Magnus Patrick C, Jayne John E, Garcia-Garcia Hector M, Swart Michael, van Es Gerrit-Anne, Tijssen Jan, Kaplan Aaron V
Cardiac Catheterization Laboratories, Heart and Vascular Center, Dartmouth-Hitchcock Medical Center/Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire.
Cardialysis BV, Rotterdam, The Netherlands.
Catheter Cardiovasc Interv. 2015 Aug;86(2):229-35. doi: 10.1002/ccd.25854. Epub 2015 Mar 30.
To compare the variability in the assessment of coronary stents among interventional cardiologists (readers) using optical coherence tomography (OCT) and intravascular ultrasound (IVUS).
IVUS is established and validated in the evaluation of coronary stent. For cardiologists without core lab expertise, the utility of IVUS is limited by image quality. OCT yields higher image resolution; however, the consistency with which these readers interpret OCT images has not been fully evaluated or compared with IVUS.
OCT and IVUS image sets (five pairs) obtained after stent placement were reviewed by readers with clinical experience in both modalities. Parameters assessed included stent expansion and symmetry, reference vessel and in-stent cross-sectional area (CSA) and diameter, and stent strut apposition as well as Multicenter Ultrasound Stenting in Coronaries criteria. These interpretations were compared with core lab readings and examined for interobserver variability.
The interobserver variability for measurement of in-stent CSA was 1.34 mm(2) using IVUS compared with 0.85 mm(2) using OCT (P = 0.024). Variation in the deviation from core lab measurement of in-stent CSA for IVUS was 1.48 mm(2) compared with 0.87 mm(2) for OCT (P = 0.042). The interobserver agreement for obtaining the Multicenter Ultrasound Stenting in Coronaries criteria using IVUS was 80.4% compared with 81.1% using OCT (P = 0.78). Compared with the corelab measurement, the readers obtained an agreement of 72.7% using IVUS vs. 67.3% using OCT (P = 0.43).
In the assessment of deployed coronary stents by practicing cardiologists, OCT images are interpreted more consistently compared with IVUS and can be used to assess stent deployment using IVUS-validated metrics.
比较介入心脏病专家（读者）使用光学相干断层扫描（OCT）和血管内超声（IVUS）评估冠状动脉支架时的变异性。
IVUS在冠状动脉支架评估中已得到确立和验证。对于没有核心实验室专业知识的心脏病专家而言，IVUS的效用受到图像质量的限制。OCT可产生更高的图像分辨率；然而，这些读者解读OCT图像的一致性尚未得到充分评估，也未与IVUS进行比较。
有两种检查方式临床经验的读者对支架置入后获得的OCT和IVUS图像集（五对）进行了回顾。评估的参数包括支架扩张和对称性、参考血管和支架内横截面积（CSA）及直径、支架支柱贴壁情况以及冠状动脉多中心超声支架置入标准。将这些解读与核心实验室的读数进行比较，并检查观察者间的变异性。
使用IVUS测量支架内CSA时，观察者间变异性为1.34mm²，而使用OCT时为0.85mm²（P = 0.024）。IVUS测量的支架内CSA与核心实验室测量值的偏差变化为1.48mm²，而OCT为0.87mm²（P = 0.042）。使用IVUS获得冠状动脉多中心超声支架置入标准的观察者间一致性为80.4%，而使用OCT为81.1%（P = 0.78）。与核心实验室测量相比，读者使用IVUS时的一致性为72.7%，使用OCT时为67.3%（P = 0.43）。
在执业心脏病专家评估已植入的冠状动脉支架时，与IVUS相比，OCT图像的解读更具一致性，并且可用于使用经IVUS验证的指标评估支架置入情况。
