Diagnostic performance of multi-branch coronary angiography-based index of microcirculatory resistance: a novel approach

Figures

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  Figure 1. CAG-IMR calculation method flow chart. (A) Coronary angiogram image of the target vessel. (B) Three-dimensional reconstruction of the multi-branch coronary artery tree. (C) Acquiring patient-specific mean aortic pressure, conducting hemodynamic simulation, and calculating CAG-IMR. (D) Post-processing of results to obtain CAG-FFR in the entire coronary tree and CAG-IMR of each branch. CAG, Coronary Angiography; IMR, Index of Microcirculatory Resistance; FFR, Fractional Flow Reserve.

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  Figure 2. Patients flow chart. CAD, coronary artery disease; ICA, invasive coronary angiography; IMR, index of microcirculatory resistance.

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  Figure 3. The multi-branch coronary artery tree CAG-IMR results of a single patient. (A) Wire-based IMR at LAD. (B) Wire-based IMR at LCX. (C) CAG-IMR at LAD. (D) CAG-IMR at LCX.

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  Figure 4. The correlation and linear regression analysis between CAG-IMR and wire-based IMR. The CAG-IMR values (depicted on the y-axis) exhibited a robust positive correlation (r = 0.84, p < 0.001) with wire-based IMR (illustrated on the x-axis).

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  Figure 5. Bland-Altman plots for pairwise comparison (mean difference: 0.88; SD: 4.75; 95% limits of agreement −8.44 to 10.19).

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  Figure 6. Receiver-operating curve for CAG-IMR, using a cutoff value of 25. The area under the curve (AUC) was calculated to be 0.97.

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  Figure 7. Intra-observer reproducibility analysis of CAG-IMR calculations by one operator at the intervals of 1 week and Inter-observer reproducibility analysis by two operators: (A) Assessment of consistency in CAG-IMR calculations, (B) Bland-Altman plot illustrating agreement. Inter-observer reproducibility analysis of CAG-IMR calculations: (C) Evaluation of consistency between two sets of CAG-IMR calculations, (D) Bland-Altman plot demonstrating agreement.