WO2020098139A1 - Procédé de calcul du rapport sans onde instantanée et du rapport de pression diastolique au repos sur la base d'une image de contraste - Google Patents

Procédé de calcul du rapport sans onde instantanée et du rapport de pression diastolique au repos sur la base d'une image de contraste Download PDF

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WO2020098139A1
WO2020098139A1 PCT/CN2019/071205 CN2019071205W WO2020098139A1 WO 2020098139 A1 WO2020098139 A1 WO 2020098139A1 CN 2019071205 W CN2019071205 W CN 2019071205W WO 2020098139 A1 WO2020098139 A1 WO 2020098139A1
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pressure
blood
blood vessel
dimensional
ratio
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PCT/CN2019/071205
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English (en)
Chinese (zh)
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霍云飞
刘广志
吴星云
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苏州润迈德医疗科技有限公司
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/02—Detecting, measuring or recording pulse, heart rate, blood pressure or blood flow; Combined pulse/heart-rate/blood pressure determination; Evaluating a cardiovascular condition not otherwise provided for, e.g. using combinations of techniques provided for in this group with electrocardiography or electroauscultation; Heart catheters for measuring blood pressure
    • A61B5/026—Measuring blood flow
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/02—Detecting, measuring or recording pulse, heart rate, blood pressure or blood flow; Combined pulse/heart-rate/blood pressure determination; Evaluating a cardiovascular condition not otherwise provided for, e.g. using combinations of techniques provided for in this group with electrocardiography or electroauscultation; Heart catheters for measuring blood pressure
    • A61B5/02007—Evaluating blood vessel condition, e.g. elasticity, compliance
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/02—Detecting, measuring or recording pulse, heart rate, blood pressure or blood flow; Combined pulse/heart-rate/blood pressure determination; Evaluating a cardiovascular condition not otherwise provided for, e.g. using combinations of techniques provided for in this group with electrocardiography or electroauscultation; Heart catheters for measuring blood pressure
    • A61B5/021—Measuring pressure in heart or blood vessels
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B6/00—Apparatus or devices for radiation diagnosis; Apparatus or devices for radiation diagnosis combined with radiation therapy equipment
    • G—PHYSICS
    • G06—COMPUTING; CALCULATING OR COUNTING
    • G06T—IMAGE DATA PROCESSING OR GENERATION, IN GENERAL
    • G06T17/00—Three dimensional [3D] modelling, e.g. data description of 3D objects
    • G06T17/20—Finite element generation, e.g. wire-frame surface description, tesselation

Definitions

  • the present invention relates to the field of coronary artery imaging evaluation, and in particular to a method of determining instantaneous wave-free ratio (iFR) and resting diastolic pressure ratio (dPR and DFR) only by contrast image and aortic pressure.
  • iFR instantaneous wave-free ratio
  • dPR and DFR resting diastolic pressure ratio
  • the blood flow reserve fraction can indicate the influence of coronary stenosis on the distal blood flow, and the diagnosis of myocardial ischemia has become a recognized index for the functional evaluation of coronary stenosis.
  • the FFR When determining FFR, it is necessary to calculate the FFR based on the average blood pressure of the myocardial hyperemia and the average pressure of the coronary aorta at the distal coronary artery through different means.
  • the maximum congestion of the myocardium requires intracoronary or intravenous injection of adenosine or ATP. Injection of adenosine or ATP will cause aortic pressure drop and have certain side effects such as atrioventricular block, sinus remission, sinus arrest, etc., contraindications Including 2 degree or 3 degree atrioventricular block, sinus disease, tracheal or bronchial asthma, and adenosine allergy.
  • the instantaneous waveform-free ratio can provide a method for measuring coronary pressure similar to the fractional flow reserve (FFR).
  • FFR fractional flow reserve
  • iFR does not require vasodilators, is simple to operate, and will be more used in coronary interventional therapy.
  • the ADVISE study found that during a certain period of diastole (called the non-wave period), the intravascular coronary microvascular resistance is relatively stable and the lowest, and during the coronary congestion made with vasodilator drugs such as adenosine The average resistance reached is similar.
  • iFR P dWave-free period / P aWave-free period
  • P dWave-free period the mean coronary pressure at the distal end of the stenotic lesion during the non-waveform period.
  • P aWave-free period during the non-waveform period Average aortic pressure.
  • Computation time of the instant non-waveform period 25% of the time after the start of the non-waveform period in diastole, and 5 ms before the start of the systole.
  • a research article was published in the top medical journal NEJM. In patients with stable angina or acute coronary syndrome, IFR-guided revascularization strategies are not inferior to FFR-guided reconstruction strategies, and major adverse cardiac events occur within 12 months. The rate is similar.
  • the existing measurement methods of instantaneous wave-free ratio (iFR) and resting diastolic pressure ratio (dPR and DFR) are mainly as follows: the corresponding diastolic interval is measured under the resting state of the pressure guide wire to determine iFR and dPR , DFR. It needs to rely on the pressure guide wire for measurement. The pressure guide wire needs to intervene in the end of the blood vessel, which increases the difficulty and risk of surgery. At the same time, the expensive price of the pressure guide wire also limits its large-scale application.
  • the object of the present invention is to provide a method for calculating the instantaneous wave-free ratio and the resting diastolic pressure ratio based on contrast images to detect myocardial ischemia in patients with coronary heart disease by conventional coronary angiography Circumstances where no vasodilators are needed (ie no myocardial hyperemia and no adenosine or ATP). Calculate the instantaneous wave-free ratio (iFR) and resting diastolic pressure ratio (dPR and DFR) from conventional contrast images, aortic pressure and blood flow.
  • iFR instantaneous wave-free ratio
  • dPR and DFR resting diastolic pressure ratio
  • a method for calculating instantaneous wave-free ratio and resting diastolic pressure ratio based on contrast image includes the following steps:
  • S01 blood pressure sensor by measuring the diastolic pressure of coronary port P a;
  • S02 Obtain the two-dimensional tube diameter and length of the blood vessel through the contrast image, and generate the three-dimensional blood vessel grid model from the two contrast images at an angle of more than 30 ° and obtain the three-dimensional tube diameter and length of the blood vessel;
  • V 2 0.43 * V 1 +35;
  • V 1 200mm / s
  • V 2 0.35 * V 1 +55
  • the step S01 includes connecting the pressure tube of the blood pressure sensor to the multi-way tee, and then connecting the coronary ostium of the heart through a contrast catheter, filling the pressure tube of the blood pressure sensor with saline, and maintaining the blood pressure sensor At the same horizontal position as the heart, the pressure wave measured by the blood pressure sensor is the pressure wave of the coronary ostium of the heart, and the average value of the instantaneous pressure during the diastolic period is Pa .
  • the method for generating a three-dimensional blood vessel grid model in step S02 includes the following steps:
  • S21 Perform 3D reconstruction on the 2D structure data of two segmented blood vessels with a mapping relationship on two X-ray coronary angiography images at an angle of more than 30 ° to obtain 3D structure data of the segmented blood vessel;
  • step S22 Repeat step S21 until the three-dimensional reconstruction of all segmented blood vessels is completed, and then merge the reconstructed segmented blood vessels to obtain a complete three-dimensional blood vessel grid model.
  • the specific method for calculating the blood flow velocity V 1 in step S03 includes the following steps:
  • S31 Obtain the specified patient's heart rate H times / minute, and obtain the image frequency from the contrast image information as S frames / second.
  • the specific method for calculating the pressure drop ⁇ P from the entrance of the coronary artery to the distal end of the coronary stenosis in the step S05 is as follows:
  • P, ⁇ , ⁇ are flow velocity, pressure, blood flow density, blood flow viscosity
  • the inlet boundary condition is the blood flow velocity
  • the outlet boundary condition is the out-flow boundary condition
  • Figure 1 is a schematic diagram of the instantaneous wave-free ratio (iFR) (Instantaneous Wave-Free Ratio); the horizontal axis is the average Pd / Pa during WFP,
  • Figure 2 is a schematic diagram of resting diastolic pressure ratio (dPR) (Disatolic Pressure Ratio); the horizontal axis is the average Pd / Pa of the entire diastolic period,
  • dPR resting diastolic pressure ratio
  • FIG. 3 is a schematic diagram of the resting diastolic pressure ratio (DFR) (Diastolic Hyperemia Free Ratio); the horizontal axis is the average Pd / Pa for the entire period, between Pa ⁇ average value Pa and downhill surface Pa;
  • DFR resting diastolic pressure ratio
  • Figure 5 is a two-dimensional blood vessel image
  • Fig. 61 is an image of the position-contrast agent flowing to the catheter port
  • Fig. 62 is an image of the position-contrast agent flowing to the distal end of the blood vessel
  • Figure 63 is an image of the second position of the contrast agent flowing to the catheter port
  • Figure 64 is an image of the second position of the contrast agent flowing to the distal end of the blood vessel
  • Figure 7 is a screenshot of the cross section of the grid
  • Figure 8 is a screenshot of the longitudinal section of the grid.
  • a method of the present invention for determining instantaneous wave-free ratio (iFR) and resting diastolic pressure ratio (dPR and DFR) only by contrast image and aortic pressure includes the following steps.
  • Step S1 coronary artery diastolic pressure port P a, which is specifically as follows by measuring the blood pressure sensor:
  • the pressure tube using the blood pressure sensor is connected to the multi-way tee, and then connected to the coronary ostium of the heart through the contrast catheter.
  • the pressure tube of the blood pressure sensor is filled with saline and keeping the blood pressure sensor and the heart at the same horizontal position.
  • the pressure wave is the pressure wave of the coronary ostium of the heart, and the average value of the instantaneous pressure during the diastolic period is Pa .
  • Step S2 Obtain the two-dimensional diameter and length of the blood vessel from the contrast image, as shown in FIG. 5, and generate the three-dimensional vessel mesh model from the two contrast images at an angle of more than 30 ° and obtain the three-dimensional diameter and length of the blood vessel ;
  • the specific method of the three-dimensional blood vessel grid model is as follows:
  • Step S3 As shown in FIGS. 61-64, during the diastolic phase, the blood (including contrast agent) is measured from the start point (61, 63) to the end point (62, 64) of a specified blood vessel (including possible criminal vessels) The time used and the blood flow velocity V 1 is calculated according to the time and the three-dimensional length of the blood vessel.
  • the specific method is as follows:
  • the corresponding images of the two-dimensional start frame and end frame as shown in Figure 61 and Figure 62 or Figure 63 and Figure 64, respectively, obtain a heartbeat period during the diastolic period Start point and end point, and then use the start point and end point to intercept the length of a diastolic blood vessel in the three-dimensional synthetic data;
  • Step S4 Calculate the blood flow velocity V 2 in the resting state
  • V 1 100 millimeters per second (mm / s)
  • V 2 0.53 * V 1 +20;
  • V 2 0.43 * V 1 +35;
  • V 1 200mm / s
  • V 2 0.35 * V 1 +55
  • step S5 The specific method for calculating the pressure drop ⁇ P from the entrance of the coronary artery to the distal end of the coronary stenosis in step S5 is as follows:
  • P, ⁇ , ⁇ are flow velocity, pressure, blood flow density, blood flow viscosity
  • the inlet boundary condition is the blood flow velocity
  • the outlet boundary condition is the out-flow boundary condition

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Abstract

La présente invention concerne un procédé de calcul d'un rapport sans onde instantanée et d'un rapport de pression diastolique au repos sur la base d'une image de contraste, consistant : à mesurer la pression Pa d'un orifice d'artère coronaire durant la diastole ; à obtenir le diamètre bidimensionnel et la longueur d'un vaisseau sanguin à l'aide d'une image de contraste, à générer un modèle de maillage de vaisseau sanguin tridimensionnel à l'aide de deux images de contraste, et à obtenir le diamètre et la longueur tridimensionnels du vaisseau sanguin ; durant la diastole du cœur, à mesurer le temps pris par le cœur contenant un agent de contraste depuis un point de départ vers un point final d'un vaisseau sanguin spécifié, et à calculer la vitesse d'écoulement du sang V1 selon le temps mesuré et de la longueur tridimensionnelle du vaisseau sanguin ; à calculer la vitesse d'écoulement du sang V2 dans un état de repos ; à utiliser V2 comme vitesse d'écoulement au niveau d'un orifice d'entrée d'artère coronaire pour calculer une chute de pression ΔP depuis l'orifice d'entrée d'artère coronaire vers une extrémité distale étroite de l'artère coronaire, la pression moyenne à l'intérieur de l'extrémité distale étroite de l'artère coronaire étant Pd = Pa - ΔP ; et à calculer afin d'obtenir un du rapport sans onde instantanée et un rapport de pression diastolique au repos. Ainsi, l'iFR, le dPR et le DFR peuvent être obtenus à l'aide d'images de contraste classiques sans utiliser de vasodilatateur.
PCT/CN2019/071205 2018-11-13 2019-01-10 Procédé de calcul du rapport sans onde instantanée et du rapport de pression diastolique au repos sur la base d'une image de contraste WO2020098139A1 (fr)

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CN201811344060.XA CN111166315B (zh) 2018-11-13 2018-11-13 基于造影图像计算瞬时无波型比率和静息态舒张期压力比率的方法
CN201811344060.X 2018-11-13

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Cited By (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
CN112971818A (zh) * 2021-01-28 2021-06-18 杭州脉流科技有限公司 微循环阻力指数的快速获取方法、装置、计算机设备和存储介质

Families Citing this family (1)

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Publication number Priority date Publication date Assignee Title
CN112704505B (zh) * 2020-11-20 2022-05-24 杭州阿特瑞科技有限公司 一种利用cta和dsa测量冠状动脉血流储备分数的方法

Citations (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
CN201949502U (zh) * 2010-06-11 2011-08-31 侯绪伟 一种用于冠状动脉造影测压的三通连接装置
US20140121513A1 (en) * 2007-03-08 2014-05-01 Sync-Rx, Ltd. Determining a characteristic of a lumen by measuring velocity of a contrast agent
US9087147B1 (en) * 2014-03-31 2015-07-21 Heartflow, Inc. Systems and methods for determining blood flow characteristics using flow ratio
CN105078440A (zh) * 2014-05-09 2015-11-25 西门子公司 无创计算冠状动脉狭窄的血液动力学指标的方法和系统
CN106537392A (zh) * 2014-04-22 2017-03-22 西门子保健有限责任公司 用于冠状动脉中的血液动力学计算的方法和系统

Family Cites Families (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
EP3244790B1 (fr) * 2015-01-15 2020-09-02 Koninklijke Philips N.V. Tomodensitométrie ifr (instantanteous wave-free ratio)
CN106327487B (zh) * 2016-08-18 2018-01-02 苏州润迈德医疗科技有限公司 基于x射线冠脉造影图像的冠状动脉血流储备分数计算方法
CN108242075A (zh) * 2018-01-05 2018-07-03 苏州润迈德医疗科技有限公司 一种基于x射线冠脉造影图像的多角度血管重建方法
CN108245178A (zh) * 2018-01-11 2018-07-06 苏州润迈德医疗科技有限公司 一种基于x射线冠脉造影图像的血液流动速度计算方法
CN108550189A (zh) * 2018-05-03 2018-09-18 苏州润迈德医疗科技有限公司 基于造影图像和流体力学模型的微循环阻力指数计算方法

Patent Citations (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20140121513A1 (en) * 2007-03-08 2014-05-01 Sync-Rx, Ltd. Determining a characteristic of a lumen by measuring velocity of a contrast agent
CN201949502U (zh) * 2010-06-11 2011-08-31 侯绪伟 一种用于冠状动脉造影测压的三通连接装置
US9087147B1 (en) * 2014-03-31 2015-07-21 Heartflow, Inc. Systems and methods for determining blood flow characteristics using flow ratio
CN106537392A (zh) * 2014-04-22 2017-03-22 西门子保健有限责任公司 用于冠状动脉中的血液动力学计算的方法和系统
CN105078440A (zh) * 2014-05-09 2015-11-25 西门子公司 无创计算冠状动脉狭窄的血液动力学指标的方法和系统

Cited By (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
CN112971818A (zh) * 2021-01-28 2021-06-18 杭州脉流科技有限公司 微循环阻力指数的快速获取方法、装置、计算机设备和存储介质
CN112971818B (zh) * 2021-01-28 2022-10-04 杭州脉流科技有限公司 微循环阻力指数的获取方法、装置、计算机设备和存储介质

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