Coronary arterydisease(CAD)has become a significant causeof heart attack,especially amongthose 40yearsoldor younger.There is a need to develop new technologies andmethods to deal with this disease.Many researchers hav...Coronary arterydisease(CAD)has become a significant causeof heart attack,especially amongthose 40yearsoldor younger.There is a need to develop new technologies andmethods to deal with this disease.Many researchers have proposed image processing-based solutions for CADdiagnosis,but achieving highly accurate results for angiogram segmentation is still a challenge.Several different types of angiograms are adopted for CAD diagnosis.This paper proposes an approach for image segmentation using ConvolutionNeuralNetworks(CNN)for diagnosing coronary artery disease to achieve state-of-the-art results.We have collected the 2D X-ray images from the hospital,and the proposed model has been applied to them.Image augmentation has been performed in this research as it’s the most significant task required to be initiated to increase the dataset’s size.Also,the images have been enhanced using noise removal techniques before being fed to the CNN model for segmentation to achieve high accuracy.As the output,different settings of the network architecture undoubtedly have achieved different accuracy,among which the highest accuracy of the model is 97.61%.Compared with the other models,these results have proven to be superior to this proposed method in achieving state-of-the-art results.展开更多
BACKGROUND Coexistent coronary artery disease is commonly seen in patients undergoing transcatheter aortic valve implantation(TAVI).Previous studies showed that pre-TAVI coronary revascularisation was not associated w...BACKGROUND Coexistent coronary artery disease is commonly seen in patients undergoing transcatheter aortic valve implantation(TAVI).Previous studies showed that pre-TAVI coronary revascularisation was not associated with improved outcomes,challenging the clinical value of routine coronary angiogram(CA).AIM To assess whether a selective approach to perform pre-TAVI CA is safe and feasible.METHODS This was a retrospective non-randomised single-centre analysis of consecutive patients undergoing TAVI.A selective approach for performing CA tailored to patient clinical need was developed.Clinical outcomes were compared based on whether patients underwent CA.The primary endpoint was a composite of allcause mortality,myocardial infraction,repeat CA,and re-admission with heart failure.RESULTS Of 348 patients(average age 81±7 and 57%male)were included with a median follow up of 19(9-31)mo.One hundred and fifty-four(44%)patients,underwent CA before TAVI procedure.Patients who underwent CA were more likely to have previous myocardial infarction(MI)and previous percutaneous revascularisation.The primary endpoint was comparable between the two group(22.6%vs 22.2%;hazard ratio 1.05,95%CI:0.67-1.64,P=0.82).Patients who had CA were less likely to be readmitted with heart failure(P=0.022),but more likely to have repeat CA(P=0.002)and MI(P=0.007).In those who underwent CA,the presence of flow limiting lesions did not affect the incidence of primary endpoint,or its components,except for increased rate of repeat CA.CONCLUSION Selective CA is a feasible and safe approach.The clinical value of routine CA should be challenged in future randomised trials.展开更多
Neurotoxicity is an infrequent adverse reaction to iodinated contrast agents. Contrast induced neurotoxicity following coronary angiogram is very rare. Renal disease is a risk factor for contrast induced neurotoxicity...Neurotoxicity is an infrequent adverse reaction to iodinated contrast agents. Contrast induced neurotoxicity following coronary angiogram is very rare. Renal disease is a risk factor for contrast induced neurotoxicity. We report a case of contrast induced neurotoxicity following coronary angiogram and intervention using Iohexol(Omnipaque 350) in an end stage renal disease patient on peritoneal dialysis who had prior exposure to iodinated contrast without any adverse reaction. Hemodialysis had to be initiated for rapid removal of the contrast agent with subsequent complete resolution of neurological deficits. This case highlights the need for interventionalists to be aware of an important adverse reaction to iodinated contrast agents, especially in individuals with renal dysfunction, and that neurotoxicity is a possibility even with prior uneventful exposures. The role and timing of hemodialysis in contrast induced neurotoxicity in patients with chronic kidney disease and in those without chronic kidney disease needs further deliberation.展开更多
Introduction: Coronary Angiogram and Percutaneous Coronary Interventions are commonly performed via the femoral route. Then, transradial coronary catheterization became a popular & default technique due to less va...Introduction: Coronary Angiogram and Percutaneous Coronary Interventions are commonly performed via the femoral route. Then, transradial coronary catheterization became a popular & default technique due to less vascular access site complications and bleeding as compared to femoral route. Distal puncture of the radial artery through the anatomical snuff box access, however, has recently been shown potential benefit, like comfort to patients and operators, as well as maintenance of blood flow through the superficial palmar arch, in case of radial artery occlusion. Our aim was to evaluate the safety and feasibility of this new approach. Methods: A cross-sectional observational prospective study of patients underwent invasive diagnostic or therapeutic coronary procedures through the distal trans-radial access and traditional radial access. The primary endpoints were to access difficulties and in-hospital access-site related complications. Results: In 2 months, 190 patients underwent coronary procedures, of which 82 (43%) were selected in both distal transradial & traditional radial group. In 2(2.4%) & 3 (3.6%) cases, distal radial & traditional radial access cannulation was unsuccessful respectively (p >0.05). The mean age was 57.7 ± 10 & 57.2 ± 10 years in successful distal transradial & traditional radial cases respectively. There were no any major vascular complications in distal transradial group while there were 2 vascular complications in traditional radial group (p > 0.05). Conclusions: Distal transradial access is feasible and safe in selected cases, when performed by experienced operators. Larger case series and randomized trials are required to determine its efficacy in reducing vascular complications when comparing to the traditional technique.展开更多
A subset of women referred to the cardiac catheterization lab for suspected myocardial infarction thought to be due to a culprit artery are found to have no obstructive coronary artery disease by angiography.The mecha...A subset of women referred to the cardiac catheterization lab for suspected myocardial infarction thought to be due to a culprit artery are found to have no obstructive coronary artery disease by angiography.The mechanism by which these women have myocardial injury varies and is not usually clear by history and angiography alone.Additional imaging,including modalities such as cardiac MRI,intravascular imaging,and computed tomography may be helpful to clarify diagnoses and direct treatment.展开更多
Introduction
According to the WHO's World Health Report 2003, 1cardiovascular disease was responsible for 16.7 million deaths annually. As a result, it is now the leading cause of death in developed count... Introduction
According to the WHO's World Health Report 2003, 1cardiovascular disease was responsible for 16.7 million deaths annually. As a result, it is now the leading cause of death in developed countries and in many developing countries. Detecting and preventing the progression of coronary artery disease is the target of many pharmaceutical, technological and other scientific programs today. Presently, the main diagnostic tool for evaluating coronary arteries is thc conventional coronary angiogram (CCA).……展开更多
Cardiac ischemia with a normal coronary angiogram can be caused by coronary microvascular dysfunction.A favorable prognosis,with excellent long-term clinical outcome,without major acute coronary events,has been consis...Cardiac ischemia with a normal coronary angiogram can be caused by coronary microvascular dysfunction.A favorable prognosis,with excellent long-term clinical outcome,without major acute coronary events,has been consistently reported in these patients.We report a patient with a normal coronary angiogram and 3 episodes of myocardial infarctions,where the formation of a ventricular aneurysm and progressive deterioration of left ventricular function was documented,and hypoperfusion of the myocardium was confirmed by cardiovascular magnetic resonance imaging,This case suggests that myocardial ischemia caused by coronary microvascular dysfunction could have a poor prognosis.Whether this case represents a special clinical condition which is between the cardiac syndrome X and coronary artery disease remains to be investigated.展开更多
Purpose: During catheter angiogram (CA) there is momentary increase in intravascular volume and pressure due to intra-arterial injection that can potentially cause vascular distention at the stenotic site, whereas on ...Purpose: During catheter angiogram (CA) there is momentary increase in intravascular volume and pressure due to intra-arterial injection that can potentially cause vascular distention at the stenotic site, whereas on CT angiogram (CTA) is unlikely due to intravenous administration. Methods: CA and CTA of the carotid artery from 29 patients were retrospectively studied. CA and CTA were obtained for each patient. Curved sagittal MPRs mirroring the carotid artery on CA were used to measure the diameter at stenosis and at the distal lumen. Mural plaque calcium content was graded on axial CTAs. Results: Accounting for repeated measurements, the likelihood that the lumen diameter from CA will be larger than CTA was higher at stenosis than distal to it but the difference in lumen diameters at stenosis was similar to CTA. There is insufficient evidence that intra-arterial hand-injection during CA leads to underestimation of the degree of stenosis. Percentage stenosis using the NASCET criteria differed between the 3 measurements, post hoc analysis showed significant difference between CA and axial CTA (p p > 0.99). The difference in lumen diameter did not depend on our calcium grading (p = 0.484). Conclusions: There is insufficient evidence to suggest that intra-arterial hand-injection contributes to vessel distention and underestimation of percent stenosis during CA in this study. Mural plaque calcium does not affect the degree of stenosis on CTA.展开更多
Out-of-hospital cardiac arrest is a common cause of death. Some therapeutic strategies performed daily are still debated, including particularly emergency coronary angiography independently of the clinical pattern. Pr...Out-of-hospital cardiac arrest is a common cause of death. Some therapeutic strategies performed daily are still debated, including particularly emergency coronary angiography independently of the clinical pattern. Primary percutaneous coronary intervention seems the strategy of choice in ST-segment elevation myocardial infarction but in other clinical presentations, benefit of coronary angiogram remains controversial. To improve management of out-of-hospital cardiac arrest and define the best timing to perform coronary angiogram, we suggest a study design based on ECG evaluation to define predictors of coronary artery disease after resuscitated cardiac arrest by distinguishing 3 groups according to ECG after resuscitation: ST segment elevation and LBBB;repolarisation disorder or no repolarisation disorder. Evaluation of ECG changes may still be useful as a triage method for establishing the indication for emergency coronary angiogram due to easy, non invasive and quick method and thus for limiting complications associated with this exam in acute phase.展开更多
Upper gastrointestinal bleeding remains a significant cause of hospital admissions. Even though the incidence of peptic ulcer disease and gastritis is decreasing, the incidence rates in neoplasm, Dieulafoy’s lesions,...Upper gastrointestinal bleeding remains a significant cause of hospital admissions. Even though the incidence of peptic ulcer disease and gastritis is decreasing, the incidence rates in neoplasm, Dieulafoy’s lesions, angiodysplasia, and esophagitis are trending up, which necessities physicians to be aware of those pathologies and their specifics. Here, we represent a case of a 62-year-old male on dual antiplatelet therapy who was transferred to our hospital due to severe melena with suspicion of upper gastrointestinal bleeding. Due to hemodynamic instability, the patient was intubated and started on vasopressors. However, several repeated EGDs and CTs of the abdomen with GI bleeding protocol did not reveal the location of active bleeding to stop it. At the same time, clinically, the patient was hemodynamically unstable with continued melena. On the last EGD, a small area of concern resembling gastric varix was clipped for identification purposes, and the patient underwent a selective angiogram with further diagnosis of Dieulafoy’s lesion, which was successfully embolized. Our case demonstrates that Dieulafoy’s lesions can present as severe life-threatening hemorrhage, hard to diagnose with traditional methods such as EGD or CTs, in which case it is recommended to proceed with an angiogram sooner rather than later for further diagnosis and treatment if needed.展开更多
For the segmentation of X-ray angiograms (XRA), the essential feature and the prior knowledge of angiographic image were analyzed, and a multi-feature based fuzzy recognition (MFFR) algorithm was proposed to infer the...For the segmentation of X-ray angiograms (XRA), the essential feature and the prior knowledge of angiographic image were analyzed, and a multi-feature based fuzzy recognition (MFFR) algorithm was proposed to infer the local vessel structure in this paper. Guided by the prior knowledge of artery vessel, a probability tracking operator (PTO) can rapidly track along the artery tree, and walk across the weak region or gaps because of disturbance or preprocessing to angiographic image. Another, the accurate measurement of the vascular axis-lines and diameters can be synchronously implemented in the tracking process. To correctly evaluate the proposed method, a simulated image of CAT and some clinical XRA images were used in the experimentations. The algorithms performed better than the conven- tional one: given one start-point, on average 92.7% of the visible segments or branches was automatically delineated; the correctness ratio of vessel structure inference reached to 90.0% on the average.展开更多
文摘Coronary arterydisease(CAD)has become a significant causeof heart attack,especially amongthose 40yearsoldor younger.There is a need to develop new technologies andmethods to deal with this disease.Many researchers have proposed image processing-based solutions for CADdiagnosis,but achieving highly accurate results for angiogram segmentation is still a challenge.Several different types of angiograms are adopted for CAD diagnosis.This paper proposes an approach for image segmentation using ConvolutionNeuralNetworks(CNN)for diagnosing coronary artery disease to achieve state-of-the-art results.We have collected the 2D X-ray images from the hospital,and the proposed model has been applied to them.Image augmentation has been performed in this research as it’s the most significant task required to be initiated to increase the dataset’s size.Also,the images have been enhanced using noise removal techniques before being fed to the CNN model for segmentation to achieve high accuracy.As the output,different settings of the network architecture undoubtedly have achieved different accuracy,among which the highest accuracy of the model is 97.61%.Compared with the other models,these results have proven to be superior to this proposed method in achieving state-of-the-art results.
文摘BACKGROUND Coexistent coronary artery disease is commonly seen in patients undergoing transcatheter aortic valve implantation(TAVI).Previous studies showed that pre-TAVI coronary revascularisation was not associated with improved outcomes,challenging the clinical value of routine coronary angiogram(CA).AIM To assess whether a selective approach to perform pre-TAVI CA is safe and feasible.METHODS This was a retrospective non-randomised single-centre analysis of consecutive patients undergoing TAVI.A selective approach for performing CA tailored to patient clinical need was developed.Clinical outcomes were compared based on whether patients underwent CA.The primary endpoint was a composite of allcause mortality,myocardial infraction,repeat CA,and re-admission with heart failure.RESULTS Of 348 patients(average age 81±7 and 57%male)were included with a median follow up of 19(9-31)mo.One hundred and fifty-four(44%)patients,underwent CA before TAVI procedure.Patients who underwent CA were more likely to have previous myocardial infarction(MI)and previous percutaneous revascularisation.The primary endpoint was comparable between the two group(22.6%vs 22.2%;hazard ratio 1.05,95%CI:0.67-1.64,P=0.82).Patients who had CA were less likely to be readmitted with heart failure(P=0.022),but more likely to have repeat CA(P=0.002)and MI(P=0.007).In those who underwent CA,the presence of flow limiting lesions did not affect the incidence of primary endpoint,or its components,except for increased rate of repeat CA.CONCLUSION Selective CA is a feasible and safe approach.The clinical value of routine CA should be challenged in future randomised trials.
文摘Neurotoxicity is an infrequent adverse reaction to iodinated contrast agents. Contrast induced neurotoxicity following coronary angiogram is very rare. Renal disease is a risk factor for contrast induced neurotoxicity. We report a case of contrast induced neurotoxicity following coronary angiogram and intervention using Iohexol(Omnipaque 350) in an end stage renal disease patient on peritoneal dialysis who had prior exposure to iodinated contrast without any adverse reaction. Hemodialysis had to be initiated for rapid removal of the contrast agent with subsequent complete resolution of neurological deficits. This case highlights the need for interventionalists to be aware of an important adverse reaction to iodinated contrast agents, especially in individuals with renal dysfunction, and that neurotoxicity is a possibility even with prior uneventful exposures. The role and timing of hemodialysis in contrast induced neurotoxicity in patients with chronic kidney disease and in those without chronic kidney disease needs further deliberation.
文摘Introduction: Coronary Angiogram and Percutaneous Coronary Interventions are commonly performed via the femoral route. Then, transradial coronary catheterization became a popular & default technique due to less vascular access site complications and bleeding as compared to femoral route. Distal puncture of the radial artery through the anatomical snuff box access, however, has recently been shown potential benefit, like comfort to patients and operators, as well as maintenance of blood flow through the superficial palmar arch, in case of radial artery occlusion. Our aim was to evaluate the safety and feasibility of this new approach. Methods: A cross-sectional observational prospective study of patients underwent invasive diagnostic or therapeutic coronary procedures through the distal trans-radial access and traditional radial access. The primary endpoints were to access difficulties and in-hospital access-site related complications. Results: In 2 months, 190 patients underwent coronary procedures, of which 82 (43%) were selected in both distal transradial & traditional radial group. In 2(2.4%) & 3 (3.6%) cases, distal radial & traditional radial access cannulation was unsuccessful respectively (p >0.05). The mean age was 57.7 ± 10 & 57.2 ± 10 years in successful distal transradial & traditional radial cases respectively. There were no any major vascular complications in distal transradial group while there were 2 vascular complications in traditional radial group (p > 0.05). Conclusions: Distal transradial access is feasible and safe in selected cases, when performed by experienced operators. Larger case series and randomized trials are required to determine its efficacy in reducing vascular complications when comparing to the traditional technique.
文摘A subset of women referred to the cardiac catheterization lab for suspected myocardial infarction thought to be due to a culprit artery are found to have no obstructive coronary artery disease by angiography.The mechanism by which these women have myocardial injury varies and is not usually clear by history and angiography alone.Additional imaging,including modalities such as cardiac MRI,intravascular imaging,and computed tomography may be helpful to clarify diagnoses and direct treatment.
文摘 Introduction
According to the WHO's World Health Report 2003, 1cardiovascular disease was responsible for 16.7 million deaths annually. As a result, it is now the leading cause of death in developed countries and in many developing countries. Detecting and preventing the progression of coronary artery disease is the target of many pharmaceutical, technological and other scientific programs today. Presently, the main diagnostic tool for evaluating coronary arteries is thc conventional coronary angiogram (CCA).……
文摘Cardiac ischemia with a normal coronary angiogram can be caused by coronary microvascular dysfunction.A favorable prognosis,with excellent long-term clinical outcome,without major acute coronary events,has been consistently reported in these patients.We report a patient with a normal coronary angiogram and 3 episodes of myocardial infarctions,where the formation of a ventricular aneurysm and progressive deterioration of left ventricular function was documented,and hypoperfusion of the myocardium was confirmed by cardiovascular magnetic resonance imaging,This case suggests that myocardial ischemia caused by coronary microvascular dysfunction could have a poor prognosis.Whether this case represents a special clinical condition which is between the cardiac syndrome X and coronary artery disease remains to be investigated.
文摘Purpose: During catheter angiogram (CA) there is momentary increase in intravascular volume and pressure due to intra-arterial injection that can potentially cause vascular distention at the stenotic site, whereas on CT angiogram (CTA) is unlikely due to intravenous administration. Methods: CA and CTA of the carotid artery from 29 patients were retrospectively studied. CA and CTA were obtained for each patient. Curved sagittal MPRs mirroring the carotid artery on CA were used to measure the diameter at stenosis and at the distal lumen. Mural plaque calcium content was graded on axial CTAs. Results: Accounting for repeated measurements, the likelihood that the lumen diameter from CA will be larger than CTA was higher at stenosis than distal to it but the difference in lumen diameters at stenosis was similar to CTA. There is insufficient evidence that intra-arterial hand-injection during CA leads to underestimation of the degree of stenosis. Percentage stenosis using the NASCET criteria differed between the 3 measurements, post hoc analysis showed significant difference between CA and axial CTA (p p > 0.99). The difference in lumen diameter did not depend on our calcium grading (p = 0.484). Conclusions: There is insufficient evidence to suggest that intra-arterial hand-injection contributes to vessel distention and underestimation of percent stenosis during CA in this study. Mural plaque calcium does not affect the degree of stenosis on CTA.
文摘Out-of-hospital cardiac arrest is a common cause of death. Some therapeutic strategies performed daily are still debated, including particularly emergency coronary angiography independently of the clinical pattern. Primary percutaneous coronary intervention seems the strategy of choice in ST-segment elevation myocardial infarction but in other clinical presentations, benefit of coronary angiogram remains controversial. To improve management of out-of-hospital cardiac arrest and define the best timing to perform coronary angiogram, we suggest a study design based on ECG evaluation to define predictors of coronary artery disease after resuscitated cardiac arrest by distinguishing 3 groups according to ECG after resuscitation: ST segment elevation and LBBB;repolarisation disorder or no repolarisation disorder. Evaluation of ECG changes may still be useful as a triage method for establishing the indication for emergency coronary angiogram due to easy, non invasive and quick method and thus for limiting complications associated with this exam in acute phase.
文摘Upper gastrointestinal bleeding remains a significant cause of hospital admissions. Even though the incidence of peptic ulcer disease and gastritis is decreasing, the incidence rates in neoplasm, Dieulafoy’s lesions, angiodysplasia, and esophagitis are trending up, which necessities physicians to be aware of those pathologies and their specifics. Here, we represent a case of a 62-year-old male on dual antiplatelet therapy who was transferred to our hospital due to severe melena with suspicion of upper gastrointestinal bleeding. Due to hemodynamic instability, the patient was intubated and started on vasopressors. However, several repeated EGDs and CTs of the abdomen with GI bleeding protocol did not reveal the location of active bleeding to stop it. At the same time, clinically, the patient was hemodynamically unstable with continued melena. On the last EGD, a small area of concern resembling gastric varix was clipped for identification purposes, and the patient underwent a selective angiogram with further diagnosis of Dieulafoy’s lesion, which was successfully embolized. Our case demonstrates that Dieulafoy’s lesions can present as severe life-threatening hemorrhage, hard to diagnose with traditional methods such as EGD or CTs, in which case it is recommended to proceed with an angiogram sooner rather than later for further diagnosis and treatment if needed.
基金Supported by the National Basic Research Program of China (Grant No. 2003CB716101)the National Natural Science Foundation of China (Grant No. 60772120)the Key National Science Foundation of China (Grant No. 30730026)
文摘For the segmentation of X-ray angiograms (XRA), the essential feature and the prior knowledge of angiographic image were analyzed, and a multi-feature based fuzzy recognition (MFFR) algorithm was proposed to infer the local vessel structure in this paper. Guided by the prior knowledge of artery vessel, a probability tracking operator (PTO) can rapidly track along the artery tree, and walk across the weak region or gaps because of disturbance or preprocessing to angiographic image. Another, the accurate measurement of the vascular axis-lines and diameters can be synchronously implemented in the tracking process. To correctly evaluate the proposed method, a simulated image of CAT and some clinical XRA images were used in the experimentations. The algorithms performed better than the conven- tional one: given one start-point, on average 92.7% of the visible segments or branches was automatically delineated; the correctness ratio of vessel structure inference reached to 90.0% on the average.
