Angiographic quantification of diffuse coronary artery disease: Reliability and prognostic value for bypass operations Michelle M. Graham, MD, FRCPC,

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Presentation transcript:

Angiographic quantification of diffuse coronary artery disease: Reliability and prognostic value for bypass operations Michelle M. Graham, MD, FRCPC, R.Jane Chambers, MD, FRCPC, Richard F. Davies, MD, PhD, FRCPC The Journal of Thoracic and Cardiovascular Surgery Volume 118, Issue 4, Pages 618-627 (October 1999) DOI: 10.1016/S0022-5223(99)70006-1 Copyright © 1999 Mosby, Inc. Terms and Conditions

Fig. 1 Example of structured reading of an angiogram with a diffuseness score of 9.5. All 8 left ventricular (LV) segments were “at risk.” A small first diagonal branch (D1) of the left anterior descending artery (LAD) was given a weight of 0.5 and a rating of 4 (0.5-1.0 mm, severe disease). The remainder of the LAD and its branches were given a combined weight of 3.5 and a rating of 1 (>2 mm, large normal vessel). A large first marginal branch (M1) of the circumflex coronary artery was given a weight of 2 and a rating of 1. The posterior intraventricular (PIV) and LV branches of the right coronary artery (RCA) were scored together and given a combined weight of 2 and a rating of 1. The Journal of Thoracic and Cardiovascular Surgery 1999 118, 618-627DOI: (10.1016/S0022-5223(99)70006-1) Copyright © 1999 Mosby, Inc. Terms and Conditions

Fig. 2 Example of structured reading of an angiogram with a diffuseness score of 18. All 8 left ventricular (LV) segments were “at risk.” A large first septal perforator (S1) was given a weight of 1. It was deemed not suitable for revascularization because of a proximal lesion and therefore given a rating of 5. Other branches of the left anterior descending artery (LAD) were rated as 3 (1-1.5 mm, moderate disease). A large first marginal branch of the circumflex artery (M1) was given a weight of 2 and a rating of 1 (>2 mm, large normal vessel). The posterior intraventricular branch (PIV) of the right coronary artery (RCA) and LV branches of the RCA were scored separately because of a lesion involving the crux. Each was given a weight of 1 and rating of 1. The Journal of Thoracic and Cardiovascular Surgery 1999 118, 618-627DOI: (10.1016/S0022-5223(99)70006-1) Copyright © 1999 Mosby, Inc. Terms and Conditions

Fig. 3 Example of structured reading of an angiogram with a diffuseness score of 36. The first diagonal branch (D1) of the left anterior descending artery (LAD) was given a weight of 1 and a rating of 4 (0.5-1.0 mm, severe disease), as was an isolated marginal branch. The first marginal branch (M1) of the circumflex artery was given a weight of 1 and rating of 3 (1.0-1.5 mm, moderate disease). The distal right coronary (RCA) and circumflex arteries filled by collaterals and were given a combined rating of 3 (<0.5 mm, very severe disease or totally occluded and poorly visualized). An RCA frame late in the angiographic cycle is shown to demonstrate the faint, late filling of the distal LAD via collaterals. This vessel was given a weight of 2 and a rating of 5. The Journal of Thoracic and Cardiovascular Surgery 1999 118, 618-627DOI: (10.1016/S0022-5223(99)70006-1) Copyright © 1999 Mosby, Inc. Terms and Conditions

Fig. 4 Influence plot of 2 independent readings of 30 angiograms by the same reader. The scale at the right represents the amount the overall correlation would change with the removal of a data point of the indicated size. The outlier represented by the large data point in the lower right quadrant was due to an inappropriately good rating being given to a totally occluded vessel that was not well visualized. With this outlier, Pearson’s r was 0.76 (P < .001). When the outlier was re-read according to the conventions developed for this method, this improved to 0.81. The Journal of Thoracic and Cardiovascular Surgery 1999 118, 618-627DOI: (10.1016/S0022-5223(99)70006-1) Copyright © 1999 Mosby, Inc. Terms and Conditions

Fig. 5 Correlation between blinded, independent determinations of the distal coronary diffuseness score by different readers. Pearson’s r was 0.83; P < .001. The Journal of Thoracic and Cardiovascular Surgery 1999 118, 618-627DOI: (10.1016/S0022-5223(99)70006-1) Copyright © 1999 Mosby, Inc. Terms and Conditions