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.
研究概览
详细说明
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.
研究类型
注册 (估计的)
联系人和位置
学习联系方式
- 姓名：Jinying Zhou, MD, PhD
- 邮箱：zhou.jinying@zs-hospital.sh.cn
研究联系人备份
- 姓名：Chenguang Li, MD, PhD
- 电话号码：021 6404 1990
- 邮箱：li.chenguang@zs-hospital.sh.cn
学习地点
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Guangzhou、中国
- 招聘中
- The First Affiliated Hospital, Sun Yat-sen University
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接触：
- Xun Hu, MD, PhD
- 电话号码：020-87608185
- 邮箱：hxun@mail.sysu.edu.cn
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Please Select
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Shanghai、Please Select、中国、200000
- 招聘中
- Zhongshan hospital, Fudan university
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接触：
- Jinying Zhou, MD, PhD
- 电话号码：021 6404 1990
- 邮箱：zhou.jinying@zs-hospital.sh.cn
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参与标准
资格标准
适合学习的年龄
- 成人
- 年长者
接受健康志愿者
取样方法
研究人群
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.
描述
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%.
学习计划
研究是如何设计的？
设计细节
队列和干预
团体/队列 |
干预/治疗 |
|---|---|
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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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研究衡量的是什么？
主要结果指标
结果测量 |
措施说明 |
大体时间 |
|---|---|---|
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Area Under the ROC Curve (AUC)
大体时间：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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次要结果测量
结果测量 |
措施说明 |
大体时间 |
|---|---|---|
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Diagnostic Accuracy
大体时间：Baseline
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Sensitivity, specificity, positive predictive value, negative predictive value.
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Baseline
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Correlation
大体时间：Baseline
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Pearson/Spearman coefficients between Angio-IMR and Wire-IMR.
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Baseline
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Agreement
大体时间：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
大体时间：Baseline
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Consistency between different software brands.
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Baseline
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合作者和调查者
研究记录日期
研究主要日期
学习开始 (实际的)
初级完成 (估计的)
研究完成 (估计的)
研究注册日期
首次提交
首先提交符合 QC 标准的
首次发布 (实际的)
研究记录更新
最后更新发布 (实际的)
上次提交的符合 QC 标准的更新
最后验证
更多信息
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