Abstract
The catheterization laboratory is an excellent resource for translational research projects requiring phenotypic analysis of coronary artery disease. Coronary angiography, a traditional method of quantifying coronary disease, remains useful for describing the extent and the severity of angiographic coronary disease but is limited by the fact that angiography only depicts the effect of atherosclerosis on the arterial lumen. For this reason, quantitative coronary angiography has been supplemented by intravascular ultrasound and other catheter-based techniques and non-invasive methods for studies involving atherosclerosis progression and regression. Other angiographic based techniques potentially useful in research include the semi-quantification of collateral circulation, thrombolysis in myocardial infarction (TIMI) frame count, and TIMI blush score. The invasive assessment of coronary flow reserve and fractional flow reserve is a valuable adjunctive technique and can be used to precisely quantify the extent of ischemia or the presence of microvascular disease. Intravascular ultrasound (IVUS) is currently considered the gold standard for early diagnosis of coronary atherosclerosis and for measuring plaque burden. The serial measurements of changes in plaque volume over time are a valuable method of discerning plaque progression and regression. Similarly, radiofrequency backscatter IVUS, a relatively new imaging modality, can be used to describe and track changes in plaque composition.
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Donnelly, P., Maurovich-Horvat, P., Vorpahl, M., et al. (2010). Multimodality imaging atlas of coronary atherosclerosis. JACC Cardiovasc Imaging, 3(8), 876–880.
Maehara, A., Mintz, G. S., & Weissman, N. J. (2009). Advances in intravascular imaging. Circ Cardiovasc Intervent, 2, 482–490.
Eshtehardi P, Luke J, McDaniel MC, Samady H (2011) Intravascular imaging tools in the cardiac catheterization laboratory: comprehensive assessment of both anatomy and physiology. J Cardiovasc Transl Res, in press.
Gould, K. L., Libscomb, K., & Hamilton, G. W. (1974). Physiologic basis for assessing critical coronary stenosis. Instantaneous flow response and regional distribution during coronary hyperemia as measures of coronary flow reserve. The American Journal of Cardiology, 33, 87–94.
Harris, P. J., Behar, V. S., Conley, M. J., Harrell, F. E., Lee, K. L., Peter, R. H., et al. (1980). The prognostic significance of 50% coronary stenosis in medically treated patients with coronary artery disease. Circulation, 62, 240–248.
Califf, R. M., Phillips, H. R., Hindman, M. C., Mark, D. B., Lee, K. L., Behar, V. S., et al. (1985). Prognostic value of a coronary artery jeopardy score. Journal of the American College of Cardiology, 5, 1055–1063.
de Feyter, P. J., Serruys, P. W., Davies, M. J., Richardson, P., Lubsen, J., & Oliver, M. F. (1991). Quantitative coronary angiography to measure progression and regression of coronary atherosclerosis. Value, limitations, and implications for clinical trials. Circulation, 84, 412–423.
Lansky, A. J., Desai, K., & Leon, M. B. (2002). Quantitative coronary angiography in regression trials: a review of methodologic considerations, endpoint selection and limitations. The American Journal of Cardiology, 89(suppl), 4B–9B.
Taylor, A., Shaw, L. J., Fayad, Z., O’Leary, D., Brown, B. G., Nissen, S., et al. (2005). Tracking atherosclerosis regression: a clinical tool in preventative cardiology. Atherosclerosis, 180, 1–10.
Glagov, S., Weisenberg, E., Zarins, C. K., Stankunavicius, R., & Kolettis, G. J. (1987). Compensatory enlargement of human atherosclerotic coronary arteries. The New England Journal of Medicine, 316, 1371–1375.
Stiel, G. M., Stiel, L. S. G., Schofer, J., Donath, K., & Mathey, D. G. (1989). Impact of compensatory enlargement of atherosclerotic coronary arteries on angiographic assessment of coronary heart disease. Circulation, 80, 1603–1609.
Losordo, D. W., Rosenfield, K., Kaufman, J., Pieczek, A., & Isner, J. M. (1994). Focal compensatory enlargement of human arteries in response to progressive atherosclerosis. In vivo documentation using intravascular ultrasound. Circulation, 89, 2570–2577.
Cohen, M., & Rentrop, K. P. (1986). Limitation of myocardial ischemia by collateral circulation during sudden controlled coronary artery occlusion in human subjects: a prospective study. Circulation, 74, 469–476.
Sabia, P. J., Powers, E. R., Ragosta, M., Sarembock, I. J., Burwell, L. R., & Kaul, S. (1992). Association between collateral residual blood flow and myocardial viability in patients with recent myocardial infarction. New Engl J Med, 327, 1825–1831.
Vernon, S. M., Camarano, G., Kaul, S., Sarembock, I. J., Gimple, L. W., Powers, E. R., et al. (1996). Myocardial contrast echocardiography demonstrates that collateral flow can preserve myocardial function beyond a chronically occluded coronary artery. The American Journal of Cardiology, 78, 958–960.
Gibson, C. M., Cannon, C. P., Daley, W. L., Dodge, T., Alexander, B., Marble, S. J., et al. (1996). TIMI frame counts. A quantitative method of assessing coronary artery flow. Circulation, 93, 879–888.
Gibson, C. M., & Schömig, A. (2004). Coronary and myocardial angiography: angiographic assessment of both epicardial and myocardial perfusion. Circulation, 109, 3096–3105.
Tonino, P. A. L., Fearon, W. F., DeBruyne, B., Oldroyd, K. G., Leesar, M. A., Ver Lee, P. N., et al. (2010). Angiographic versus functional severity of coronary artery stenoses in the FAME study. Journal of the American College of Cardiology, 55, 2816–2821.
Pijls, N. H., De Bruyne, B., Peels, K., Van Der Voort, P. H., Bonnier, H. J., Bartunek, J., et al. (1996). Measurement of fractional flow reserve to assess the functional severity of coronary-artery stenoses. The New England Journal of Medicine, 334, 1703–1708.
Bishop, A. H., & Samady, H. (2004). Fractional flow reserve: critical review of an important physiology adjunct to angiography. American Heart Journal, 147, 792–802.
Kern, M. J., Lerman, A., Bech, J. W., DeBruyne, B., Eeckhout, E., Fearon, W. F., et al. (2006). Physiologic assessment of coronary artery disease in the cardiac catheterization laboratory. Circulation, 114, 1321–1341.
Kern, M. J., & Samady, H. (2010). Current concepts of integrated coronary physiology in the catheterization laboratory. Journal of the American College of Cardiology, 55, 173–185.
Ragosta, M., Samady, H., Isaacs, R. B., Gimple, L. W., Sarembock, I. J., & Powers, E. R. (2004). Coronary flow reserve in diabetic patients with end-stage renal disease and normal epicardial coronary arteries. American Heart Journal, 147, 1017–1023.
Nissen, S. E., Tuzcu, E. M., Schoenhagen, P., Brown, E. G., Ganz, P., Vogel, R. A., et al. (2004). Effect of intensive compared with moderate lipid-lowering therapy on progression of coronary atherosclerosis. A randomized controlled trial. JAMA, 291, 1071–1080.
Nissen, S. E., Tardif, J. C., Nicholls, S. M., Revkin, J. H., Shear, C. L., Duggan, W. T., et al. (2007). Effect of torcetrapib on the progression of coronary atherosclerosis. N Eng J Med, 356, 1304–1316.
Nicholls, S. J., Hsu, A., Wolski, K., Hu, B., Bayturan, O., Lavoie, A., et al. (2010). Intravascular ultrasound derived measures of coronary atherosclerotic plaque burden and clinical outcome. Journal of the American College of Cardiology, 55, 2399–2407.
Nasu, K., Tsuchikane, E., Katoh, O., Fujita, H., Surmely, J. F., Ehara, M., et al. (2008). Plaque characterization by virtual histology intravascular ultrasound analysis in patients with type 2 diabetes. Heart, 94, 429–433.
Serruys, P. W., García-García, H. M., Buszman, P., Erne, P., Verheye, S., Aschermann, M., et al. (2008). Integrated biomarker and imaging study-2 investigators. Effects of the direct lipoprotein-associated phospholipase A(2) inhibitor darapladib on human coronary atherosclerotic plaque. Circulation, 118, 1172–1182.
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Ragosta, M. Techniques for Phenotyping Coronary Artery Disease in the Cardiac Catheterization Laboratory for Applications in Translational Research. J. of Cardiovasc. Trans. Res. 4, 385–392 (2011). https://doi.org/10.1007/s12265-011-9274-2
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DOI: https://doi.org/10.1007/s12265-011-9274-2