Angiography is the established imaging technique for coronary imaging. Angiography is routinely used during all coronary diagnostic and interventional procedures.
Cardialysis has broad experience in different types of quantitative and qualitative angiography analysis since its foundation in 1983. To date, the Angiographic Core Lab has been involved in over 110 trials.
Quantitative Coronary Analysis (QCA)
QCA is a technique that provides objective and reproducible measurements of coronary artery dimensions. QCA is particularly useful for assessing the vessel lumen size, (re) occurrence of a (re-)stenosis after coronary interventions, the evaluation of mechanical interventional devices (e.g. stents) and the long-term progression and regression of coronary atherosclerosis.
Cardialysis has applied a new approach to bifurcation analysis. As an addition to the conventional QCA analysis, a coronary bifurcation can be analyzed as a single object, including the central bifurcation area together with the angulation of the bifurcation. The entire bifurcation segment can be divided in a 6-segment or into a 11-segment bifurcation model.
Besides a 2D QCA application, our Core Lab is also applying 3D QCA. Out-of-plane magnification and foreshortening errors are minimized by calculating a true geometric shape in 3D space from two or more 2D x-ray projections. QCA 3D offers improved analysis of difficult lesions and segment anatomy.
Qualitative (Visual) Assessment
The Angiography Core Lab has extensive experience in qualitative assessment of angiograms. The visual assessment of an angiogram may involve the analysis of morphological parameters, the coronary anatomy, the filling of coronary arteries, the cardiac function, and the evaluation of the result of an intervention according to pre-set definitions.
Myocardial Blush Grade
Myocardial blush is a measure of myocardial reperfusion in patients with acute myocardial infarction. It is estimated visually or measured using the Quantitative Blush Evaluator (QuBE).
The SYNTAX Score is an angiographic tool to grade the complexity of coronary artery disease by characterizing the entire coronary tree with respect to the number of lesions and their functional impact, location and complexity. The SYNTAX Score can also be used to compare the complexity of coronary artery disease in individual patients and entire patient cohorts. At the Cardialysis Core Lab, we also apply the newly developed multislice computed tomography (MSCT) SYNTAX Score.
Angiography Left Ventricular Analysis
Left Ventricular analysis is the contour detection of the diastolic and systolic left ventricle. The difference between the diastolic and systolic state is expressed as the percentage of the ejection fraction of the left ventricle. Using software with automatic contour detection, the left ventriculograms are analyzed to assess global and regional left ventricular function, volume calculation and wall motion analysis during e.g. procedural and follow-up studies.
Transcatheter Aortic Valve (TAVI/TAVR) Implantation analysis
Angiographic Quantitative Aortic Regurgitation Videodensitometric Analysis
This analysis enables quantification of aortic regurgitation before, during and after Transcatheter Aortic Valve Implantation/Replacement (TAVI or TAVR) procedures. The analysis enables quantification of aortic regurgitation based on the Videodensitometry. By confining the analysis area to the left ventricle outflow tract (LVOT) the feasibility, practically of the analysis has been improved significantly.
Validity and reproducibility of this method has been demonstrated in a phantom model, pre-clinical setting and clinical studies. 1-7 Furthermore, a post-procedural aortic regurgitation > 17% based on this novel methodology has been associated with higher mortality. This methodology can also be used to guide the TAVI (TAVR) procedure (e.g. for additional post dilatation). The analysis process with the dedicated software has been validated according to the Cardialysis standards.(e.g. GCP and GAMP)
Angiographic analysis for TAVI analysis
In addition, to the ‘Angiographic Quantitative Aortic Regurgitation Videodensitometric Analysis’ the Core Lab can also provide ‘Angiographic analysis for TAVI’ which consist of qualitative assessment (e.g. Sellers grading and Frame fracture) and quantitative analysis of implantation depth. The analysis process with the dedicated software has been validated according to the Cardialysis standards.(e.g. GCP and GAMP)