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Cardiovascular and
Coronary Artery Imaging
This page intentionally left blank
Cardiovascular and Coronary
Artery Imaging
Volume 1

Edited by

AYMAN S. EL-BAZ
University of Louisville, Louisville, KY, United States;
University of Louisville at AlAlamein International
University (UofL-AIU), New Alamein City, Egypt

JASJIT S. SURI
AtheroPoint, Roseville, CA, United States
Academic Press is an imprint of Elsevier
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525 B Street, Suite 1650, San Diego, CA 92101, United States
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The Boulevard, Langford Lane, Kidlington, Oxford OX5 1GB, United Kingdom
Copyright © 2022 Elsevier Inc. All rights reserved.
No part of this publication may be reproduced or transmitted in any form or by any means,
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can be found at our website: www.elsevier.com/permissions.
This book and the individual contributions contained in it are protected under copyright by the
Publisher (other than as may be noted herein).
Notices
Knowledge and best practice in this field are constantly changing. As new research and
experience broaden our understanding, changes in research methods, professional practices, or
medical treatment may become necessary.
Practitioners and researchers must always rely on their own experience and knowledge in
evaluating and using any information, methods, compounds, or experiments described herein. In
using such information or methods they should be mindful of their own safety and the safety of
others, including parties for whom they have a professional responsibility.
To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors,
assume any liability for any injury and/or damage to persons or property as a matter of products
liability, negligence or otherwise, or from any use or operation of any methods, products,
instructions, or ideas contained in the material herein.
British Library Cataloguing-in-Publication Data
A catalogue record for this book is available from the British Library
Library of Congress Cataloging-in-Publication Data
A catalog record for this book is available from the Library of Congress
ISBN: 978-0-12-822706-0

For Information on all Academic Press publications

visit our website at https://www.elsevier.com/books-and-journals

Publisher: Mara Conner

Acquisitions Editor: Tim Pitts
Editorial Project Manager: Mariana L. Kuhl
Production Project Manager: Surya Narayanan Jayachandran
Cover Designer: Mark Rogers
Typeset by MPS Limited, Chennai, India
Contents

List of contributors xv

1. Advanced coronary artery imaging: optical coherence tomography 1

Damian Valencia, Juan Linares, Zachary Gilbert, Ryan Stuart, Olusola Adekoya,
Oscar Valencia, Rosaria Jordan and Brian Schwartz

1.1 Introduction 1
1.2 Basic principles of light 1
1.2.1 Backscatter 1
1.2.2 Attenuation 2
1.3 Mechanism and technical modalities of OCT 2
1.3.1 Time domain 2
1.3.2 Frequency domain 5
1.3.3 Spatially encoded 6
1.3.4 Time encoded 6
1.4 Scanning techniques 6
1.4.1 Single point scanning 7
1.4.2 Parallel scanning 7
1.5 Pullback 7
1.6 Image interpretation 8
1.6.1 Basic image orientation and interpretation 8
1.6.2 Image interpretation and normal coronary anatomy 8
1.6.3 Coronary plaque and thrombus characterization 9
1.6.4 Imaging coronary stents 11
1.7 Image artifact 13
1.7.1 Inadequate blood purging 13
1.7.2 Saturation artifact 13
1.7.3 Nonuniform rotational distortion 16
1.7.4 Sew-up artifact (seam artifact) 18
1.7.5 Fold-over artifact 18
1.7.6 Bubble artifact 18
1.7.7 Tangential light drop-out 20
1.7.8 Merry-go-round artifact 20
1.7.9 Blooming artifact 20
1.8 Clinical applications 22
1.8.1 Plaque analysis 22
1.8.2 Diagnostic imaging: stable coronary artery disease 22

v
vi Contents

1.8.3 Interventional imaging: acute coronary syndrome 22

1.8.4 Postintervention imaging 22
1.9 Safety and complications 24
1.10 Innovations of OCT 24
1.10.1 C7-XR system 24
1.10.2 ILUMIEN system 25
1.10.3 ILUMIEN OPTIS system 25
1.10.4 OPTIS integrated system 25
1.10.5 OPTIS mobile system 26
1.11 Clinical trials 26
1.11.1 ILUMIEN I trial 26
1.11.2 ILUMIEN II Trial 26
1.11.3 ILUMIEN III Trial 26
1.11.4 ILUMIEN IV Trial 27
References 27

2. Technique of cardiac magnetic resonance imaging 33

Ahmed Abdel Khalek Abdel Razek, Dalia Fahmy and Germeen Albair Ashmalla
2.1 Introduction 33
2.2 Physical principles and pulse sequences 33
2.2.1 Data acquisition 33
2.2.2 Morphologic sequences 34
2.2.3 Future directions 41
References 41

3. The role of automated 12-lead ECG interpretation in the diagnosis and risk
stratification of cardiovascular disease 45
Salah S. Al-Zaiti, Ziad Faramand, Khaled Rjoob, Dewar Finlay and Raymond Bond

3.1 Introduction 45
3.2 Basic knowledge of ECG physiology 46
3.3 The 12-lead ECG 50
3.4 ECG signal processing 52
3.5 Cardiovascular diseases diagnosed by the 12-lead ECG 57
3.5.1 Rhythm disorders 57
3.5.2 Conduction disorders 60
3.5.3 Chamber enlargement 61
3.5.4 Cardiac ischemia or infarction 61
3.6 Automated ECG interpretation 64
3.7 “Logic” used in automated ECG interpretation systems 67
3.8 Machine learning and automated 12-lead ECG analysis 69
 Contents vii

3.9 Basic principles of risk stratification 73

3.9.1 The role of ECG in risk stratification 74
3.10 ECG-derived markers for risk stratification 75
3.10.1 ECG risk markers based on conduction disturbances 76
3.10.2 ECG risk markers based on structural changes 77
3.10.3 ECG risk markers based on repolarization abnormalities 79
3.10.4 ECG risk markers based on distortion in heart rhythm regulation 81
3.11 Challenges and opportunities 82
References 83

4. Extracting heterogeneous vessels in X-ray coronary angiography

via machine learning 89
Binjie Qin, Mingxin Jin and Song Ding
4.1 Introduction 89
4.2 Related works 90
4.3 MCR-RPCA: motion coherency regularized RPCA for vessel extraction 93
4.3.1 Motivation and problems 93
4.3.2 Candidate contrast-filled vessel detection via statistically structured MoG-RPCA 94
4.3.3 Motion coherency regularized RPCA for trajectory decomposition 98
4.4 SVS-net: sequential vessel segmentation via channel attention network 103
4.4.1 Architecture of sequential vessel segmentation-network 104
4.4.2 Segmentation experimental results 111
4.5 VRBC-t-TNN: accurate heterogeneous vessel extraction via tensor completion of X-ray
coronary angiography backgrounds 113
4.5.1 Global intensity mapping 115
4.5.2 Background completion using t-TNN 116
4.5.3 Experimental results 120
4.6 Conclusion 123
Acknowledgment 123
References 123

5. Assessing coronary artery disease using coronary computed

tomography angiography 129
Mina M. Benjamin, Marco Shaker and Mark G. Rabbat
5.1 Introduction 129
5.1.1 The utility of CCTA in Coronary artery disease diagnosis and prognostication 129
5.2 Patient selection 131
5.2.1 Other utilities of computed tomography angiography, that is, other than in
coronary artery disease 132
5.2.2 CCTA technique and quality factors 132
viii Contents

5.3 Spatial resolution 133

5.4 Temporal resolution 134
5.5 Technical issues in specific patient subgroups 134
5.5.1 The future of CCTA 135
5.6 Clinical trials comparing CCTA to other modalities 139
5.7 Conclusion 140
References 140

6. Multimodality noninvasive cardiovascular imaging for the evaluation of

coronary artery disease 147
Chris Anthony, Reza Reyaldeen and Bo Xu
6.1 Introduction 147
6.2 Ischemic cascade 148
6.3 Exercise stress echocardiography 149
6.4 Pharmacologic stress echocardiography 150
6.5 Myocardial perfusion stress echocardiography 152
6.6 Left ventricular strain in exercise stress echocardiography 152
6.7 Limitations of stress echocardiography 153
6.8 Computed tomography coronary calcium score 153
6.9 Limitations of coronary artery calcium 155
6.10 Computed tomography coronary angiogram 155
6.11 Limitations of computed tomography coronary angiogram 158
6.12 Computed tomography in combination with single-photon emission tomography 158
6.13 Computed tomography in combination with positron emitting tomography 160
6.14 Limitations and strengths of positron emission tomography and SPECT imaging 161
6.15 CTCA and fractional flow reserve 161
6.16 Limitations of FFR CCTA 162
6.16.1 Cardiac magnetic resonance imaging in coronary artery disease 163
6.16.2 Cardiac magnetic resonance perfusion imaging 163
6.17 Cardiac magnetic resonance angiography 163
6.17.1 Limitations of cardiac magnetic resonance 165
6.18 Conclusion 165
References 165

7. Magnetic resonance imaging of ischemic heart disease 171

Ahmed Abdel Khalek Abdel Razek, Dalia Fahmy and Germeen Albair Ashmalla

7.1 Introduction 171

7.2 Cardiac MR imaging of myocardial infarction 171
7.2.1 CMR of acute infarction 171
7.2.2 CMR with clinical suspicion of acute coronary syndrome 172
 Contents ix

7.2.3 Visualization and characterization of jeopardized myocardium 172

7.3 MR indicators of myocardial infraction severity 173
7.3.1 Infarct size and extent of transmural involvement 173
7.3.2 Microvascular obstruction 174
7.3.3 Intramyocardial hemorrhage 174
7.3.4 Myocardial infarct heterogeneity 174
7.3.5 Right ventricular infarction 175
7.3.6 Missed infarcts 175
7.3.7 Chronic myocardial infarction 175
7.4 Myocardial infarction complications 175
7.4.1 Thrombus 175
7.4.2 LV aneurysm 176
7.5 Future directions 176
References 177

8. CT angiography of anomalous pulmonary veins 181

Ahmed Abdel Khalek Abdel Razek, Maha Elmansy, Mahmoud Abd El-Latif
and Hala Al-Marsafawy
8.1 Introduction 181
8.2 Classification 182
8.3 Anomalous in caliber of pulmonary veins 182
8.3.1 Stenosis of pulmonary vein 182
8.3.2 Atresia of pulmonary vein 182
8.3.3 Pulmonary venous varix 183
8.4 Total anomalous pulmonary venous return 183
8.4.1 Supracardiac type 183
8.4.2 Cardiac type 184
8.4.3 Infracardiac type 184
8.4.4 Mixed type 184
8.5 Partial anomalous pulmonary venous return 187
8.5.1 Partial anomalous venous return (PAPVR) 187
8.5.2 Veno-venous bridge 188
8.5.3 Scimitar syndrome 188
8.5.4 Pseudo-Scimitar syndrome 188
8.5.5 Cortriatriatum sinister 188
8.5.6 Levoatriocardinal vein 189
8.5.7 PAPVR of left upper pulmonary vein (LUL PAPVR) 189
8.6 Merits, limitations, and future directions 190
8.7 Conclusion 190
References 190
Further reading 193
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