Klaudia Proniewska

The basics of intravascular optical coherence tomography.

Optical coherence tomography (OCT) has opened new horizons for intravascular coronary imaging. It utilizes near-infrared light to provide a microscopic insight into the pathology of coronary arteries in vivo. Optical coherence tomography is also capable of identifying the chemical composition of atherosclerotic plaques and detecting traits of their vulnerability. At present it is the only tool to measure the thickness of the fibrous cap covering the lipid core of the atheroma, and thus it is an exceptional modality to detect plaques that are prone to rupture (thin fibrous cap atheromas). Moreover, it facilitates distinguishing between plaque rupture and plaque erosion as a cause of acute intracoronary thrombosis. Optical coherence tomography is applied to guide angioplasties of coronary lesions and to assess outcomes of percutaneous coronary interventions broadly. It identifies stent malapposition, dissections, and thrombosis with unprecedented precision. Furthermore, OCT helps to monitor vessel healing after stenting. It evaluates the coverage of stent struts by the neointima and detects in-stent neoatherosclerosis. With so much potential, new studies are warranted to determine OCTs clinical impact. The following review presents the technical background, basics of OCT image interpretation, and practical tips for adequate OCT imaging, and outlines its established and potential clinical application.

A 12–month angiographic and optical coherence tomography follow-up after bioresorbable vascular scaffold implantation in patients with ST-segment elevation myocardial infarction

The aim of the study was to evaluate the healing process at 12 months after ABSORB™ bioresorbable vascular scaffold (BVS) implantation in patients with ST‐segment elevation myocardial infarction (STEMI).

Comparison between optical coherence tomography and intravascular ultrasound in detecting neointimal healing patterns after stent implantation

BACKGROUND The amount of data comparing intravascular ultrasound (IVUS) and optical coherence tomography (OCT) for the detection of stent coverage in clinical settings is limited. AIM To make a qualitative and quantitative assessment of the vascular healing patterns in patients after stent implantations visualised by both IVUS and OCT. METHODS Images were obtained in patients with clinical symptoms of angina, who had had a bare metal stent implanted in the previous 12 months. Angiography, IVUS and OCT were performed in 14 coronary arteries. Measurements of stent, lumen and neo-intima areas and dimensions were performed in stented regions and in both 10 mm references. IVUS, OCT, and angiographic data were compared in matched regions. Off-line analyses were performed by an independent core lab. RESULTS 14 stents were imaged without any procedural complications. The nominal stent length was 28 ± 4.5 mm. OCT was the most accurate technique for assessing stent length (28.12 ± 6.8 mm), while QCA underestimated length due to foreshortening (22.16 ± 6.39 mm) and IVUS was vulnerable to random error due to discontinuous pullbacks and vessel movements (24.21 ± 7.90 mm). Minimum lumen area (MLA) and minimum lumen diameter (MLD) in reference sites were comparable in IVUS and OCT, whereas there were significant differences between these two modalities for MLA (3.30 ± 1.49 vs. 2.19 ± 1.30 mm², p = 0.0046) and for MLD (2.42 ± 0.51 vs. 1.58 ± 0.56 mm², p = 0.0023) in stented segments. There was a slight overestimation of lumen volume (130.18 ± 70.61 vs. 117.82 ± 67.02 mm³, p = 0.7256),a marked overestimation of stent volume (179.29 ± 97.58 vs. 226.46 ± 108.76 mm³, p = 0.0544) and a statistically significant difference in the neointima volume (49.11 ± 39.70 vs. 108.64 ± 43.77 mm³, p = 0.0060) by IVUS compared to OCT. Mean neointima burden in IVUS was much smaller than in OCT (20.79 ± 14.27% vs. 58.16 ± 18.25%, p = 0.0033). CONCLUSIONS OCT can precisely quantify struts coverage and is more accurate than IVUS in the assessment of vascular healing in patients after stent implantation.

A holographic doctors’ assistant on the example of a wireless heart rate monitor

Abstract Microsoft has created HoloLens glasses, a high-tech device used for holographic purposes, which is unique and superior to other available solutions. We present a new idea of a holographic assistant to doctors, using as an example a wireless patient data monitor. A dedicated application will be created to be used by doctors, allowing hands-free access to patient cards/data, reviewing of new/old examination results, and even the ability to work on real-time data. Doctors will be able to use this in the examination room, at a patient’s bedside, or in an entirely different location. Currently, analysis of patient data is done mostly by the doctor; however, huge progress in computer hardware performance and artificial intelligence (AI) algorithms has allowed the development of new methods used to analyze and classify patient examination results. In the same way that doctors learn and practice how to treat patients during their studies, algorithms can learn to spot abnormalities, allowing current technology and advanced AI algorithms to be joined in one high-tech solution that should provide initial assessment of patients’ health and give treatment guidance, if necessary.

Image Analysts’ Eye Movement Patterns During Intravascular OCT Interpretation

The evaluation of eye movement patterns during the analysis of medical images could be especially helpful in assessing the efficiency of this process. It could further influence the improvement and duration of the analysis as well as the learning pathways. In the presented study Eye-Tracker was used to evaluate analysts’ eye-paths during assessments of intravascular Optical Coherence Tomography (OCT) images. The various levels of experience of analysts, that took part in the study, led to noticeable differences in the interpretation of vessel’s images. As expected, the analysis duration was longer for the analyst in training (107 min) than for the experienced one (69 min).

TCT-74 A Serial 3- and 9-year Optical Coherence Tomography Assessment of Vascular Healing Response to Sirolimus- and Paclitaxel-Eluting Stents

nos: 73 76 TCT-73 Serial Three-Vessel Optical Coherence Tomography and Intravascular Ultrasound Analysis of Changing Morphologies Associated of Plaque Progression in Patients With Stable Angina Pectoris Myong Hwa Yamamoto, kennosuke yamashita, Mitsuaki Matsumura, Seitarou Ebara, Toshitaka Okabe, Shigeo Saito, Koichi Hoshimoto, Kisaki Amemiya, Tadayuki Yakushiji, Naoei Isomura, Hiroshi Araki, Chiaki Obara, Masahiko Ochiai, Gary Mintz, Akiko Maehara Cardiovascular Research Foundation, New York, New York, United States; Showa University Northern Yokohama Hospital, Yokohama, Japan; Cardiovascular Research Foundation, New York, New York, United States; NorthPoint Solutions, LLC; Showa University Northern Yokohama Hospital, Tokyo, Japan; Showa University Northern Yokohama Hospital, Yokohama, Japan; CRF; Showa universty yohohama northern hospital, Yokohama, Japan; Showa University Northern Yokohama Hospital, Yokohama, Japan; Showa University Northern Yokohama Hospital, Yokohama, Japan; Showa Univ. Northern Yokohama Hospital, Yokohama, Japan; Ospedale Sacco Vialba; Showa University Northern Yokohama Hospital, Kanagawa, Japan; Cardiovascular Research Foundation, Washington, District of Columbia, United States; Cardiovascular Research Foundation, New York, New York, United States BACKGROUND OCT morphologies associated with plaque progression are not well-studied. METHODS We used baseline and 8-mo follow-up 3-vessel OCT and IVUS to assess 124 non-culprit lesions (IVUS plaque burden 40%) in 45 pts with stable angina after culprit lesion percutaneous coronary intervention. Plaque progression was defined as IVUS minimum lumen area decrease >0.5mm2. Lipid plaques by OCT were defined as signal-poor regions with diffuse borders. RESULTS Overall, 24/124 plaques progressed and were characterized by OCT as plaque rupture (n1⁄44), new layer appearance (n1⁄47), thickening of fibrous cap (n1⁄47), or no OCT morphological change with negative remodeling by IVUS (n1⁄46, vessel area at baseline 12.2 [9.9, 18.7]mm2 to follow-up; 10.2 [8.0, 18.5]mm2, p1⁄40.17) (Figure). Pts with plaque progression (n1⁄416) reported less statin use (31.3% vs. 72.4%, p1⁄40.007) and higher baseline LDL-C (110.0 vs. 87.0 mg/dL, p1⁄40.007) and hs-CRP (0.097 vs. 0.051 mg/dL, p1⁄40.004). Multivariable logistic regression analysis showed that lipid plaque by OCT was an independent predictor of plaque progression (OR: 10.2, p1⁄40.001). Progression (n[24) Non-progression (n[103) P value Baseline lumen area, mm2 (IVUS) 4.6 [3.8, 6.3] 4.8 [3.5, 6.4] 0.83 Baseline plaque burden, % (IVUS) 62.8 [55.8, 70.2] 58.7 [53.2, 67.7] 0.17 Baseline remodeling index (IVUS) 0.93 [0.90, 0.97] 0.95 [0.86, 1.02] 0.72 Follow-up lumen area, mm2 (IVUS) 3.7 [2.8, 4.5] 4.8 [3.6, 6.4] 0.007 Baseline thin-cap fibroatheroma (OCT) 6 (25.0%) 4 (3.9%) <0.001 Baseline lipid plaque (OCT) 20 (83.3%) 30 (29.1%) <0.001 Baseline cap thickness, mm 0.11 [0.06, 0.20] 0.12 [0.09, 0.20] 0.39 Baseline lipid index (mean lipid arc multiplied by lipid length) 493 [305, 906] 324 [174, 589] 0.18 D lipid index -17.0 [-84.9, 16.2] 12.4 [-12.3, 33.9] 0.02 CONCLUSION OCT lipid plaque was a predictor of plaque progression even in pts with stable angina; in turn, plaque progressions was associated with distinct OCT morphologies that changed during follow-up. CATEGORIES IMAGING: Intravascular TCT-74 A Serial 3and 9-year Optical Coherence Tomography Assessment of Vascular Healing Response to Sirolimusand Paclitaxel-Eluting Stents Mariusz Tomaniak, Janusz Kochman, Lukasz Koltowski, Arkadiusz Pietrasik, Adam Rdzanek, Jacek Jąkała, Klaudia Proniewska, Krzysztof Malinowski, Krzysztof Filipiak, Grzegorz Opolski Medical University of Warsaw, Warsaw, Poland; Medical University of Warsaw, Warsaw, Poland; Medical University of Warsaw, Warszawa, Poland; Medical University of Warsaw, Warsaw, Poland; Medical University of Warsaw, Warsaw, Poland; UC Davis; Krakow Cardiovascular Research Institute, Krakow, Poland; Rush University; Hannover Medical School; Dept. of Cardiology, Medical University of Warsaw, Warsaw, Poland BACKGROUND Early-generation drug-eluting stents (DES) have been demonstrated to delay vascular healing. Limited optical coherence tomography (OCT) data on the very long-term neointimal response after DES implantation are available. METHODS The aim of this single–centre study was to conduct a longterm OCT assessment of stent strut coverage, malapposition, protrusion and neoatherosclerosis as markers of neointimal response at 3 and 9 years after implantation of sirolimus-eluting stents (SES) and paclitaxel-eluting stents (PES). Consecutive patients undergoing elective PCI with SES (Cypher, Cordis) or PES (Taxus, Boston Scientific) were included. An OCT evaluation was performed after 3 and 9 years. Struts’ analyses were conducted at 1 mm longitudinal intervals in a frame-by-frame fashion by the independent core laboratory. RESULTS Between 3and 9-years following the stent implantation the lumen, neointimal and malapposition area did not increase in the assessed 22 SES and 25 PES patients. An OCT analysis confirmed similar neointimal coverage with comparable number of uncovered struts at 3and 9 years in SES and PES group (p1⁄4 0.68; 0.79). There was no significant difference in the incidence of malapposed or protruding struts between 3and 9-year follow-up in each type of stent. Likewise, no features of neoatheroslerosis progression were observed with a comparable rate of thin cap fibroatheroma (TCFA) found in 6.67% of SES patients and 8.0 % of PES patients at 9 years (p1⁄40.20). J O U R N A L O F T H E A M E R I C A N C O L L E G E O F C A R D I O L O G Y , V O L . 6 8 , N O . 1 8 , S U P P L B , 2 0 1 6 B31 Parameter SES PES p value (3 vs. 9 years) 3 years 9 years 3 years 9 years p (SES); p (PES) Minimal lumen area, mm2 3.60 3.22 4.83 4.53 0.15; 0.26 Lumen area, mm2 4.95 4.76 6.78 6.39 0.46; 0.15 Neointima area, mm2 0.75 1.07 1.13 1.14 0.25; 0.95 Uncovered struts per stent, % 11.75 4.89 2.12 2.44 0.68; 0.79 Protruding struts per stent, % 4.22 0.51 1.26 0 0.25; 0.32 Mallaposed struts per stent, % 0.12 0.87 0.54 1.07 0.13; 0.23

TCT-796 Highly Calcific Carotid Lesions Endovascular Revascularization Using a Novel, Dual-layer Carotid Stent System CGuardTM: Analysis from the PARADIGM Study

TCT-796 Highly Calcific Carotid Lesions Endovascular Revascularization Using a Novel, Dual-layer Carotid Stent System CGuardTM: Analysis from the PARADIGM Study Adam Mazurek, Mariusz Trystuła, Jacek Jąkała, Andrzej Brzychczy, Anna Borraty nska, Agata Le sniak-Sobelga, Małgorzata Urba nczyk, R. Paweł Bany s, Wojciech Zajdel, Klaudia Proniewska, Lukasz Partyka, Krzysztof Zmudka, Piotr Podolec, Piotr Musialek Department od Cardiac and Vascular Diseases, John Paul II ND Hospital, Krakow, Poland; School of Medicine, University of California, Irvine; UC Davis; Kurume-univaersity; John Paul II Hospital, Krakow, Poland; Al Qassimi Hospital; Clinical centre of Serbia; John Paul II Hospital, Krakow, Poland; Clinical Dept. of Interventional Cardiology, John Paul II Hospital, Krakow, Poland; Krakow Cardiovascular Research Institute, Krakow, Poland; University Hospital Krakow, Krakow, Poland; John Paul II Hospital in Krakow, Krakow, Poland; Clinical Center of Serbia; John Paul II Hospital, Krakow, Poland

Data mining with Random Forests as a methodology for biomedical signal classification

Abstract As the contribution of specific parameters is not known and significant intersubject variability is expected, a decision system allowing adaptation for subject and environment conditions has to be designed to evaluate biomedical signal classification. A decision support system has to be trained in its desirable functionality prior to being used for patient monitoring evaluation. This paper describes a decision system based on data mining with Random Forests, allowing the adaptation for subject and environment conditions. This methodology may lead to specific system scoring by an artificial intelligence-supported patient monitoring evaluation system, which may help find a way of making decisions concerning future treatment and have influence on the quality of patients’ life.

Multimodality imaging of intermediate lesions: Data from fractional flow reserve, optical coherence tomography, near-infrared spectroscopy-intravascular ultrasound

BACKGROUND Fractional flow reserve (FFR) assesses a functional impact of the atheroma on the myocardial ischemia, but it does not take into account the morphology of the lesion. Previous optical coherence tomography (OCT), intravascular ultrasound (IVUS) and near-infrared spectroscopy (NIRS) studies presented their potential to detect vulnerable plaques, which is not possible by FFR assessment. With the following study, the intermediate lesions were assessed by FFR, OCT and combined NIRS-IVUS imaging to identify plaque vulnerability. METHODS Thirteen intermediate lesions were analyzed simultaneously by FFR, OCT and combined NIRS-IVUS imaging. RESULTS Two lesions were found to have FFR ≤ 0.80 (0.65 and 0.76). The other 11 lesions had FFR > 0.80 with a mean FFR 0.88 ± 0.049. Two lesions with FFR ≤ 0.80 had plaque burden (PB) > 70% and minimal lumen area (MLA) < 4 mm2, but neither of these 2 lesions were identified as OCT de-fined thin fibrous cap atheroma (TCFA), or NIRS-IVUS possible TCFA. Among the other 11 lesions with FFR > 0.80, 8 were identified as OCT-defined TCFA, 4 had PB > 70%, 6 had MLA < 4 mm2, 2 had both PB > 70% and MLA < 4 mm2, 3 lesions were identified as NIRS-IVUS possible TCFA, and 4 lesions had lipid core burden index > 400. CONCLUSIONS The FFR-negative lesions pose traits of vulnerability as assessed simultaneously by IVUS, OCT and NIRS imaging.