1. Circ Cardiovasc Interv
Revascularization Decisions in Patients With Stable Angina and Intermediate Lesions
by Gabor G. Toth, Balint Toth, Nils P. Johnson, Frederic De Vroey, Luigi Di Serafino, Stylianos Pyxaras, Dan Rusinaru, Giuseppe Di Gioia, Mariano Pellicano, Emanuele Barbato, Carlos Van Mieghem, Guy R. Heyndrickx, Bernard De Bruyne, and William Wijns
Circ Cardiovasc Interv
Volume 7(6):
December 16, 2014
Copyright © American Heart Association, Inc. All rights reserved.

2. Snapshot depicting the web platform of the virtual catheterization laboratory.
Snapshot depicting the web platform of the virtual catheterization laboratory. Still frames and the corresponding cine loops were available in high resolution and magnification. Participants were asked to indicate localization and visually estimated percent diameter stenosis of the identified stenoses using single-choice and free-text questions. Determination of significance or choice of additional diagnostic tool needed to be stated in a single-choice question. Detailed instructions and patient characteristics could be reached through pop-up windows.
Gabor G. Toth et al. Circ Cardiovasc Interv. 2014;7:
Copyright © American Heart Association, Inc. All rights reserved.

3. Decision patterns for the 5 cases and 12 stenoses.
Decision patterns for the 5 cases and 12 stenoses. Visually estimated percent diameter stenosis (%DS) values as compared with the quantitatively measured %DS values, and the corresponding decision making patterns on all 12 individual stenoses in the 5 individual cases. Upper, Light, black circles denote individual survey responses, whereas the overlying thick red circles depict the measured and quantified severity derived using quantitative coronary angiography. FFR indicates fractional flow reserve; LAD, left anterior descending coronary artery; LCx, left circumflex coronary artery; and RCA, right coronary artery.
Gabor G. Toth et al. Circ Cardiovasc Interv. 2014;7:
Copyright © American Heart Association, Inc. All rights reserved.

4. Discrepancy between visually estimated and quantitatively measured percent diameter stenosis (%DS).
Discrepancy between visually estimated and quantitatively measured percent diameter stenosis (%DS). Absolute difference between visually estimated %DS and quantitatively measured %DS is indicated on the y axis. A value more than zero refers to visual overestimation (red zone), whereas a value less than zero refers to visual underestimation (blue zone). x axis indicates different anatomic localizations. Red bars mark the mean±SD of the underlying individual light gray survey responses. LAD indicates left anterior descending coronary artery; LCx, left circumflex coronary artery; and RCA, right coronary artery.
Gabor G. Toth et al. Circ Cardiovasc Interv. 2014;7:
Copyright © American Heart Association, Inc. All rights reserved.

5. Distribution of different decisions and the appropriateness of purely angiogram-based decisions.
Distribution of different decisions and the appropriateness of purely angiogram-based decisions. Left, The distribution of decisions over the entire data set: in 7% of all evaluations an imaging modality (quantitative coronary angiography, intravascular ultrasound, or optical coherence tomography) was requested and in 21% the need for fractional flow reserve (FFR) was expressed. In the rest 71% angiography was found sufficient by the participants to decide about significance. Among the latter, the proportion of concordance and discordance with the known functional metric is depicted in the right.
Gabor G. Toth et al. Circ Cardiovasc Interv. 2014;7:
Copyright © American Heart Association, Inc. All rights reserved.

6. Relationship between experience with fractional flow reserve (FFR) or intravascular ultrasound and different decision patterns in overall data set (A1/B1) and in the subgroup of solely angiogram-based decisions (A2/B2).
Relationship between experience with fractional flow reserve (FFR) or intravascular ultrasound and different decision patterns in overall data set (A1/B1) and in the subgroup of solely angiogram-based decisions (A2/B2). Parallel to increasing experience with FFR, participants based their decisions significantly less frequently solely on angiogram, but requested FFR more often. In addition, among the solely angiogram-based decisions, there was a significant improvement in terms of concordant decisions. The concordance rate did not reach 60%, not even in the subgroup with most extensive experience with FFR.
Gabor G. Toth et al. Circ Cardiovasc Interv. 2014;7:
Copyright © American Heart Association, Inc. All rights reserved.