In contrast to the TFG classification scheme, the CTFC is quantitative rather than qualitative, it is objective rather than subjective, it is a continuous rather than a categorical variable, and it is reproducible. Some of the advantages of the TIMI frame count method are as follows. This refined measure allows calculation of the velocity proximal and distal to the lesion. Knowing the time for dye to go down the artery from the CTFC (CTFC/30=seconds), and length of the artery (either from an angioplasty guide wire or by planimetry), dye velocity (cm/s) can also be calculated in a more refined fashion. These frame counts are corrected for the longer length of the LAD by dividing by 1.7 to arrive at the CTFC. These standard distal landmarks are as follows: in the RCA, the first branch of the posterolateral artery in the circumflex system, the most distal branch of the obtuse marginal branch, which includes the culprit lesion in the dye path and in the LAD, the distal bifurcation, which is also known as the "moustache," "pitchfork" or "whale’s tail". In the last frame, dye begins to enter (but does not necessarily fill) a standard distal landmark in the artery. In the first frame used for TIMI frame counting, a column of dye touches both borders of the coronary artery and moves forward. Each frame is 1/30th of a second, and the angiogram is therefore essentially a measure of the time for dye to go down the artery. In this method, the number of cineframes required for dye to reach standardized distal landmarks are counted. To overcome these limitations, Gibson developed a more objective and precise index of coronary blood flow called the corrected TIMI frame count (CTFC). There are several limitations to the TFG classification scheme. It was originally referred to as the "frames to opacification" but was later renamed the TIMI frame count. Selected anatomic landmarks are used for the analysis. The TIMI Frame Count is counted using an electronic frame counter. Thus, a frame count of 30 would mean that 1 second was required for dye to traverse the artery. The number is expressed based upon a cinefilming rate of 30 frames/second. TIMI frame count is defined as the number of cineframes required for contrast to reach a standardized distal coronary landmark in the culprit vessel. Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D.
Technique Quantification of LV Function Quantification of Mitral RegurgitationĮditor-In-Chief: C. Quantitative Coronary Angiography Definitions of Preprocedural Lesion Morphology Irregular Lesion Disease Extent Arterial Foreshortening Infarct Related Artery Restenosis Degenerated SVG Collaterals Aneurysm Bifurcation Trifurcation Ulceration
Preprocedural Lesion Morphology Eccentricity Irregularity Ulceration Intimal Flap Aneurysm Sawtooth Pattern Length Ostial location Angulation Proximal tortuosity Degenerated SVG Calcification Total occlusion Coronary Artery Thrombus TIMI Thrombus Grade TIMI Thrombus Grade 0 TIMI Thrombus Grade 1 TIMI Thrombus Grade 2 TIMI Thrombus Grade 3 TIMI Thrombus Grade 4 TIMI Thrombus Grade 5 TIMI Thrombus Grade 6 TIMI Myocardial Perfusion Grade TMP Grade 0 TMP Grade 0.5 TMP Grade 1 TMP Grade 2 TMP Grade 3ĪCC/AHA Lesion-Specific Classification of the Primary Target Stenosis
TIMI Flow Grade TIMI Grade 0 Flow TIMI Grade 1 Flow TIMI Grade 2 Flow TIMI Grade 3 Flow TIMI Grade 4 Flow Pulsatile Flow Deceleration Standard Views Left Coronary Artery Right Coronary Artery Separate Ostia Anomalous Origins Case Example Fistula Appropriate Use Criteria for RevascularizationĬoronary arteries Dominance Right System Left System Left Main Left Anterior Descending Circumflex Median Ramus
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