leiden, The Netherlands. · Cardiovascular Research Center Aalst, OLV Clinic, Aalst, Belgium. william.wyns@nuigalway.ie. · The Lambe Institute for Translational Medicine and Curam, National University of Ireland, Galway, University Road, Galway, Ireland. william.wyns@nuigalway.ie. · Saolta University Healthcare Group, Galway, Ireland. william.wyns@nuigalway.ie. ·Int J Cardiovasc Imaging · Pubmed #29080150.

ABSTRACT: We sought to assess in-stent variations in fractional flow reserve (FFR) in patients with previous percutaneous coronary intervention (PCI) and to associate any drop in FFR with findings by optical coherence tomography (OCT) imaging. Suboptimal post-PCI FFR values were previously associated with poor outcomes. It is not known to which extent in-stent pressure loss contributes to reduced FFR. In this single-arm observational study, 26 patients who previously underwent PCI with drug-eluting stent or scaffold implantation were enrolled. Motorized FFR pullback during continuous intravenous adenosine infusion and OCT assessments was performed. Post-PCI FFR < 0.94 was defined as suboptimal. At a median of 63 days after PCI (interquartile range: 59-64 days), 18 out of 26 patients (72%) had suboptimal FFR. The in-stent drop in FFR was significantly higher in patients with suboptimal FFR vs. patients with optimal FFR (0.08 ± 0.07 vs. 0.01 ± 0.02, p < 0.001). Receiver operating characteristic curve analysis showed that an in-stent FFR variation of > 0.03 was associated with suboptimal FFR. In patients with suboptimal FFR, the OCT analyses revealed higher mean neointimal area (respectively: 1.06 ± 0.80 vs. 0.51 ± 0.23 mm

19 Article Relationship Between Coronary Contrast-Flow Quantitative Flow Ratio and Myocardial Ischemia Assessed by SPECT MPI. 2017

Smit, Jeff M / Koning, Gerhard / van Rosendael, Alexander R / Dibbets-Schneider, Petra / Mertens, Bart J / Jukema, J Wouter / Delgado, Victoria / Reiber, Johan H C / Bax, Jeroen J / Scholte, Arthur J. ·Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, Postal zone 2300 RC, Leiden, ZA, 2333, The Netherlands. · Medis medical imaging systems B.V., Leiden, The Netherlands. · Department of Nuclear Medicine, Leiden University Medical Center, Leiden, The Netherlands. · Department of Medical Statistics, Leiden University Medical Center, Leiden, The Netherlands. · Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands. · Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, Postal zone 2300 RC, Leiden, ZA, 2333, The Netherlands. a.j.h.a.scholte@lumc.nl. ·Eur J Nucl Med Mol Imaging · Pubmed #28685228.

ABSTRACT: PURPOSE: A new method has been developed to calculate fractional flow reserve (FFR) from invasive coronary angiography, the so-called "contrast-flow quantitative flow ratio (cQFR)". Recently, cQFR was compared to invasive FFR in intermediate coronary lesions showing an overall diagnostic accuracy of 85%. The purpose of this study was to investigate the relationship between cQFR and myocardial ischemia assessed by single-photon emission computed tomography myocardial perfusion imaging (SPECT MPI). METHODS: Patients who underwent SPECT MPI and coronary angiography within 3 months were included. The cQFR computation was performed offline, using dedicated software. The cQFR computation was based on 3-dimensional quantitative coronary angiography (QCA) and computational fluid dynamics. The standard 17-segment model was used to determine the vascular territories. Myocardial ischemia was defined as a summed difference score ≥2 in a vascular territory. A cQFR of ≤0.80 was considered abnormal. RESULTS: Two hundred and twenty-four coronary arteries were analysed in 85 patients. Overall accuracy of cQFR to detect ischemia on SPECT MPI was 90%. In multivariable analysis, cQFR was independently associated with ischemia on SPECT MPI (OR per 0.01 decrease of cQFR: 1.10; 95% CI 1.04-1.18, p = 0.002), whereas clinical and QCA parameters were not. Furthermore, cQFR showed incremental value for the detection of ischemia compared to clinical and QCA parameters (global chi square 48.7 to 62.6; p <0.001). CONCLUSIONS: A good relationship between cQFR and SPECT MPI was found. cQFR was independently associated with ischemia on SPECT MPI and showed incremental value to detect ischemia compared to clinical and QCA parameters.

20 Article Automatic identification of coronary tree anatomy in coronary computed tomography angiography. 2017

Cao, Qing / Broersen, Alexander / de Graaf, Michiel A / Kitslaar, Pieter H / Yang, Guanyu / Scholte, Arthur J / Lelieveldt, Boudewijn P F / Reiber, Johan H C / Dijkstra, Jouke. ·Division of Image Processing, Department of Radiology, C2S, Leiden University Medical Center, PO Box 9600, Albinusdreef 2, 2300 RC, Leiden, The Netherlands. · Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands. · Medis Medical Imaging Systems BV, Leiden, The Netherlands. · Laboratory of Image Science and Technology, Southeast University, Nanjing, China. · Division of Image Processing, Department of Radiology, C2S, Leiden University Medical Center, PO Box 9600, Albinusdreef 2, 2300 RC, Leiden, The Netherlands. j.dijkstra@lumc.nl. ·Int J Cardiovasc Imaging · Pubmed #28647774.

ABSTRACT: An automatic coronary artery tree labeling algorithm is described to identify the anatomical segments of the extracted centerlines from coronary computed tomography angiography (CCTA) images. This method will facilitate the automatic lesion reporting and risk stratification of cardiovascular disease. Three-dimensional (3D) models for both right dominant (RD) and left dominant (LD) coronary circulations were built. All labels in the model were matched with their possible candidates in the extracted tree to find the optimal labeling result. In total, 83 CCTA datasets with 1149 segments were included in the testing of the algorithm. The results of the automatic labeling were compared with those by two experts. In all cases, the proximal parts of main branches including LM were labeled correctly. The automatic labeling algorithm was able to identify and assign labels to 89.2% RD and 83.6% LD coronary tree segments in comparison with the agreements of the two experts (97.6% RD, 87.6% LD). The average precision of start and end points of segments was 92.0% for RD and 90.7% for LD in comparison with the manual identification by two experts while average differences in experts is 1.0% in RD and 2.2% in LD cases. All cases got similar clinical risk scores as the two experts. The presented fully automatic labeling algorithm can identify and assign labels to the extracted coronary centerlines for both RD and LD circulations.

21 Article Accuracy and reproducibility of fast fractional flow reserve computation from invasive coronary angiography. 2017

van Rosendael, A R / Koning, G / Dimitriu-Leen, A C / Smit, J M / Montero-Cabezas, J M / van der Kley, F / Jukema, J W / Reiber, J H C / Bax, J J / Scholte, A J H A. ·Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, Postal zone 2300 RC, 2333 ZA, Leiden, The Netherlands. · Medis Medical Imaging Systems B.V., Leiden, The Netherlands. · Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands. · Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, Postal zone 2300 RC, 2333 ZA, Leiden, The Netherlands. a.j.h.a.scholte@lumc.nl. ·Int J Cardiovasc Imaging · Pubmed #28642995.

ABSTRACT: Fractional flow reserve (FFR) guided percutaneous coronary intervention (PCI) is associated with favourable outcome compared with revascularization based on angiographic stenosis severity alone. The feasibility of the new image-based quantitative flow ratio (QFR) assessed from 3D quantitative coronary angiography (QCA) and thrombolysis in myocardial infarction (TIMI) frame count using three different flow models has been reported recently. The aim of the current study was to assess the accuracy, and in particular, the reproducibility of these three QFR techniques when compared with invasive FFR. QFR was derived (1) from adenosine induced hyperaemic coronary angiography images (adenosine-flow QFR [aQFR]), (2) from non-hyperemic images (contrast-flow QFR [cQFR]) and (3) using a fixed empiric hyperaemic flow [fixed-flow QFR (fQFR)]. The three QFR values were calculated in 17 patients who prospectively underwent invasive FFR measurement in 20 vessels. Two independent observers performed the QFR analyses. Mean difference, standard deviation and 95% limits of agreement (LOA) between invasive FFR and aQFR, cQFR and fQFR for observer 1 were: 0.01 ± 0.04 (95% LOA: -0.07; 0.10), 0.01 ± 0.05 (95% LOA: -0.08; 0.10), 0.01 ± 0.04 (95% LOA: -0.06; 0.08) and for observer 2: 0.00 ± 0.03 (95% LOA: -0.06; 0.07), -0.01 ± 0.03 (95% LOA: -0.07; 0.05), 0.00 ± 0.03 (95% LOA: -0.06; 0.05). Values between the 2 observers were (to assess reproducibility) for aQFR: 0.01 ± 0.04 (95% LOA: -0.07; 0.09), for cQFR: 0.02 ± 0.04 (95% LOA: -0.06; 0.09) and for fQFR: 0.01 ± 0.05 (95% LOA: -0.07; 0.10). In a small number of patients we showed good accuracy of three QFR techniques (aQFR, cQFR and fQFR) to predict invasive FFR. Furthermore, good inter-observer agreement of the QFR values was observed between two independent observers.

22 Article A novel four-dimensional angiographic approach to assess dynamic superficial wall stress of coronary arteries in vivo: initial experience in evaluating vessel sites with subsequent plaque rupture. 2017

Wu, Xinlei / von Birgelen, Clemens / Muramatsu, Takashi / Li, Yingguang / Holm, Niels Ramsing / Reiber, Johan H C / Tu, Shengxian. ·Med-X Research Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China. ·EuroIntervention · Pubmed #28262624.

ABSTRACT: AIMS: Repetitive, fluctuating stress is an important biomechanical mechanism that underlies the rupture of atherosclerotic plaques. We developed a novel coronary angiography-based method for in vivo four-dimensional analysis of dynamic superficial wall stress (SWS) in coronary plaques and applied it for the first time in two clinical cases. Our aim was to investigate the potential relationship between dynamic stress concentration at baseline and plaque rupture during acute coronary syndrome (ACS) several months later. METHODS AND RESULTS: Three-dimensional angiographic reconstructions of the interrogated arteries were performed at several phases of the cardiac cycle, followed by finite element analysis to obtain the dynamic SWS data. The peak stress at baseline was found at the distal and proximal lesion longitudinal shoulders, being 121.8 kPa and 98.0 kPa, respectively. Intriguingly, in both cases, the sites with the highest SWS concentration at baseline co-registered with the location of plaque rupture during ACS, respectively six and 18 months after the baseline angiographic assessment. CONCLUSIONS: A novel angiography-based analysis method for four-dimensional evaluation of dynamic SWS was feasible for investigating plaque biomechanical behaviour in vivo. Initial experience suggests that this technique could be useful in exploring mechanisms of future plaque rupture.

23 Article Quantitative angiography methods for bifurcation lesions: a consensus statement update from the European Bifurcation Club. 2017

Collet, Carlos / Onuma, Yoshinobu / Cavalcante, Rafael / Grundeken, Maik / Généreux, Philippe / Popma, Jeffrey / Costa, Ricardo / Stankovic, Goran / Tu, Shengxian / Reiber, Johan H C / Aben, Jean-Paul / Lassen, Jens Flensted / Louvard, Yves / Lansky, Alexandra / Serruys, Patrick W. ·Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands. ·EuroIntervention · Pubmed #28067200.

ABSTRACT: Bifurcation lesions represent one of the most challenging lesion subsets in interventional cardiology. The European Bifurcation Club (EBC) is an academic consortium whose goal has been to assess and recommend the appropriate strategies to manage bifurcation lesions. The quantitative coronary angiography (QCA) methods for the evaluation of bifurcation lesions have been subject to extensive research. Single-vessel QCA has been shown to be inaccurate for the assessment of bifurcation lesion dimensions. For this reason, dedicated bifurcation software has been developed and validated. These software packages apply the principles of fractal geometry to address the "step-down" in the bifurcation and to estimate vessel diameter accurately. This consensus update provides recommendations on the QCA analysis and reporting of bifurcation lesions based on the most recent scientific evidence from in vitro and in vivo studies and delineates future advances in the field of QCA dedicated bifurcation analysis.

24 Article Assessment of endothelial shear stress in patients with mild or intermediate coronary stenoses using coronary computed tomography angiography: comparison with invasive coronary angiography. 2017

Huang, Dexiao / Muramatsu, Takashi / Li, Yingguang / Yang, Wenjie / Nagahara, Yasuomi / Chu, Miao / Kitslaar, Pieter / Sarai, Masayoshi / Ozaki, Yukio / Chatzizisis, Yiannis S / Yan, Fuhua / Reiber, Johan H C / Wu, Renhua / Pu, Jun / Tu, Shengxian. ·Department of Medical Imaging, The Second Affiliated Hospital, Medical College of Shantou University, Shantou, 515041, Guangdong, People's Republic of China. · Department of Cardiology, Fujita Health University Hospital, Toyoake, Japan. · Division of Image Processing, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands. · Department of Radiology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China. · Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China. · Cardiovascular Biology and Biomechanics Laboratory, Cardiovascular Division, University of Nebraska Medical Center, Omaha, NE, USA. · Department of Medical Imaging, The Second Affiliated Hospital, Medical College of Shantou University, Shantou, 515041, Guangdong, People's Republic of China. cjr.wurenhua@vip.163.com. · Department of Cardiology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China. pujun310@hotmail.com. ·Int J Cardiovasc Imaging · Pubmed #27796815.

ABSTRACT: Characterization of endothelial shear stress (ESS) may allow for prediction of the progression of atherosclerosis. The aim of this investigation was to develop a non-invasive approach for in vivo assessment of ESS by coronary computed tomography angiography (CTA) and to compare it with ESS derived from invasive coronary angiography (ICA). A total of 41 patients with mild or intermediate coronary stenoses who underwent both CTA and ICA were included in the analysis. Two geometrical models of the interrogated vessels were reconstructed separately from CTA and ICA images. Subsequently, computational fluid dynamics were applied to calculate the ESS, from which ESS

25 Article Anatomical and functional assessment of Tryton bifurcation stent before and after final kissing balloon dilatation: Evaluations by three-dimensional coronary angiography, optical coherence tomography imaging and fractional flow reserve. 2017

Pyxaras, Stylianos A / Toth, Gabor G / Di Gioia, Giuseppe / Ughi, Giovanni J / Tu, Shengxian / Rusinaru, Dan / Adriaenssens, Tom / Reiber, Johan H C / Leon, Martin B / Bax, Jeroen J / Wijns, William. ·Cardiovascular Research Center Aalst, OLV Clinic, Aalst, Belgium. · II. Medizinische Klinik, Klinikum Coburg, Coburg, Germany. · Department of Cardiology, University Heart Centre, Graz, Austria. · Department of Cardiovascular Medicine, University Hospitals Leuven, KU Leuven, Leuven, Belgium. · School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China. · Division of Image Processing, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands. · Center for Interventional Vascular Therapy, Columbia University Medical Center, New York Presbyterian Hospital, New York, New York. · Department of Cardiology, Heart & Lung Centrum, Leiden University Medical Center, Leiden, The Netherlands. · The Lambe Institute for Translational Medicine and Curam, National University of Ireland, Galway and Saolta University Healthcare Group, Galway, Ireland. ·Catheter Cardiovasc Interv · Pubmed #27567002.

ABSTRACT: OBJECTIVES: To assess the anatomical and functional impact of final kissing balloon inflation (FKBI) after implantation of a dedicated bifurcation stent system. BACKGROUND: Current evidence suggests clinical benefit of FKBI in patients undergoing bifurcation dilatation using the Tryton side branch stent (Tryton-SBS). We hypothesized that FKBI improves anatomical reconstruction and functional results of bifurcation treated by Tryton-SBS. METHODS: An unselected group of patients with complex bifurcation coronary lesions undergoing percutaneous coronary intervention (PCI) with Tryton-SBS underwent paired anatomical assessment with two- and three-dimensional quantitative coronary analysis (2D- and 3D-QCA), and optical coherence tomography (OCT), including 3D reconstruction before and after FKBI. Functional assessment by fractional flow reserve (FFR) was performed in the main branch (MB) and side branch (SB) before and after FKBI. RESULTS: Paired pre- and post-FKBI data were obtained in 10 patients. By OCT imaging, FKBI increased both the SB ostial area (4.93 ± 2.81 vs. 7.43 ± 2.87 mm CONCLUSIONS: In patients with complex bifurcation stenosis undergoing PCI with a dedicated bifurcation system, FKBI is associated with improved anatomical and functional results at the SB level, without compromising the result at the MB. © 2016 Wiley Periodicals, Inc.

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