State of the Art in Quantitative Coronary Arteriography

275 Pages·1986·5.657 MB·English

by  Paul de Leeuw (auth.), J. H. C. Reiber PhD, P. W. Serruys MD (eds.)

STATE OF THE ART IN QUANTITATIVE CORONARY
ARTERIOGRAPHY
DEVELOPMENTS IN
CARDIOVASCULAR MEDICINE
Recent volumes
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STATE OF THE ART
IN QUANTITATIVE
CORONARY
ARTERIOGRAPHY
edited by
J.H.C. REIBER, PhD and P.W. SERRUYS, MD
Department oj Cardiology, Thorax Center, Erasmus University
Rotterdam, The Netherlands
1986 MARTINUS NIJHOFF PUBLISHERS
a member of the KLUWER ACADEMIC PUBLISHERS GROUP
DORDRECHT / BOSTON / LANCASTER
Distributors
jar the United States and Canada: Kluwer Academic Publishers, 101 Philip
Drive, Assinippi Park, Norwell, MA 02061, USA
jar the UK and Ireland: Kluwer Academic Publishers, MTP Press Limited,
Falcon House, Queen Square, Lancaster LAI lRN, UK
jar all other countries: Kluwer Academic Publishers Group, Distribution Center,
P.O. Box 322, 3300 AH Dordrecht, The Netherlands
Library of Congress Cataloging in Publication Data
ISBN- 13: 978-94-010-8401-7 e-ISBN-13: 978-94-009-4279-0
DOl: 10.1007:978-94-009-4279-0
Copyright
© 1986 by Martinus Nijhoff Publishers, Dordrecht.
Softcover reprint of the hardcover 1s t edition 1986
All rights reserved. No part of this publication may be reproduced, stored in a
retrieval system, or transmitted in any form or by any means, mechanical,
photocopying, recording, or otherwise, without the prior written permission of
the publishers,
Martinus Nijhoff Publishers, P.O. Box 163, 3300 AD Dordrecht,
The Netherlands.
v
Table of contents
List of Contributors VII
Introduction XI
M.E. Bertrand
Part I: Technical developments in coronary angiography
1. Quality considerations on cine-imaging and PTCA-fluoroscopy
anticipating a digital future 3
Paul de Leeuw
2. Digital coronary arteriography 17
Robert A. Vogel
3. Digital imaging modalities for coronary and myocardial wall studies 33
Joachim H. Bursch, P.H. Heintzen, K. Moldenhauer
4. Myocardial densograms from digital subtraction angiography with
apparent cardiac arrest 51
Tjeerd van der Werf, H. Stegehuis, R.M. Heethaar
5. A tomographic approach to intravenous coronary arteriography 67
Erik L. Ritman, A.A. Bove
6. CT of the heart 79
Martin J. Lipton
Part II: Quantitative coronary cineangiography
7. Quantitation of coronary artery stenosis severity: limitations of
angiography and computerized information extraction 103
J. Richard Spears, T. Sandor
8. A second look at quantitative coronary angiography: some
unexpected problems 125
Robert H. Selzer, A. Shircore, P.L. Lee, L. Hemphill, D.H.
Blankenhorn
9. Approaches towards standardization in acquisition and quantitation
VI
of arterial dimensions from cineangiograms 145
lohan H.C. Reiber, P.W. Serruys, C.l. Kooijman, C.l. Slager,
l.C.H. Schuurbiers, A. den Boer
Part III: Can we measure coronary blood flow from contrast injection?
10. Determination of coronary blood flow and myocardial perfusion by
digital image processing 175
Paul Spiller, F.-K. Schmiel
11. Densitometric assessment of coronary blood velocity and flow in
man from coronary angiography: possibilities and problems 193
Rudiger Simon, 1. Amende, G. Herrmann, W. Quante, P.R.
Lichtlen
Part IV: Coronary obstruction and its physiologic significance
12. Assessment of stenosis severity 209
K. Lance Gould, R.L. Kirkeeide
13. Effects of coronary artherosclerosis on coronary reserve 229
Melvin L. Marcus, D.G. Harrison, C.W. White, L.F. Hiratzka
14. Effects of coronary artery stenosis, aortic insufficiency and aortic
stenosis on coronary blood flow in the dog 239
C. Richard Conti, R.L. Feldman, W.W. Nichols, R.G. Macdonald,
C.l. Pepine
15. Pressure gradient, exercise thallium-201 scintigraphy, quantitative
coronary cineangiography: in what sense are these measurements
related? 251
Patrick W. Serruys, W.W. Wijns, R. Geuskens, P. de Feyter,
M. van den Brand, l.H.C. Reiber
Index of sU,bjects 271
VII
List of contributors
Amende I, MD, Abteilung Kardiologie, Medizinische Hochschule Hannover, Postfach 610180,
D-3000 Hannover 61, Germany.
Blankenhorn DH, MD. University Southern California School of Medicine, 2025 Zonal Ave, Los
Angeles. CA 90033, U.S.A.
Boer A den, BSc, Thoraxcenter, Erasmus University and University Hospital Dijkzigt, PO Box
1738,3000 DR Rotterdam, the Netherlands.
Bove AA, MD, PhD, Division of Cardiovascular Diseases and Internal Medicine, Mayo Medical
School, Rochester, Minnesota 55905, U.S.A.
Brand M van den, MD, Thoraxcenter, Erasmus University and University Hospital Dijkzigt, P.O.
Box 1738, 3000 DR Rotterdam. the Netherlands.
Bursch JH, MD, Abteilung Kinderkardiologie, Klinikum der Christian-Albrechts-Universitat zu
Kiel, Schwanenweg 20, 2300 Kiel 1. Germany.
Conti CR, MD, Department of Medicine, Division of Cardiovascular Medicine. University of
Florida, College of Medicine, Box 1-277, Gainesville, Florida 32601 and VA Medical Center,
Gainesville, Florida 32601, U.S.A.
Feldman RL, MD, Department of Medicine, Division of Cardiovascular Medicine, University of
Florida, College of Medicine, Box 1-277, Gainesville, Florida 32601 and VA Medical Center,
Gainesville, Florida 32601, U.S.A.
Feyter P de, MD, Thoraxcenter, Erasmus University and University Hospital Dijkzigt, P.O. Box
1738,3000 DR Rotterdam, the Netherlands.
Geuskens R, MD, Thoraxcenter, Erasmus University and University Hospital Dijkzigt, P.O. Box
1738, 3000 DR Rotterdam, the Netherlands.
Gould KL, MD, Division of Cardiology. University of Texas, Medical School at Houston. P.O.
Box 20708, Houston. Texas 77225. U.S.A.
Harrison DG, MD. Department of Internal Medicine and The Cardiovascular Center, University
of Iowa, Iowa City, Iowa 52242, U.S.A.
Heethaar RM, PhD, Department of Cardiology and Department of Medical Physics, University
Hospital, State University, CatharijnesingellOl, 3583 CP Utrecht, the Netherlands.
Heintzen PH, MD, Abteilung Kinderkardiologie, Klinikum der Christian-Albrechts-Universitat zu
Kiel, Schwanenweg 20, 2300 Kiell. Germany.
Hemphill L, MD, University of Southern California. School of Medicine. 2025 Zonal Ave, Los
Angeles. California 90033, U.S.A.
Herrmann G, MD, Abteilung Kardiologie, Medizinische Hochschule Hannover, Postfach 610180.
D-3000 Hannover 61, Germany.
Hiratzka LF, MD, Department of Internal Medicine and The Cardiovascular Center, University
of Iowa, Iowa City. Iowa 52242, U.S.A.
VIII
Kirkeeide, RL, PhD, Division of Cardiology, University of Texas Medical School at Houston,
P.O. Box 20708. Houston. Texas 77225, U.S.A.
Kooijman, CJ, MSc, Thoraxcenter, Erasmus University and University Hospital Dijkzigt. PO Box
1738, 3000 DR Rotterdam, the Netherlands.
Lee PL, PhD. Jet Propulsion Laboratory, California Institute of Technology. 4800 Oak Grove
Drive. Pasadena. California 91109, U.S.A.
Leeuw. P de. MSc, Philips Medical Systems, Best. The Netherlands.
Lichtlen PRo MD. Abteilung Kardiologie. Medizinische Hochschule Hannover. Postfach 610180.
D-3000 Hannover 61. Germany.
Lipton MJ, MD, Department of Radiology, University of California San Francisco. California
94143. U.S.A.
Macdonald RG. MD. Department of Medicine. Division of Cardiovascular Medicine, University
of Florida. College of Medicine. Box J-277. Gainesville. Florida 32601 and VA Medical Center.
Gainesville. Florida 32601. U.S.A.
Marcus. ML, MD. Department of Internal Medicine and the Cardiovascular Center. University of
Iowa. Iowa City. Iowa 52242. U.S.A.
Moldenhauer K, MD. Abteilung Kinderkardiologie. Klinikum der Christian-Albrechts-Universitat
zu Kiel. Schwanenweg 20. 2300 Kiell. Germany.
Nichols WW. PhD. Department of Medicine. Division of Cardiovascular Medicine. University of
Florida. College of Medicine. Box J-277. Gainesville, Florida 32601 and VA Medical Center.
Gainesville, Florida 32601. U.S.A.
Pepine CJ. MD. Department of Medicine, Division of Cardiovascular Medicine. University of
Florida, College of Medicine. Box J-277. Gainesville, Florida 32601 and VA Medical Center,
Gainesville. Florida 32601. U.S.A.
Quante W, BSc, Abteilung Kardiologie, Medizinische Hochschule Hannover. Postfach 610180,
D-3000 Hannover 61. Germany.
Reiber JHC. PhD, Thoraxcenter, Erasmus University and University Hospital Dijkzigt. PO Box
1738. 3000 DR Rotterdam. The Netherlands.
Ritman EL. MD. PhD, Department of Physiology and Biophysics, Mayo Medical School.
Rochester, Minnesota 55905, U.S.A.
Sandor T, DP, Department of Radiology, Brigham and Women's Hospital, Harvard Medical
School. Massachusetts 02215, U.S.A.
Schmiel FK, MD, Department of Cardiology, Medizinische Einrichtungen der Universitiit
Dusseldorf, Medizinische Klinik und Poliklinik, Klinik B. Moorenstrasse 5, 4000 Dusseldorf 1,
Germany.
Schuurbiers JCH, BSc, Thoraxcentcr, Erasmus University and University Hospital Dijkzigt, PO
Box 1738, 3000 DR Rotterdam, the Netherlands.
Serruys PW, MD, Thoraxcenter, Erasmus University and University Hospital Dijkzigt, P.O. Box
1738, 3000 DR Rotterdam, The Netherlands;
Selzer RH, MSc, Jet Propulsion Laboratory. California Institute of Technology, 4800 Oak Grove
Drive, Pasadena, California 91109, U.S.A.
Shircorc A, BSc. Informatics General Corp .• 21OS0 Van Owen Street, Canoga Park. California
91304. U.S.A.
Simon R. MD, Abteilung Kardiologie. Medizinische Hochschule Hannover. Postfach 610180.
D-3000 Hannover 61. Germany.
Slager CJ, MSc. Thoraxcenter. Erasmus University and University Hospital Dijkzigt. PO Box
1738. 3000 DR Rotterdam. the Netherlands.
Spears JR. MD. Beth Israel Hospital, Cardiovascular Division. 330 Brookline Avenue. Boston,
Massachusetts 0221S0, U.S.A.
Spiller p, MD. Department of Cardiology, Medizinische Einrichtungen der Universitat
Dusseldorf. Medizinische Klinik und Poliklinik, Klinik B. Moorenstrasse 5, 4000 Dusseldorf 1,
Germany.
IX
Stegehuis H, MSc. Department of Cardiology and Department of Medical Physics, University
Hospital, State University, Catharijnesingel101, 3583 CP Utrecht. the Netherlands.
Vogel RA. MD, Department of Cardiology. Veterans Administration, 2215 Fuller Road. Ann
Arbor, Michigan 48105. USA.
Werf T van der, MD. Department of Cardiology, St. Radboud Hospital, Catholic University.
Geert Grooteplein Zuid 8, 6525 AG Nijmegen. the Netherlands.
Wijns WW. MD. Thoraxcenter, Erasmus University and University Hospital Dijkzigt P.O. Box
1738,3000 DR. Rotterdam, the Netherlands.
White CW, MD, Department of Internal Medicine and the Cardiovascular Center, University of
Iowa, Iowa City, Iowa 52242, U.S.A.
XI
Introduction
Over the past twenty years, technical advances in coronary arteriography have
contributed to our understanding of the pathophysiologic aspects and natural
history of coronary artery disease. Probably more than 700.000 coronary arterio
grams are performed annually throughout the world. Usually, these arteriograms
are interpreted visually to determine the morphologic extent and severity of
coronary artery disease. These subjective determinations, which are hampered
.by relatively large intra- and interobserver variations, are used as a basis for
critically important therapeutic decisions: Which arteries are to be revascular
ized, which lesions are suitable for coronary bypass surgery or for percutaneous
coronary angioplasty? To improve on this clinical decision making, on the treat
ment and follow-up of such patients, new, objective and reproducible techniques
for the assessment of the extent and severity of coronary artery disease, both in
terms of anatomy and functional significance of the lesions, must be made widely
available. With such new procedures and technologies the efficacy of new thera
peutic procedures, the effects of vasodilating and constricting drugs, and the
results of long-term studies on the regression and progression of atherosclerotic
plaque can be determined in an objective and cost-effective manner.
In this book the state-of-the-art in quantitative coronary arteriography is
reviewed, including the progress in technical and clinical developments in coro
nary arteriography (conventional cineangiography, digital cardiovascular imag
ing and X-ray tomography), the methodology and clinical applications of quan
titative coronary cineangiography which allows the assessment of objective and
reproducible measurements on arterial dimensions from 35 mm cinefilm, the
measurement of coronary blood flow from contrast injections, and finally, the
determination of the physiologic significance of coronary lesions and the relation
to the morphologic abnormalities.
Each chapter has been authored by an expert from either Europe or the USA,
who has contributed to the developments in his particular field. The basic
principles of each technique, the results from validation studies and the clinical
applications are described in detail. Guidelines are provided for standardized