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Biomedical subjects

G Finet

Publications and source records attributed to G Finet.

At least 19 recordsLinked to original sources

Evaluation of an automatic intraluminal edge detection technique for intravascular ultrasound images.

Intravascular ultrasound (IVUS) imaging enables detailed analysis and precise measurements of vascular cross-sections. However, to achieve a reduction in the existing level of observer variability requires the development of quantitative IVUS. We have developed a fully automatic intraluminal edge detection technique, based on adaptive active contour models and called ADDER (adaptive damping dependent on echographic regions) that allows the quantitation of the intraluminal cross-sectional area (ICSA). Using a 30-MHz mechanically rotated transducer mounted at the tip of a 3.5-F catheter, 58 normal and pathologic arterial segments (from coronary, renal, splenic, iliac, and carotid arteries) were imaged in vitro. These images were analyzed by 2 experts, E1 and E2, who manually traced the intraluminal contour twice for each image, as well as with ADDER. Intra-observer variabilities for ICSAs were found to be excellent (-1.454 +/- 3.51% for E1, 0.96 +/- 5.4% for E2). The inter-observer variability was 2.1 +/- 4.3%. The success factor for ADDER was 89%. Its intra-observer variability was null, as the method always finds a unique contour. The correlation between the automatically detected ICSA and the manual ICSA was: r = 0.99 (y = 1.03x + 0.89 mm2). Morphometric variations between manually and automatically traced contours, analyzed by the centerline method, were 100 +/- 140 mm on average. In conclusion, the ADDER automatic contour detection applied to IVUS images is robust and characterized by small systematic and random errors; therefore, quantitative IVUS is a useful tool in clinical research trials.

Blood Vessels

Left ventricular pressure-volume relationships before and after cardiomyoplasty in patients with heart failure.

BACKGROUND: The aim of this study was to elucidate whether beneficial effects of cardiomyoplasty (CMP) in patients with dilated cardiomyopathy are the result of a decrease in existing ventricular dilatation or a prevention of further dilatation. METHODS AND RESULTS: Combined micromanometer-conductance catheters were used to evaluate left ventricular pressure-volume relationships in six patients with dilated cardiomyopathy before and at 6 and 12 months after CMP. Acute changes in preload and afterload were induced by a standardized leg-tilting intervention and a bolus infusion of nitroglycerin. After CMP, end-diastolic volume (EDV) decreased from 138+/-10 to 103+/-18 mL/m2 (P<.01) at 6 months and to 83+/-17 mL/m2 (P<.01) at 12 months. End-diastolic pressure (EDP) decreased from 20.2+/-6.4 to 13.9+/-7.7 mm Hg (P<.01) at 6 months after CMP. Peak ejection rate and ejection fraction increased at 6 months after CMP from 594+/-214 to 799+/-214 mL/s (P<.05) and from 26.6+/-4.7% to 40.1+/-8.3% (P<.05), respectively. Peak dP/dt decreased at 12 months after CMP from -842+/-142 to -712+/-168 mm Hg/s (P<.05). Leg-tilting before CMP increased EDP from 20.2+/-6.4 to 25.6+/-5.2 mm Hg (P<.01), end-systolic pressure (ESP) from 118+/-17 to 122+/-17 mm Hg (P<.05), and tau from 50.8+/-2.8 to 53.8+/-2.3 ms (P<.05). Six months after CMP, leg-tilting also increased EDV from 103+/-18 to 110+/-22 mL/m2 (P<.05) and ESV from 62+/-14 to 66+/-14 mL/m2 (P<.05). Before CMP, nitroglycerin decreased EDP from 20.2+/-6.4 to 10.4+/-3.8 mm Hg (P<.01), ESP from 118+/-17 to 96+/-11 mm Hg (P<.05), ESV from 100+/-11 to 89+/-7 mL/m2 (P<.05), and tau from 50.8+/-2.8 to 44.5+/-3.7 ms (P<.05). Six months after CMP, nitroglycerin decreased EDP, ESP, and tau to similar values. CONCLUSIONS: Our findings show that up to 1 year after CMP, marked decreases in left ventricular volume are present. Our measurements suggest that CMP actively reduced the dilated ventricle but did not prevent a higher EDV on an increased venous return. The latissimus dorsi muscle wrap contraction results in better synchronization of contraction and more rapid emptying of the left ventricle.

Cardiomyopathy, Dilated

Effect of the direct nitric oxide donors linsidomine and molsidomine on angiographic restenosis after coronary balloon angioplasty. The ACCORD Study. Angioplastic Coronaire Corvasal Diltiazem.

BACKGROUND: Nitric oxide (NO) donors, in addition to their vasodilator effect, decrease platelet aggregation and inhibit vascular smooth muscle cell proliferation. These actions could have beneficial effects on restenosis after coronary balloon angioplasty. METHODS AND RESULTS: In a prospective multicenter, randomized trial, 700 stable coronary patients scheduled for angioplasty received direct NO donors (infusion of linsidomine followed by oral molsidomine) or oral diltiazem. Treatment was started before angioplasty and continued until 12 to 24 hours before follow-up angiography at 6 months. The primary study end point was minimal lumen diameter, assessed by quantitative coronary angiography, 6 months after balloon angioplasty. Clinical variables were well matched in both groups. However, despite intracoronary administration of isosorbide dinitrate, the reference diameter in the NO donor group was significantly greater than in the diltiazem group on the preangioplasty, postangioplasty, and follow-up angiograms. Pretreatment with an NO donor was associated with a modest improvement in the immediate angiographic result compared with pretreatment with diltiazem (minimum luminal diameter, 1.94 versus 1.81 mm; P = .001); this improvement was maintained at the 6-month angiographic follow-up (minimal lumen diameter, 1.54 versus 1.38 mm; P = .007). The extent of late luminal narrowing did not differ significantly between groups (loss index in the NO donor and diltiazam groups, 0.35 +/- 0.78 and 0.46 +/- 0.74, respectively; P = .103). Restenosis, defined as a binary variable (> or = 50% stenosis), occurred less often in the NO donor group (38.0% versus 46.5%; P = .026). Combined major clinical events (death, nonfatal myocardial infarction, and coronary revascularization) were similar in the two groups (32.2% versus 32.4%). CONCLUSIONS: Treatment with linsidomine and molsidomine was associated with a modest improvement in the long-term angiographic result after angioplasty but had no effect on clinical outcome. The improved angiographic result related predominantly to a better immediate procedural result, because late luminal loss did not differ significantly between groups.

Aged

Ultrasound contrast agent in intravascular echography: an in vitro study.

The intravascular ultrasound image of the intraluminal contour depends on the difference between acoustic impedances of the media which create the endoluminal interface. There are several limitations to the visualization and detection of this interface. These limitations are due to artifacts encountered during image formation and to anatomical complexity. The purpose of this study is to obtain intraluminal contour enhancement using ultrasound contrast agent (UCA). Therefore, our objective was to address the feasibility of this technique by documenting the following: (i) the acoustic properties of UCA at 30 MHz; (ii) in vitro experimentation with tube or postnecrotic artery; and (iii) suitable digital processing. The images obtained with UCA (enhanced image quality) and subtracted from those without UCA provided, after simple digital processing, accurate visualization of the arterial lumen. The image obtained exhibits an even, high-contrast intraluminal edge. Such characteristics facilitate contour extraction by the automated contour detection procedures.

Contrast Media

Validation of a new quantitative coronary angiography analysis system used to evaluate densitometric lumen remodelling.

Arterial lumen volume, determined by sequential coronary angiography, could have advantages over more commonly used variables (such as percent stenosis or minimal lumen diameter) as a primary endpoint in clinical trials evaluating post-angioplasty restenosis or atherosclerotic plaque progression. We validated a quantitative coronary angiography analysis (QCA) system aimed at measuring lumen volume from coronary angiography films by a densitometric method. Using images of polyacrylate models filled with different concentrations of contrast medium, accuracy (mean of the differences between known and measured values of a measurement) and precision (standard deviation of the difference) were lower than or equal to 0.09 and 0.21 mm, respectively, for diameters ranging from 1.5 to 16 mm. In terms of volume measurement, accuracy was 30.2 mm3 and precision 5.7 mm3 for a known volume of 620.2 mm3. To assess the short-term variations of lumen volume measurements under conditions resembling those encountered in clinical trials, a special image comparison program of the QCA system was used to measure the same coronary artery segment on two images taken 10 minutes apart in 21 patients. The mean difference between the two measurements was 1.7 +/- 12.4 mm3, with a coefficient of variation of 15%. An error of +/-2 frames in the selection of images to be analyzed had little influence on the results. We conclude that the QCA system provides easy-to-achieve standardization of the image acquisition process and sufficient reproducibility for repeated measurement of volume of a coronary artery segment, which can serve as the primary endpoint in clinical trials evaluating atherosclerotic plaque progression or restenosis after angioplasty.

Angioplasty

[Analysis of the diagnostic value of endovascular ultrasound with roc curves. Practical implications].

Intravascular ultrasound enables detection of the components of atherosclerotic plaques. The diagnostic value was assessed by ROC (receiver operating characteristic) curves on images acquired in vitro and correlated with the histological findings in 61 arteries. Five questions were asked of each operator; the reply was represented by a continuous variable in order to express all nuances of judgement. The area under the ROC curve, Az, was the criterion of performance (0.5 : chance response : 1.0 : all replies were accurate). Detection of plaque was satisfactory (Az = 0.89). The three layer appearance of muscular arteries was well recognised (Az = 0.94). The fibrous composition of a plaque was only just satisfactory (Az = 0.88) with 38.7% interindividual variability. The lipid composition of the plaque was poorly recognised (Az = 0.76) with large interindividual variability (52.8%) : hypoechogenicity was too ambiguous a sign from the acoustic point of view. A hypoechogenic zone must not be synonymous with a lipid plaque but a cellular zone. Calcium can almost always be detected (Az = 0.98) with a very low interindividual variability (10.7%), fibrohyaline progression of some plaques can be confusing. The authors present a more objective description of endovascular ultrasonographic images. They conclude that the diagnostic performance of 30 MHz intravascular ultrasound is satisfactory but several limitations are apparent in the interpretation of images, especially hypoechogenic zone and hyper-reflective zones with high attenuation.

Arteries

Parameters that influence accuracy and precision of quantitative coronary arteriography.

The limited resolution of any imaging system causes edge blurring of objects acquired with X-ray. In digital angiography, this effect combined with noise gives rise to systematic and random errors in the determination of vessel dimensions. The influence of bandwidth limitation on the estimation of tube diameter is established by a theoretical approach: it leads to over and underestimations of catheter and vessel diameter dimensions. Therefore a correction is proposed that counterbalances the point spread function (PSF) offset. The residual inaccuracy and the variability of measurement of phantom tubes are analyzed and evaluated in controlled conditions. Some of the parameters which govern their extent are identified: field-of-view, catheter size, concentration of contrast agent.

Coronary Angiography

Can we optimize our angiographic views every time? Qualitative and quantitative evaluation of a new functionality.

RATIONALE AND OBJECTIVES: For determining the optimum angulations of the x-ray beam with respect to the vascular morphology of a given patient, the authors present a solution combining a single-plane angiographic system and a dedicated procedure. METHODS: The clinical evaluation of the vessel profiling acquisitions focuses on qualitative appraisal and quantitative analysis of conventional and optimum projections. RESULTS: The qualitative evaluation demonstrates the pitfall for an operator to discern optimum from conventional projections. The 70% of preferences for vessel profiling bear witness to the constraints imposed occasionally by the optimum angulations, which may be impracticable for various reasons. However, vessel profiling yields lesions inspection at an optimum view, free of geometric foreshortening. Moreover, there is less risk of superimposition with other branches. From a quantitative standpoint, vessel profiling unveils the lesion with a length significantly longer than in conventional view. CONCLUSIONS: Vessel profiling offers a qualitative optimization of angiographic images and more exact quantitative analysis.

Angiocardiography

[Optimization of coronary angiographic views. Qualitative and quantitative evaluation of a new system].

A coronary angiographic view is said to be "optimal" when the directing radius of the X-ray beam is perpendicular to the long axis of a stenosis. The object was to fulfill two criteria: 1) the accurate calculation of the spatial orientation of the stenosis to obtain the optimal position, 2) rapid and optimal positioning of the angiographic material with easy rotation around the axis of the stenosis. Two combined solutions were proposed:the Advantx L/C (GE Medical systems) angiocardiographic system with three motorised axes of rotation and a specific software. This software takes into account two longitudinal axes of the stenosis traced by the operator in two conventional incidences and then determines the angles of optimal positioning (accuracy +/-5 degrees). During 97 consecutive coronary angiograms, the software was used in 23 cases (24%) and judged to be useful in 16 cases (70%). In 2 of the 23 cases (8%) the mechanical angles calculated could not be used, the incidences being incompatible with the patient's position. During the angiograms, the best two images of stenosis (one conventional, one optimal) were retained to form a pair of images. Eight observers analysed 37 pairs of images shown side by side. 65% of the images selected from each pair as being the best descriptive appearance of the stenosis came from the optimised system. During quantitative analysis, only the length of stenosis differed statistically between the two modes of acquisition (1.26 +/- 0.36 mm; p = 0.0014). This system is useful during coronary angiography for providing optimal views of stenosis free from any geometric distorsion and without superimposition of adjacent branches.

Coronary Angiography

Beat-to-beat analysis of left ventricular pressure-volume relation and stroke volume by conductance catheter and aortic Modelflow in cardiomyoplasty patients.

BACKGROUND: Since the clinical introduction of dynamic cardiomyoplasty, a discrepancy has been observed between unchanged measurements of cardiac function and improved clinical outcome. METHODS AND RESULTS: We performed a beat-to-beat analysis of cardiac performance at rest in nine cardiomyoplasty patients 6 to 24 months after operation. Conductance and micromanometer catheters were placed in left ventricle and aorta and used for measurements over a 15-second period, during which the wrapped latissimus dorsi (LD) muscle was stimulated for 10 seconds in a 1:2 synchronization mode followed by a 5-second period without LD stimulation. The synchronization delay between start of the QRS complex and the LD contraction was changed from 4 up to 125 ms at the patient's clinical stimulation strength and at an increased supramaximal amplitude. Comparing the LD assisted period to the unassisted period, at the clinical settings no significant changes in stroke volume (SV) as measured by the conductance technique and the aortic Modelflow technique were observed. A significant (P < .05) rise in left ventricular end-diastolic pressure (LVEDP) was observed directly after the assisted 10-second period. The peak ejection rate (PER) of left ventricular volume increased (P < .05), with a mean of 28 +/- 23% during the LD stimulated beats. At the patient's individual best setting, SV of the stimulated beats increased (P < .01) by a mean of 20 +/- 15%. Systolic aortic pressure increased (P < .01) by a mean of 7 mm Hg, peak negative dP/dt increased (P < .01), and PER increased, with a mean of 68 +/- 24% (P < .01). LVEDP was similar in stimulated and unstimulated beats and increased (P < .05) in the nonpaced 5-second period. The delay for the best setting ranged from 25 to 125 ms; the stimulus strength was 1.5 to 3 V higher than the clinical setting. At the patient's individual worst setting, SV remained unchanged and PER was higher, with a mean of 30 +/- 25% (P < .05). The worst setting was observed at the 1.5- to 3-V-higher stimulus strength; in six patients, it was at a short delay (4 to 25 ms) and in three patients, at the longest delay (100 to 125 ms). CONCLUSIONS: By the left ventricular conductance catheter and aortic Modelflow methods, improvement in cardiac function by dynamic cardiomyoplasty was demonstrated in this patient group. The synchronization interval, stimulus strength, and stimulus duration appeared to be critical for obtaining optimal improvement.

Aged

Risk and results of bypass grafting using bilateral internal mammary and right gastroepiploic arteries.

From January 1990 to June 1994, 240 patients (mean age, 60 +/- 10 years) underwent myocardial revascularization with the exclusive use of in situ bilateral internal mammary and right gastroepiploic arteries. Left ventricular function was normal in 34% of patients, moderately impaired in 58.5%, and severely impaired in 7.5%. The mean number of distal anastomoses was 3.5 +/- 0.7 and the rate of complete myocardial revascularization was 80%. Early mortality was 0.4%, and complications occurred in 20 patients: myocardial infarction, 1.6%; intraaortic balloon pump, 0.8%; reoperation for bleeding, 0.8%; and mediastinitis, 0.4%. Early (15th postoperative day) angiographic control of grafts was performed in 51 patients; the rate of functional and patent anastomoses was 100% for internal mammary arteries and 96% for gastroepiploic arteries. Early functional results (3 +/- 1 postoperative months) were studied in 141 patients during exercise test with medical treatment: 99% were symptom-free and 14% had ischemic modification of electrocardiograms. A 2-year postoperative functional assessment without medical treatment was performed during exercise test in 66 patients: 98% were symptom-free and 26% had ischemic modification of electrocardiograms; during the same procedure, thallium myocardial scintigraphy was obtained in 50 patients and 18 patients had moderate ischemic defect on exercise. Ischemic modifications of electrocardiograms and defects seen on thallium scintigraphy were correlated significantly with incomplete revascularization (p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Abdominal Muscles

Late hemodynamic results after cardiomyoplasty in congestive heart failure.

Between November 1989 and September 1990, a cardiomyoplasty procedure was performed in 12 male patients with a mean age of 59 years. All patients were in New York Heart Association class III. Reinforcement cardiomyoplasty was isolated in 4 patients and associated with a cardiac procedure in 8. There were no perioperative deaths. Failure of cardiomyoplasty occurred in 5 patients because of recurrence of disabling congestive heart failure: 3 patients died late, and 2 had heart transplantation. The actuarial survival rate was 83% at 1 year and 73% at 2 years. Hemodynamic studies were done preoperatively in all patients, at 6 months postoperatively in 11 patients, at 1 year in 8, and at 2 years in 7. At the 2-year follow-up, 6 of the 7 survivors who did not have transplantation were functionally improved with reduced medical treatment. The following indices improved significantly at the 2-year evaluation compared with baseline: exercise capacity (63 +/- 13 W versus 83 +/- 17 W); left ventricular (LV) end-diastolic pressure (20 +/- 7 mm Hg versus 11 +/- 5 mm Hg); and angiographic LV ejection fraction (0.25 +/- 0.09 versus 0.40 +/- 0.15). Pulmonary artery pressure, pulmonary capillary wedge pressure, and cardiac index remained unchanged. Four patients underwent beat-to-beat analysis of LV function at 2 years; during skeletal muscle stimulation, stroke volume increased by 7% to 35% and LV end-systolic pressure, by 5% to 9%. In the 5 patients with failed cardiomyoplasty, mean pulmonary artery pressure and LV end-diastolic volume were higher preoperatively than in the 7 survivors.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged

[Artefacts and intravascular ultrasonography. Analysis and implications for a better reliability in the interpretation of images and measurements].

Intravascular ultrasound catheters provide cross-sectional images of vessel walls and surrounding tissues with rotating transducers, and the behavior of ultrasound in heterogeneous media both cause degradation of image quality. Qualitative and quantitative analyses of in vivo studies are operator-dependent and limited by artifacts. We investigated these limitations by an in vitro study on plexiglass phantoms and segments of fresh arteries. We observed, analyzed and interpreted the most specific reasons for image artifacts: geometric distortions, the point spread function of the imaging system and the near field effects. Various practical implications have resulted from this study. Knowledge of the most obvious pitfalls will enable the user to obtain maximum benefits from intravascular ultrasound imaging, and to appreciate its limitations.

Arterial Occlusive Diseases

Artifacts in intravascular ultrasound imaging: analyses and implications.

The ability of an intravascular ultrasound catheter to give cross-sectional images of vessel walls and surrounding tissues, and the behavior of ultrasound in heterogeneous media, are at the origin of degradation of image quality. Qualitative and quantitative analyses of in vivo studies are then operator-dependent and are limited by artifacts. We investigated these limitations by an in vitro study on plexiglass phantoms and segments of fresh arteries. We used a 20 MHz transducer mounted on the tip of a 4.8 F catheter and an interventional ultrasound system. The ultrasound beam is reflected onto the rotating transducer at 600 rotations per minute (RPM), creating 360 degrees real-time images (10 images/second). We then observed, analyzed and interpreted the most specific reasons for image artifacts: geometric distortions, multiple echoes, the point spread function (PSF) of the imaging system, near-field effects, "petal-shaped" effect, and ultrasound speckle. Various practical implications have resulted from this study. Only a thorough knowledge of how to avoid some of the most obvious pitfalls will enable the user to obtain maximum benefits from intravascular ultrasound imaging, and to appreciate its limitations.

Arteries

[Intravascular echographic imaging: experimental validations and limits. An in vitro study].

Intravascular ultrasound is a new method of visualizing details of vascular pathology, providing (real time) high resolution images of vascular walls. Most of the research on the technique has explored its qualitative and quantitative capabilities to improve the assessment of atherosclerotic vascular disease in vivo. Intravascular ultrasound differs from angiography and angioscopy in its ability to penetrate below the surface of the vessel lumen, demonstrating specific appearances of the distribution and composition of plaque. Image analysis is operator dependent. Although this technology is very promising limitations such as artefacts and loss of image quality in heavily calcified vessels hinder its use. There is hope that this imaging technique may ultimately improve the results of endovascular interventions.

Arteries

[Technique for measuring the atheroma volume in men].

The evaluation of the impact of therapy on the evolution of atherosclerotic lesions or restenosis after angioplasty requires the use of techniques of vascular imaging. The reference invasive method is digital angiography although it does not provide data on the arterial wall thickness. This parameter can be approached however by intravascular ultrasound imaging, a technique which has a number of important practical limitations. Of the non-invasive techniques available, Doppler ultrasonography is the only one that can be used in clinical trials. Nuclear magnetic resonance imaging is the object of much research and is without doubt the technique of the future. The choice of model of atherosclerosis influences that of the imaging technique: cineangiography for coronary arteries, digital angiography or Doppler ultra sonography for lower limb arteries and Doppler ultrasonography for the carotid arteries. Interpretation of angiography is now performed quantitatively by videodensitometry. Interpretation of other techniques should be performed by a second independent observer and "blinded" with respect to the order in which the investigations were performed and to the treatment administered. The criteria of judgment may be qualitative (progression, stabilisation, regression) or quantitative, the latter having a number of advantages over the former. Of the quantitative criteria, the percentage stenosis, though widely used, does not fully answer the question posed, and neither does the diameter of the stenosis. The volume of the arterial lumen calculated from videodensitometric data would seem to be the best, by its sensitivity and additivity, current angiographic parameter.(ABSTRACT TRUNCATED AT 250 WORDS)

Angiography, Digital Subtraction

[Diverticulum of the right atrium. A case report and review of the literature].

Congenital atrial diverticula are rare, especially those involving the right atrium. This condition was observed in a 52 year old man who presented with palpitations. The diagnosis was made by two-dimensional echocardiography and confirmed by CT scan, magnetic resonance imaging and angiography. In the absence of significant invalidity, no treatment was recommended. Only three other cases of this condition have been previously reported, all of which were referred for surgery for thrombotic complications, arrhythmias and cardiac failure. Anatomo-pathological analysis showed different appearances: fibrous tissue and lipomatous degeneration. In the absence of associated heart disease, these aneurysms are probably congenital.

Angiocardiography