Coronary artery disease (CAD) is the most common type of heart disease and the leading cause of death globally: one in four people lose their lives to CAD annually. Coronary arteries provide the heart with the oxygen-rich blood that it needs to function, carrying away oxygen-depleted blood. In a patient with CAD, atheromatous plaques build inside the coronary arteries, reducing the flow of oxygen-rich blood to the heart muscle by narrowing or blocking the arteries. The patient may then experience deadly angina, myocardial fraction, or heart attack.
Coronary Tree Diagrams: Their Use and Benefits
For a cardiologist to evaluate CAD and develop a treatment plan appropriate for the patient, the coronary arteries must first be defined. While the location of atherosclerotic lesions may be suggested through provocative stress testing, left heart catheterization or computed tomography (CT) coronary angiogram are necessary for identifying a definitive location. Coronary tree anatomy varies between each person, making exact recognition critical. With coronary tree diagrams, cardiologists can locate and visualize the coronary arteries.
Coronary tree diagrams enable cardiologists to track lesions, stenting, grafts, and the size and variations of native arteries. While interventions and coronary artery bypass surgeries make tracking difficult, coronary tree diagrams are useful guiding instruments. They provide a greater understanding of a patient’s history and may be added to their permanent medical records. These diagrams also assist cardiologists as they interpret cardiac catheterization reports, read surgical records, and communicate with their teammates.
Wrapping around the outside of the heart, coronary arteries resemble branches, pumping blood into the heart muscle. Two main coronary arteries—left and right—ensure the flow of oxygen and nutrients. Without healthy arteries, patients may develop atherosclerosis, which causes plaque buildup within the inner lining of the artery. To monitor blockages, coronary artery trees may be pulled from a coronary computed tomography angiography (CCTA), an oft-used technique for assessing patients who may have coronary artery disease.
For a cardiologist to diagnose CAD on CCTA images, the coronary artery tree is extracted. Due to their simplicity and computation efficiencies, methods of CAT extraction based on minimum path techniques are commonly used. Coronary artery trees are composed of three main branches: the right coronary artery, the left anterior descending, and the left circumflex, as well as their respective side branches. With these branches defined, the visualization tools used by radiologists to examine coronary arteries, including multiplanar reformatting and curved reformatting, gain accurate extraction.
In 2012, The National Library of Medicine described coronary computed tomography angiography as “becoming the most promising modality for assessing coronary heart disease and for quantifying plaques.” With CCTA, cardiologists can visualize the vessel lumen, atherosclerotic plaque, and stenosis without invasive catheterization procedures.
When a CCTA is performed, dye is injected through an IV into a patient’s arm or hand. A CT, a combination of computer technology and X-rays, then creates 3D images from inside the body. With these, cardiologists can detect any coronary artery abnormalities and irregular heart functions, including plaque buildup. Johns Hopkins Medicine outlines the reasons that a patient may need a CCTA:
- Abnormal test results after stress testing, echocardiograms, or electrocardiograms
- Atypical coronary artery structures
- Coronary artery disease symptoms, including chest pain, weakness, or shortness of breath
- A previous coronary artery bypass graft
Factors including the small size of coronary arteries, reconstruction artifacts caused by irregular heartbeats, beam hardening, and partial volume averaging make the identification of plaques challenging, even with 3D imaging. Severe occlusion or low contrast in coronary arteries may lead to gaps in vessel images, and surrounding veins may be extracted wrongly. These errors require manual correction from an expert; operators should be trained in diagram creation and report interpretation.
The Benefits of Automatic Coronary Tree Diagrams with NovaCardio
With the Visual Coronary Tool, a modality that integrates with all NovaCardio machines, cardiologists gain automatic coronary tree diagram creation. Focusing less on branching, these conceptual reports provide cardiologists and radiologists with the visualization necessary for CAD detection. The Visual Coronary Tool provides physicians with the ability to easily create a diagram of a patient’s coronary anatomy. Able to represent vessels and bypass grafts, lesions, and stents, it also generates texts for each report. With syntax score capabilities and PCI registry, it’s useful to surgeons, non-cardiologists, and patients alike.
According to EncaptureMD, it can “describe the coronary anatomy in a meaningful way.” High-quality, uncomplicated diagrams provide a detailed look at the heart for a deeper understanding of each unique patient. A stronger treatment plan can be developed with automatically generated Visual Coronary Tool tree diagrams. By treating the patient from within, NovaCardio and Encapture MD can help improve patient outcomes, increase efficiency, and eliminate errors with cutting-edge technology integrating with all major hemodynamic systems.
Here at Novarad, we believe that the key to a successful imaging center is to work smarter, not harder, to deliver the type of care and outcomes that patients desire.
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