Impact of Hyperemic State on Angio-IMR Performance
The Impact of Hyperemic State on the Performance of Angiography Derived Indices in Assessing Coronary Microvascular Disease
The goal of this observational study is to evaluate the diagnostic performance of angiography-derived microcirculatory indices (Angio-IMR) in assessing patients with stable angina or suspected coronary artery disease. The main questions it aims to answer are:
How do the numerical values of Angio-IMR from five different software vendors change across three physiological states (resting, sub-hyperemia induced by nitroglycerin, and maximal hyperemia induced by adenosine)? Which physiological state and software algorithm provide the highest diagnostic accuracy (Area Under the Curve, AUC) for diagnosing Coronary Microvascular Disease (CMD) when compared to the gold standard wire-based IMR? Researchers will compare the Angio-IMR results calculated under the three different physiological conditions within the same patient to see how the hyperemic state impacts the performance and consistency of these non-invasive indices.
Participants will:
Undergo standard-of-care coronary angiography and physiological assessment using a pressure wire for index of microvascular resistance (Wire-IMR) as part of their clinical management.
Have their angiographic images captured at three specific time points: at rest, after intracoronary nitroglycerin, and during adenosine-induced maximal hyperemia.
Allow their de-identified imaging and clinical data to be analyzed by an independent core laboratory using five different Angio-IMR software platforms to evaluate microvascular function.
연구 개요
상세 설명
Study Overview and Procedural Protocol
This is a prospective, multi-center, diagnostic accuracy study employing a self-controlled design. All participants will undergo coronary angiography and physiological assessment according to standard clinical indications. During the procedure, specific angiographic images will be systematically captured for the target vessel at three distinct physiological time points:
Resting State: Baseline coronary angiography without any hyperemic agents. Sub-hyperemic State: Following the intracoronary administration of nitroglycerin.
Maximal Hyperemic State: During continuous intracoronary infusion of adenosine to achieve maximal microvascular vasodilation.
Immediately following image acquisition, the reference standard measurement-Wire-IMR-will be performed using a pressure-sensor-equipped guidewire under maximal hyperemia.
Core Laboratory Imaging Analysis and Blinding
All angiographic data will be de-identified and transferred to a centralized, independent Cardiovascular Imaging Core Laboratory at Zhongshan Hospital, Fudan University. The analysis will be conducted as follows:
Software Platforms: Five different commercially available Angio-IMR software platforms (anonymized as A, B, C, D, and E) will be used to calculate microvascular resistance.
Independent Analysis: Five dedicated analysts, each specialized in one specific software platform, will perform the calculations. Each analyst will be blinded to the patients' clinical information, the Wire-IMR gold standard results, and the results from the other four software platforms.
Standardization: A primary researcher, not involved in the software measurements, will pre-define the target vessel segments and measurement frames to ensure consistency across all five software platforms.
Statistical Considerations and Data Management The study aims to determine if the coronary hyperemic state significantly alters the fluid dynamics modeling utilized by Angio-IMR algorithms. AUC will be calculated for each software at each of the three states. A head-to-head comparison of AUCs will be performed using DeLong's test. To maintain data integrity, results from the core laboratory and the clinical centers will remain strictly separated until the final database lock.
연구 유형
등록 (추정된)
연락처 및 위치
연구 연락처
- 이름: Jinying Zhou, MD, PhD
- 이메일: zhou.jinying@zs-hospital.sh.cn
연구 연락처 백업
- 이름: Chenguang Li, MD, PhD
- 전화번호: 021 6404 1990
- 이메일: li.chenguang@zs-hospital.sh.cn
연구 장소
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Guangzhou, 중국
- 모병
- The First Affiliated Hospital, Sun Yat-sen University
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연락하다:
- Xun Hu, MD, PhD
- 전화번호: 020-87608185
- 이메일: hxun@mail.sysu.edu.cn
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Please Select
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Shanghai, Please Select, 중국, 200000
- 모병
- Zhongshan Hospital, Fudan University
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연락하다:
- Jinying Zhou, MD, PhD
- 전화번호: 021 6404 1990
- 이메일: zhou.jinying@zs-hospital.sh.cn
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참여기준
자격 기준
공부할 수 있는 나이
- 성인
- 고령자
건강한 자원 봉사자를 받아들입니다
샘플링 방법
연구 인구
The study population consists of adult patients (aged 18 and older) clinically diagnosed with stable angina or suspected coronary artery disease who are scheduled to undergo conventional coronary angiography and invasive physiological assessment.
Participants are prospectively and consecutively recruited from multiple clinical centers in China. The population specifically targets individuals with non-obstructive coronary arteries (stenosis < 50%) or those with moderate stenosis (50%-90%) but preserved epicardial flow (FFR > 0.80), where assessment of coronary microvascular function is clinically indicated to investigate the cause of ischemia.
설명
Inclusion Criteria:
- Stable angina or suspected coronary heart disease.
- Scheduled for coronary angiography and physiological assessment.
- Target vessel with stenosis < 50% or 50%-90% with fractional flow reserve (FFR) > 0.80.
- Provided informed consent.
Exclusion Criteria:
- Hemodynamic instability (acute myocardial infarction, cardiogenic shock, severe arrhythmia).
- Contraindications to angiography (e.g., end-stage renal disease).
- Contraindications to adenosine (e.g., severe asthma, high-degree atrial-ventricular block).
- Life expectancy < 1 year or pregnancy.
- Target vessel unsuitable for wire operation (left main lesion, severe tortuosity) or stenosis > 90%.
공부 계획
연구는 어떻게 설계됩니까?
디자인 세부사항
코호트 및 개입
그룹/코호트 |
개입 / 치료 |
|---|---|
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Single cohort, self-controlled
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Unlike the reference standard "Wire-IMR," which requires the advancement of a specialized pressure-sensor guidewire into the distal coronary artery, Angio-IMR is a wire-free technology.
It derives microvascular resistance indices purely through computational fluid dynamics (CFD) or specialized mathematical models based on standard coronary angiographic projections.
This eliminates the risk of wire-induced vascular injury or spasm.
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연구는 무엇을 측정합니까?
주요 결과 측정
결과 측정 |
측정값 설명 |
기간 |
|---|---|---|
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Area Under the ROC Curve (AUC)
기간: Baseline
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Comparison of AUC for 5 types of Angio-IMR against Wire-IMR (Gold standard, CMD defined as Wire-IMR ≥ 25) under three states.
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Baseline
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2차 결과 측정
결과 측정 |
측정값 설명 |
기간 |
|---|---|---|
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Diagnostic Accuracy
기간: Baseline
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Sensitivity, specificity, positive predictive value, negative predictive value.
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Baseline
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Correlation
기간: Baseline
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Pearson/Spearman coefficients between Angio-IMR and Wire-IMR.
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Baseline
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Agreement
기간: Baseline
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Bland-Altman analysis (Bias and Limits of Agreement).
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Baseline
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Inter-vendor Agreement
기간: Baseline
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Consistency between different software brands.
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Baseline
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공동 작업자 및 조사자
연구 기록 날짜
연구 주요 날짜
연구 시작 (실제)
기본 완료 (추정된)
연구 완료 (추정된)
연구 등록 날짜
최초 제출
QC 기준을 충족하는 최초 제출
처음 게시됨 (실제)
연구 기록 업데이트
마지막 업데이트 게시됨 (실제)
QC 기준을 충족하는 마지막 업데이트 제출
마지막으로 확인됨
추가 정보
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