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Biomedical subjects

C J Slager

Publications and source records attributed to C J Slager.

At least 55 records · Page 3Linked to original sources
PubMed1993

Comparison of models for quantitative left ventricular wall motion analysis from two-dimensional echocardiograms during acute myocardial infarction.

To develop quantitative analysis of regional left ventricular wall motion in the absence of a gold standard, an objective statistical measure to compare models of wall motion is described. This measure can be derived from wall motion analysis of subgroups of patients with different patterns of wall motion. A priori knowledge of the exact localization of wall motion abnormalities is not needed. Two-dimensional echocardiograms were analyzed from 79 patients with myocardial infarction. The following 4 models were compared: Model I was based on the descent of the base toward the stable apex during systole. Models II and III measured area reduction with fixed- and floating-reference systems, respectively. Model IV was the centerline model. Classification by the electrocardiogram of the myocardial infarction as anterior (n = 37), posterior (n = 17) and inferior (n = 25) provided the a priori probability for classification of myocardial infarction. The a posteriori probability for classification of myocardial infarction was derived from the detection of wall motion abnormalities by echocardiographic analysis. The mean difference between a posteriori and a priori probability is a measure for the diagnostic value of the model, and was measured for 200 regions/patient. Use of the described measure revealed model I to be the most informative model and model III the least informative. Thus, the described statistical measure contributes to the development of regional wall motion analysis.

Adult↗
PubMed1993

Maximal blood flow velocity in severe coronary stenoses measured with a Doppler guidewire. Limitations for the application of the continuity equation in the assessment of stenosis severity.

In vitro and animal experiments have shown that the severity of coronary stenoses can be assessed using the continuity equation if the maximal blood flow velocity of the stenotic jet is measured. The large diameter and the low range of velocities measurable without frequency aliasing with the conventional intracoronary Doppler catheters precluded the clinical application of this method for hemodynamically significant coronary stenoses in humans. This article reports the results obtained using a 12 MHz steerable angioplasty guidewire in a consecutive series of 52 patients undergoing percutaneous coronary angioplasty (61 coronary stenoses). The ratio between coronary flow velocity in a reference segment and in the stenosis was used to estimate the percent cross-sectional area stenosis. A Doppler recording suitable for quantitation was obtained in the stenotic segment in only 10 of 61 arteries (16%). The time-averaged peak velocity increased from 15 +/- 5 to 115 +/- 26 cm/sec from the reference normal segment to the stenosis. Volumetric coronary flow calculated from the product of mean flow velocity and cross-sectional area was similar in the stenosis and in the reference segment (33.2 +/- 14.9 vs 33.5 +/- 17.0 mL/min, respectively, difference not significant). The percent cross-sectional area stenosis and minimal luminal cross-sectional area derived from the Doppler velocity measurements using the continuity equation and calculated with quantitative angiography were also similar (Doppler, 86.7 +/- 5.1% and 1.00 +/- 0.48 mm2; quantitative angiography, 85.9 +/- 7.9% and 1.02 +/- 0.50 mm2).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1993

Digital geometric measurements in comparison to cinefilm analysis of coronary artery dimensions.

Six months follow-up post-PTCA angiograms from 31 patients were acquired digitally and on cinefilm and used for a comparison of geometric coronary measurements at the site of the previous dilatation. On 70 images of 34 coronary segments quantitative analysis was performed both on-line, using the Automated Coronary Analysis package of the Philips Digital Cardiac Imaging System (DCI, pixel matrix 512 x 512) and off-line, using the Cardiovascular Angiography Analysis System (CAAS). With the CAAS a cine-video conversion is performed and a 6.9 x 6.9 mm region of interest from the 18 x 24 mm cineframe is digitized into a 512 x 512 pixel matrix. In both systems the vascular contours are assessed by means of operator-independent edge detection algorithms. The angiographic catheter was used for calibration. Best agreement between DCI and CAAS was found for obstruction diameter and minimal luminal diameter, respectively (r = 0.82; y = 0.12 + 0.97x; SEE = 0.29). The reconstructed reference diameter related to a computed reference contour yields lower correlation (r = 0.76; y = 0.27 + 0.91x; SEE = 0.37). Worst results were obtained from the relative measure of percent diameter stenosis as well as from the derived parameter of plaque area. The on-line digital approach of geometric coronary assessments provides good agreement with cinefilm analysis when direct measurements of coronary dimensions are applied.

Algorithms↗
PubMed1993

Intracoronary blood flow velocity and transstenotic pressure gradient using sensor-tip pressure and Doppler guidewires: a new technology for the assessment of stenosis severity in the catheterization laboratory.

In a patient undergoing percutaneous balloon angioplasty of a stenotic proximal right coronary artery the transstenotic pressure gradient was measured using a 0.018" guidewire with a distal optical microsensor. Blood flow velocity was measured proximal to the stenosis using a 0.018" Doppler guidewire. Transstenotic pressure gradient and blood flow velocity were measured in baseline conditions and after intracoronary injection of 12.5 mg of papaverine. Coronary blood flow was calculated from the measured blood flow velocity and the corresponding cross-sectional area. The measured pressure gradients were compared with the values derived from the stenosis geometry assessed with quantitative coronary angiography (automated edge detection measurements in two orthogonal views, assuming an elliptical cross-sectional area). The measured transstenotic pressure gradient was 15 mm Hg in baseline conditions and 42 mm Hg at the peak effect of the papaverine injection. A 50% flow velocity increase was observed at peak hyperemia (time-averaged maximal flow velocity = 30 cm/s before and 45 cm/s after papaverine). The transstenotic pressure gradient calculated from the measured stenosis geometry was 20 mm Hg and 42 mm Hg in baseline and hyperemic conditions, respectively. The combined use of a pressure and a Doppler guidewire provides a complete assessment of the transstenotic pressure/coronary flow velocity relation at rest and after pharmacologically induced hyperemia and allows the characterization of stenosis hemodynamics and functional severity.

Angioplasty, Balloon, Coronary↗
PubMed1993

Experimental validation of geometric and densitometric coronary measurements on the new generation Cardiovascular Angiography Analysis System (CAAS II).

Computer-assisted contour detection and videodensitometric cross sectional area assessment of coronary artery obstructions on the CAAS II system were validated in vitro and in vivo by angiographic cinefilm recording and automated measurement of stenosis phantoms (luminal diameter 0.5, 0.7, 1.0, 1.4, 1.9 mm) which were first inserted in a plexiglass model and then serially implanted in swine coronary arteries. "Obstruction diameter" (OD) and "obstruction area" (OA) values obtained from 10 in vitro and 19 in vivo images at the site of the artificial stenoses were compared with the true phantom dimensions. The in vitro assessment of OD yielded an accuracy of 0.00 +/- 0.11 mm (correlation coefficient: r = 0.98, y = 0.18 + 0.82x, standard error of estimate: SEE = 0.08), whereas the in vivo measurement of OD gave an accuracy of -0.01 +/- 0.18 mm (r = 0.94, y = 0.22 + 0.82x, SEE = 0.15). The assessment of OA gave an accuracy of -0.08 +/- 0.21 mm2 in vitro (r = 0.97, y = 0.08 + 0.99x, SEE = 0.22) and -0.22 +/- 0.32 mm2 in vivo (r = 0.95, y = 0.21 + 1.01x, SEE = 0.33). The mean reproducibility was +/- 0.09 mm for geometric measurements and +/- 0.21 mm2 for videodensitometric assessments, respectively. Thus, due to inherent limitations of the imaging chain, the reliability of geometric coronary measurements is still far superior to videodensitometric assessments of vessel cross sectional areas.

Absorptiometry, Photon↗
PubMed1993

Mechanical features and in vivo imaging of a polymer stent.

A polyethylene-terephthalate (PETP, polyester), self-expanding, braided mesh stent has been developed for percutaneous (coronary) arterial implantation. In vitro measurements showed that the radial pressure delivered by this device was similar to a self-expanding, stainless steel stent. Due to hysteresis-like behaviour, it proved necessary to mount the polymer stent on the delivery system immediately before the placement procedure, and to select a diameter in the unconstrained condition, which was 60% larger than the diameter of the target vessel. Eight polyester stents were implanted in peripheral arteries of four pigs. Except for heparin during the implantation procedure, antithrombotic or antiplatelet drugs were not administered. After four weeks repeat angiography revealed that one of the stents was subtotally occluded. At autopsy, two other stents proved to be located in the aortic bifurcation, probably due to failure of the delivery system. Quantitative angiographic assessment showed that the mean luminal diameters at the site of stent placement were 3.3 +/- 0.2 mm before, 3.2 +/- 0.2 mm immediately after, and 2.7 +/- 0.5 mm at four weeks after implantation. Intravascular ultrasound (IVUS) examination after 4 weeks could identify the individual struts of the stents, as well as their length. In addition, a description of the extent of neointimal hyperplasia was feasible. The IVUS assessment was validated by histological examination. In conclusion, polyester stents can be constructed with mechanical properties similar to stainless steel stents. After implantation in porcine peripheral arteries, five of six correctly placed stents were patent at four weeks. Imaging of stents by angiography and IVUS provided complementary information.

Angiography↗
PubMed1993

Electrical nerve and muscle stimulation by radio frequency surgery: role of direct current loops around the active electrode.

Tissue cutting by electrosurgery is often accompanied with stimulation of nerves and muscles, despite the high frequency of the alternating current being applied. The main source of this stimulation is thought to be the generation of low frequency current by the nonlinear sparking process. However, measurement of this low-frequency current, in the generator electrode's circuit, showed relatively small values, barely sufficient to support this hypothesis. In this study more powerful low frequency current could be identified, indeed also originating from the nonlinear sparking process. Local direct and low frequency currents, at a level of tens of milliamperes, appeared to be generated between different sites of the active electrode-tissue interface. Probably these local currents have not been noticed before as they cannot be detected in the outer chain of generator, electrodes, and connecting wires. This finding may explain why most measures, intended to prevent stimulation by modifying this outer chain, had only limited success.

Catheter Ablation↗
PubMed1993

Heart function after injection of small air bubbles in coronary artery of pigs.

By its nature, vaporization of atherosclerotic plaques by laser irradiation or spark erosion may produce a substantial amount of gas. To evaluate the effect of gas embolism possibly caused by vaporization techniques, air bubbles with diameters of 75, 150, or 300 microns, each in a volume of 2 microliters/kg, were selectively injected subproximal in the left anterior descending coronary artery of seven anesthetized pigs (28 +/- 3 kg). Systemic hemodynamics such as heart rate, left ventricular pressure and its peak positive first derivative, and mean arterial pressure did not change after air injection, whereas there was a minor change in peak negative first derivative of left ventricular pressure. After injection of air bubbles there was a maximal relative reduction of systolic segment shortening (SS) in the myocardium supplied by the left anterior descending coronary artery of 27, 45, and 58% for 75-, 150-, and 300-microns bubbles, respectively, and a relative increase of postsystolic SS (PSS) of 148, 200, and 257% for 75-, 150-, and 300-microns bubbles, respectively. Recovery of SS and PSS started after 2 min and was completed after 10 min. A difference in SS and PSS changes between different bubble size injections could be demonstrated. From this study it is clear that depression of regional myocardial function after injection of air bubbles could pass unnoticed on the basis of global hemodynamic measurements.

Animals↗
PubMed1992

In-vivo validation of on-line and off-line geometric coronary measurements using insertion of stenosis phantoms in porcine coronary arteries.

Geometric coronary artery measurements with the Phillips Digital Cardiac Imaging System (DCI) and the Cardiovascular Angiography Analysis System (CAAS) were validated using percutaneous insertion of radiolucent stenosis phantoms in swine coronary arteries. Angiographic visualization of the stenosis lumens (phi 0.5, 0.7, 1.0, 1.4, 1.9 mm) was simultaneously recorded on DCI and cinefilm. The acquisition systems were calibrated by either the diameter of the guiding catheter (catheter CAL) or the isocenter method (isocenter CAL). Minimal luminal diameters (MLD) obtained with CAAS and DCI on 20 corresponding cineframes were compared with the true phantom diameters (PD). The accuracy of MLD measurements with the CAAS using isocenter CAL was -0.07mm, the precision 0.21 mm (r = 0.91; y = 0.30 + 0.79x; SEE = 0.19), with catheter CAL the accuracy was 0.09 mm, the precision 0.23 mm (r = 0.89; y = 0.19 + 0.74x; SEE = 0.19). The accuracy of MLD measurements using the DCI with isocenter CAL was 0.08 mm, the precision 0.15 min (r = 0.96; y = 0.08 + 0.86x; SEE = 0.14), with catheter CAL the accuracy was 0.18 mm, the precision 0.21 mm (r = 0.92; y = 0.09 + 0.76x; SEE = 0.17). DCI underestimated PD with isocenter CAL (p less than 0.05) and with catheter CAL (p less than 0.001). MLD can be measured with high accuracy, both applying on-line digital as well as off-line cineangiographic analysis. The results of digital measurements demonstrate high reliability of the new digital software package.

Animals↗
PubMed1992

Electrical impedance of layered atherosclerotic plaques on human aortas.

Electrical impedance measurements were performed on 13 atherosclerotic human aortic segments at 67 measuring spots in order to determine whether or not on the basis of these data a distinction can be made between atherosclerotic lesions and normal tissue. Stenosis localization and guidance of interventional techniques could be among the applications of an impedance measuring technique implemented on a catheter system. The experimental results, obtained with a two-electrode measuring technique, show that the apparent resistivity of an atherosclerotic spot does not necessarily deviate much from the resistivity of normal tissue. This is clarified by histology which shows that the majority of lesions has a surface layer of connective, fibrous tissue having almost similar conducting properties as the normal arterial wall. For gaining a deeper understanding of the way in which the measured data come about, a physical model of an atherosclerotic lesion is presented and confronted with the data. Both experimental data and theoretical considerations lead to the conclusion that only when the superficial fibrous layer is absent or very thin in relation to the size of the measuring electrode, the measured resistivity at a lesion is much higher than at normal spots. This occurs as a consequence of the high ohmic properties of the calcified or lipid deposits in the atherosclerotic lesion.

Aortic Diseases↗
PubMed1992

Development of a polymer endovascular prosthesis and its implantation in porcine arteries.

A polyethylene-terephthalate braided mesh stent has been developed for application in the (coronary) arterial tree. In vitro measurements showed that the radial pressure delivered by this device was in the same range as that of a stainless steel stent. Hysteresis-like behavior, however, occurred after constraining the polyester stent for a period of only 15 minutes on a delivery system for percutaneous implantation. This implies that the polymer stent must be mounted on this delivery system immediately before the placement procedure, and that either a diameter in the unconstrained condition must be selected, which is considerably larger than the diameter of the target vessel, or stent expansion has to be enhanced by balloon expansion. Taking into account the results obtained during the in vitro studies, we investigated the angiographic patency and histologic features after implantation of this polyester stent in peripheral arteries of pigs. In four animals eight stents were placed. Except for heparin during the implantation procedure only, antithrombotic or antiplatelet drugs were not administered. After 4 weeks repeat angiography was performed. Angiography revealed that five of the six correctly placed stents were patent. At autopsy, two additional patent stents proved to be located in the aortic bifurcation, probably due to failure of the delivery system. Quantitative assessment showed that the mean luminal diameters of the site of stent placement were 3.3 +/- 0.2 mm before, 3.2 +/- 0.2 mm immediately after, and 3.1 +/- 0.3 mm at 4 weeks after implantation. Histology demonstrated an inflammatory reaction of variable severity around the stent fibers. Quantitative histologic measurements showed that the thickness of the neointima was 114 +/- 38 mum after 4 weeks. In conclusion, polyester stents can be constructed with mechanical properties similar to stainless steel stents. Hysteresis-like behavior of polyester stents, however, influences the selection of the nominal stent diameter as well as the forces exerted to the vessel wall. After implantation in porcine peripheral arteries, five of six correctly placed stents were patent at 4 weeks. The extent of neointimal proliferation was similar to that observed after placement of metal stents in swine, despite the presence of a more pronounced inflammatory reaction.

Angioplasty, Balloon, Coronary↗
PubMed1991

Cyclic changes of blood echogenicity in high-frequency ultrasound.

Ultrasound images from human arteries obtained in vivo with an intravascular 30 MHz ultrasound imaging device show that blood echogenicity changes during the cardiac cycle. Quantitative measurements of blood echogenicity during the cardiac cycle suggest that these variations may be related to changes in the state of erythrocyte aggregation, which are induced by varying shear rate.

Blood Flow Velocity↗
PubMed1990

Early and late arterial healing response to catheter-induced laser, thermal, and mechanical wall damage in the rabbit.

Pulsed lasers are being promoted for laser angioplasty because of their capacity to ablate obstructions without producing adjacent thermal tissue injury. The implicit assumption that thermal injury to the artery is to be avoided was tested. Thermal lesions were produced in the iliac arteries and aorta of normal rabbits by a) electrical spark erosion, b) the metal laser probe, and c) continuous wave neodymium-yttrium aluminum garnet (Nd-YAG) laser energy through the sapphire contact probe. High-energy doses were used to induce substantial damage without perforating the vessel wall. Thermal lesions (n = 77) were compared with mechanical lesions (n = 22) induced by oversized balloon dilation. Medial necrosis was induced by all four injury methods. Provided no extravascular contrast was observed after the injury, all damaged segments were patent after 1 to 56 days. The progression of healing with myointimal proliferation was remarkably similar for all injuries. At 56 days, the neointima measured up to 370 microns. In conclusion, provided no perforation with contrast extravasation occurred, the normal rabbit artery recovered well from transmural thermal injury. The wall healing response is largely nonspecific.

Angioplasty, Balloon↗
PubMed1988

Intra-arterial ultrasonic imaging for recanalization by spark erosion.

Presently several new methods are being developed to recanalize obstructed arteries during catheterization. Intra-arterial high frequency ultrasonic imaging may be used as a guidance for these new techniques. Spark erosion is a new obstruction removal technology. Experiments have shown that this method can be applied in a selective way. An ultrasonic intra-arterial imaging system allows for the proper indication of the spark erosion catheter relative to the obstruction. The first in vitro results of this study illustrate that integration of catheter tip imaging and spark erosion is possible.

Angioplasty, Balloon↗
PubMed1987

[A method of intraluminal echoarteriography].

Interventional cardiology and new recanalisation methods have pressed the need for high frequency intra-arterial imaging to visualize obstructions. In a first in-vitro set-up it is shown that intra-arterial echo imaging is possible. Ideas to further integrate this with spark erosion are presented and serve for further study.

Cardiac Catheterization↗