One of the pillars of Diagram concerns the Imaging Corelab, where several techniques are used to analyse medical image information.
Coronary angiography (CAG) is the golden standard for visualisation of coronary intervention. Using intra-coronary catheters, with which the right and left coronary artery can be selectively sounded, contrast administration in the coronary artery takes place. Images of the coronary arteries and the left ventricle are made using X-ray. These images are digitally stored and can be analyzed both quantitatively and qualitatively.
Quantitative analysis (QCA) is a valuable technique within intervention cardiology to obtain objective and reproducible measurements of coronary vessels. This technique is used for examining the direct and long term results of Percutaneous Coronary Interventions (PCI), either in combination with another treatment strategy or not.
Intravascular ultrasound (IVUS) provides a cross-section analysis of vessels. IVUS is mainly applied to assess the coronary arteries before after stent implantation. The Corelab provides extensive IVUS analysis regarding plaque composition and stent apposition and healing for research purposes.
Optical Coherence Tomography (OCT) is a research method using Infrared to provide high-resolution images as compared to IVUS.
The OCT is used to get additional information about the morphology of the atheromas. Furthermore, it can analyze vessel healing after stent implantation to coronary arteries. The Corelab provides extensive OCT analysis for research purposes including lesions analysis as well as analysis of implanted stent.
Intravascular Near Infrared Spectroscopy (NIRS) detects with high precision the lipid deposition within coronary arteries. The Corelab provides a combined NIRS and IVUS analysis.
Cardiac MRI analysis
Magnetic Resonance Imaging (MRI) is a non-invasive method with no use of X-ray radiation but of magnetism and radio waves, and which is extremely suitable as a result of this, to reveal differences between soft tissues. The contrast between the tissues can be varied by the use of several sequences of radio waves. In monitored periods during the heart cycle, prerecordings can be made which can reveal the movement of the heart. Cardiac MRI provides a unique quantitative analysis of the heart contractility and valves functions. Furthermore, it can recognize myocardial ischemia and inflammation. The Corelab provides Cardiac MRI analysis for research purposes.
At the Corelab all Electocardiogram (ECG) analyses are carried out by the Standard Operating Procedures (SOP’s) of Diagram. Because of this, we can guarantee objectivity and reproducibility in the assessment of 12 ECG derivatives. Particularly the degree of success of reperfusion can be stipulated reliably by combining QCA and quantitative ECG analyses.
Quantitative ECG analysis
The ECG’s are quantitatively analyzed on rhythm, conductance, and repolarization. Of course here, by derivation, all fragments and the dynamics of depolarisation and repolarisation are measured.
A holter is a small wearable device that can track the heart rhythm and other variables like conduction disturbances, ST, QT and heart rate variability. Holter analysis can be facilitated by the Corelab of Diagram.
Computed tomography (CT) of coronary arteries and heart structures provides a deep insight before any planned procedures. CT can visualise plaque composition and stenosis of coronary arteries. Regarding the heart structure CT is available to reconstruct the heart anatomy before transcatheter valve implantation, cryoablation of pulmonary veins and left atrial appendage closure. The Corelab provides heart CT analysis for research purposes.
Intravascular hemodynamic assessment
The following intravascular hemodynamic assessments can be performed by the Corelab of Diagram:
- Coronary Flow Reserve (CRF)
- Fraction Flow Reserve (FFR)
- Instantaneous pressure ratio (IFR)
- The novel Relative Flow Reserve (RFR)