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Quantification of rate of coronary artery disease progression by a new method of angiographic analysis
F L Moreno1, K L Stoops, R A Hackworthy
1LDS Hospital, Salt Lake City, UT 84143.
Insights
A simplified quantitative method accurately measures coronary artery disease progression, distinguishing true stenosis changes from variability. This aids in assessing disease advancement over time for therapeutic trial planning.
Area of Science:
- Cardiology
- Medical Imaging Analysis
Background:
- Coronary artery disease (CAD) progression assessment is crucial for patient management and clinical trials.
- Accurate quantification of atherostenosis progression is needed to differentiate disease advancement from measurement variability.
Purpose of the Study:
- To develop and validate a simplified quantitative method for assessing coronary artery disease progression using angiography.
- To determine the rate and variability of atherostenosis progression in patients with CAD.
Main Methods:
- A simplified quantitative analysis of single and paired coronary angiograms was performed.
- Lumen diameter (LD) and total stenosis change (TSC) were calculated for discrete lesions.
- Method validation included correlation with established methods (Brown/Dodge) and assessment of inter- and intraobserver variability.
Main Results:
- Excellent correlation was found between the simplified method and the Brown/Dodge method for LD measurement (r = 0.99).
- High interobserver (r = 0.98) and intraobserver (r = 0.99) agreement was observed.
- Long-term analysis (0.6-4.3 years) revealed significant stenosis progression (TSC = 2.0 +/- 1.3 mm), distinguishable from short-term variability.
Conclusions:
- The simplified quantitative method reliably distinguishes true coronary artery disease progression from variability.
- This method provides approximate rates and variability of progression, useful for clinical trial power calculations.
- Prospective studies utilizing this method are indicated for further validation and application.
Abstract:
To assess the rate and variability of atherostenosis progression in patients with coronary artery disease at baseline angiography, we used a simplified quantitative method of analysis to study single angiograms in 54 patients and paired angiograms in 29 patients. All discrete lesions were identified, then traced and digitized to determine lumen diameter (LD), and summed to give the total LD; the differences in LD for paired angiograms were summed to give total stenosis change (TSC). The following results were obtained: Correlation between LD measured by our method and LD determined by the Brown/Dodge method was excellent (r = 0.99, N = 54). There also was a high correlation between interobserver (r = 0.98, N = 54) and intraobserver (r = 0.99, N = 54) findings. Short-term TSC (N = 9, angiograms paired at less than 1 week) was negligible (0.03 +/- 0.38 mm). Long-term (N = 20, angiograms paired at 0.6 to 4.3 years) total LD differed significantly from baseline total LD (4.1 +/- 2.5 mm vs 6.0 +/- 3 mm; p less than 0.001), and TSC (2.0 +/- 1.3 mm) in long-term patients differed significantly from TSC in short-term patients (p less than 0.001). These results show that true coronary disease progression occurring over 1 to 4 years can be distinguished from intraobserver, interobserver, and interstudy variability by means of a simplified method and provide approximate rates and variability of progression. These results will be useful for power calculations in therapeutic trials aimed at slowing progression. Further prospective studies with the use of this method appear indicated.