1. Invasive Assessment of Coronary Artery Disease
Journal of Nuclear Cardiology | Official Journal of the American Society of Nuclear Cardiology
Invasive Assessment of Coronary Artery Disease
Stylianos A. Pyxaras, MD, William Wijns, MD, PhD, Johan HC Reiber, PhD,
and Jeroen J. Bax, MD, PhD
Cardiology Department, Coburg-Clinic, Coburg, Germany; 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; and Heart-Lung Centrum, Leiden University Medical Center, Leiden, The Netherlands
Copyright American Society of Nuclear Cardiology

2. Journal of Nuclear Cardiology | Official Journal of the American Society of Nuclear Cardiology
BACKGROUND
1- Accurate diagnostic assessment during heart catheterization is important for prognostic stratification and treatment of patients with coronary artery disease
2- Coronary angiography has been integrated with intravascular imaging modalities that allow in-depth analysis of the epicardial vessel anatomy
3- Invasively assessed resting and hyperemic pressure gradients define the hemodynamic relevance of the coronary artery lesions
4- The integration of anatomical and functional information provides improved diagnostic and prognostic value and can guide (the need for) revascularization
Copyright American Society of Nuclear Cardiology

3. Journal of Nuclear Cardiology | Official Journal of the American Society of Nuclear Cardiology
Summary- 1
Quantitative assessment of coronary angiography.
Panel A: Quantitative coronary angiogiography (QCA) of a severe mid-LAD lesion; the red lines indicate the automatically detected reference vessel diameter (RVD) of the analysed coronary segment; the yellow lines indicate the vessel lumen.
Panel B: Zoomed image of the analysed segment.
Panel C: Output of the QCA analysis – obstruction diameter (corrresponding to minimal luminal diameter – MLD), RVD, diameter stenosis, area stenosis, and obstruction length.
LAD: left anterior descending artery; MLD: minimal luminal diameter; QCA: quantitative coronary angiography; RVD: reference vessel diameter.
Copyright American Society of Nuclear Cardiology

4. Journal of Nuclear Cardiology | Official Journal of the American Society of Nuclear Cardiology
Summary- 2
OCT imaging.
Panel A shows a coronary angiogram with a sub-occlusive mid-LAD stenosis, OCT-analysis identifies an extended dissection (panel B). The coronary angiogram of Panel C demonstrates an occluded stent in the proximal LAD; OCT shows in-stent thrombosis (Panel D), responsible for the vessel occlusion. The coronary angiogram of Panel E is at first glance unremarkable, however OCT reveals a massive stent-malapposition of a previously implanted drug-eluting stent (panel F); Panel G shows the 3D-OCT of this latter (the asterisk corresponds to the vessel wall, which is at a considerable distance from the stent struts, here indicated by arrow).
LAD: left anterior descending artery; OCT: optical coherence tomography; 3D-OCT: three-dimensional optical coherence tomography.
Copyright American Society of Nuclear Cardiology

5. Journal of Nuclear Cardiology | Official Journal of the American Society of Nuclear Cardiology
Summary- 3
Schematic representation of physiology-derived metrics used for the functional assessment of coronary artery disease in the catheterization laboratory. Fractional flow reserve (FFR) measures the epicardial vessel pressure-drop, reflecting the epicardial vessel conductance, independently from the microvasculature. The index of microvasculature resistance (IMR) assesses instead the coronary microcirculation. Both metrics are assessed during conditions of maximal hyperemia.
FFR: fractional flow reserve; IMR: index of microvasculature resistance; Pa: aortic pressure; Pd: intracoronary pressure.
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6. CONCLUSIONS & FUTURE DIRECTIONS
Journal of Nuclear Cardiology | Official Journal of the American Society of Nuclear Cardiology
CONCLUSIONS & FUTURE DIRECTIONS
1- Invasive diagnostic assessment in the cardiac catheterization laboratory offers invaluable information, allowing real-time prognostic stratification and guiding interventional procedures
2- Intravascular imaging accurately describes atherosclerotic coronary lesions and guides stent deployment
3- Fractional flow reserve allows on-site ischemia-driven revascularization
4- An integrated anatomical-physiological approach can potentially maximize the benefit in terms of clinical outcome
Copyright American Society of Nuclear Cardiology