Cardiac Cath AutoSummary Logic

Introduction

The AutoSummary algorithm creates language statements based on cardiac catheterization diagrams.

Diagnostic AutoSummary

Diagnostic AutoSummary bases the results on diagram dominance as determined by the anatomical vessel statement generation order, categorize main vessels, and categorize side branches. Graft endpoint anastomosis follow the same anatomical order as the native vessels.

  • Right Dominant
    • Main vessels and side branches order:
      • LM
      • LAD
      • Diagonals
      • Septal Perforators
      • Ramus
      • Circumflex
      • Obtuse Marginals
      • Right Coronary
      • Acute Marginals
      • Right Posterior AV
      • Right Posterior Descending
      • AV Groove
      • Posterior Descending Septal Perforators
      • Right posterolaterals
    • Left Dominant
      • Main vessels and side branches order:
        • LM
        • LAD
        • Diagonals
        • Septal Perforators
        • Ramus
        • Circumflex
        • AV Groove
        • Left Posterior Descending Artery
        • Obtuse Marginals
        • Left posterolateral
        • Posterior Descending Septal Perforators
        • Right Coronary
        • Acute Marginals
    • Co-Dominant
      • LM
      • LAD
      • Diagonals
      • Septal Perforators
      • Ramus
      • Circumflex
      • AV Groove
      • Left Posterior Descending Artery
      • Obtuse Marginals
      • Left posterolateral
      • Right Coronary
      • Acute Marginals
      • Right Posterior AV
      • Right Posterior Descending
      • Posterior Descending Septal Perforators

Diseased Vessel Segment/Graft Statement Generation

Documented Stenosis

Description Qualifier

≤10

Patent

≤20

Luminal irregularities

≤30

Minimal

≤40

Mild

≤50

Moderate

≤70

Obstructive

≤80

Significant

≤90

Severe

≤95

Critical

≤99

Subtotal occlusion

=100

Total occlusion

Lesion Statement Generation

This form is used for lesions starting in the LM and extending into other main segments.

Lesion statements display in the following format:

Vessel segment: [Pre-procedure stenosis]% stenosis, [selected segment/lesion properties]

Main Vessel segment(start) to main vessel segment (end): [Pre-procedure stenosis]% stenosis, [selected segment/lesion properties]

Main vessel segment (start) extending into branch vessel segment (end), branch vessel segment (end), and branch vessel segment(end): [Pre-procedure stenosis]% stenosis, [selected segment/lesion properties].

Examples

Proximal Left Anterior Descending: Obstructive 70% stenosis, acute total occlusion, moderately calcified, concentric plaque, moderate proximal segment tortuosity, extremely angulated segment, high/c lesion, FFR performed: ratio is 0.8.

Proximal Left Anterior Descending to Mid Left Anterior Descending: Severe 90% stenosis, acute total occlusion, moderately calcified, concentric plaque, moderate proximal segment tortuosity.

Left Main extending into the Mid Left Anterior Descending and 1st Diagonal: Luminal Irregularities 15% stenosis.

Graft Statement Generation

Graft statement lists the number of grafts visualized.

EXAMPLES

The graft statement generation repeats for additional grafts.

Graft statements display in the following format:

Graft Type to Vessel segment: [Pre-procedure stenosis]% stenosis, [selected segment/lesion properties] LIMA to {segment}: [Pre-procedure stenosis]% stenosis, [selected segment/lesion properties]RIMA to {segment}: [Pre-procedure stenosis]% stenosis, [selected segment/lesion properties] SVG to {segment}: [Pre-procedure stenosis]% stenosis, [selected segment/lesion properties] Sequential graft to {segment} and {segment}: [Pre-procedure stenosis]% stenosis, [selected segment/lesion properties]Y-graft to {segment} and {segment}: [Pre-procedure stenosis]% stenosis, [selected segment/lesion properties]

Example

LIMA graft to Proximal Left Anterior Descending: Severe 90% stenosis, acute total occlusion, moderately calcified, concentric plaque, high/c lesion. SVG to Mid Right Coronary: patent.

Aneurysm Statement Generation

Aneurysm statements display in the following format:

Vessel segment: [aneurysm size] aneurysm [selected aneurysm properties/measurements].

Vessel segment(start) to vessel segment (end): [aneurysm size] aneurysm [selected aneurysm properties/measurements].

Example

Proximal Left Anterior Descending: large aneurysm with neck flow measuring 2 cm by 1 cm with a length of 4 cm.

Interventional Rule

Synapse populates interventional rule statements into the Interventional Finding field and bases the diagram dominance on anatomical vessel statement order, categorize main vessels, and categorize side branches as described for Diagnostic Findings.

Graft endpoint anastomosis follow the same anatomical order as the native vessels.

Generate Intervention Findings

The statements includes the aneurysm and lesion if both are present. Stents that do not treat the entire lesion will be noted by an abbreviated segment range after the treatment.

PCI lesion statements display in the following format :

Vessel segment: [Pre-procedure stenosis]% stenosis treated with [list of associated treatments with associated inventory items], max inflation pressure [highest inflation pressure for each inventory item] atm. [post-procedure stenosis]% residual stenosis, TIMI [post-procedure TIMI value] flow. [Successful/Unsuccessful] intervention.

Main Vessel segment(start) to main vessel segment (end): [Pre-procedure stenosis]% stenosis treated with [list of associated treatments with associated inventory items]. [post-procedure stenosis]% residual stenosis, TIMI [post-procedure TIMI value] flow. Successful/Unsuccessful] intervention.

Main Vessel segment(start) to main vessel segment (end): [aneurysm size] aneurysm treated with [list of associated treatments with associated inventory items. [Successful/Unsuccessful] intervention.

Examples

Proximal Left Anterior Descending: 70% stenosis treated with Pronto LP Aspiration Catheter 6F, TREK RX 2.5mm X 15mm, two NC TREK RX 3mm X 15mm, SYNERGY 4.00X38MM, and NC TREK RX 4mm X 12mm. 0% residual stenosis, TIMI: 3 flow. Successful intervention.

Proximal Left Anterior Descending to Mid Left Anterior Descending: 90% stenosis treated two NC TREK RX 3mm X 15mm, and SYNERGY 4.00 X 38M. 0% residual stenosis, TIMI 3 flow. Successful intervention.

Left Main extending into Mid Left Anterior Descending: 90% stenosis treated TREK RX 2.5mm X 15mm, and SYNERGY 4.00 X 38M. 0% residual stenosis, TIMI 3 flow. Successful intervention.

Proximal Left Anterior Descending to Mid Left Anterior Descending extending into the 1st Diagonal: 70% stenosis treated with kissing stents: SYNERGY 4.00 X 38M (pLAD-mLAD), and SYNERGY 3.00 X 30M (pLAD-1st Diag). 0% residual stenosis.

Ventriculography Rule

The ventriculography rule populates statements into the Left Ventricle Finding field. Synapse generates left Ventriculogram statements from the hotspots scores.

If all segments are in a grouping match, Synapse combines these groups into an overarching statement with the name of the group for the segment.

Wall Grouping

All

  • All left ventricular walls

Apex

  • Apical Septum
  • Apical Posterior
  • Anteroapical
  • Inferoapical

Posterior

  • Basal posterior
  • Mid posterior
  • Apical posterior

Septal

  • Basal septum
  • Mid septum
  • Apical septum

Anterior

  • Anterobasal
  • Anterolateral
  • Anteroapical

Inferior

  • Inferobasal
  • Mid inferior
  • Inferoapical

Wall Scoring

The wall scoring statements display in the following format:

[wall] wall(s) is/are [score]

The following are wall scores:

  • Unable to interpret = score of “uninterpretable”.
  • Only use this statement for normals when the all group is used.
  • All walls that have the same score should be inserted into a single sentence.

Ejection Fraction

Synapse populates the ejection fraction rule statements into the Conclusions field. Synapse generates the LV Ejection Fraction statements from the EF field on the Ventriculography tab.

Documented Ejection Fraction %

Description Qualifier

EF >= 70

Hyperdynamic systolic function

50 <= EF < 70

Normal systolic function

40 <= EF < 50

Mild systolic dysfunction

30 <= EF < 40

Moderate systolic dysfunction

EF < 30

Severe systolic dysfunction

Systolic Function/Dysfunction Statement Generation

Ejection fraction statements display in the following format:

[Descriptive Qualifier] left ventricular systolic [function/dysfunction]. Ejection fraction of [Selected EF Value]

Examples

Normal left ventricular systolic function. Ejection fraction of 60%

Moderate left ventricular systolic dysfunction. Ejection fraction of 35%

Impressions Rule

Synapse populates the impression rule statements into the Impression Finding field. Statement generation is from the Coronary Diagram, Wall Scoring, and LV EF Field.

Impressions Statement Generation Priority

Normal Coronaries

This condition applies only if all the coronaries are normal.

Example

No disease noted in the Left Main, Left Anterior Descending, Right, or Circumflex coronary arteries.

Interventions

If a lesion has multiples of the same treatment type, Synapse counts the stents individually but lists balloons as multiples. Lesions treated with stents and balloons only mention the stents.

Intervention statements display in the following format:

[Vessel segment] was treated with a [treatment type].

Examples:

Proximal Right Coronary Artery was treated with a Drug Eluting Stent.

Left Main extending into the Proximal Left Anterior Descending Artery was treated with 2 drug eluting stents.

1st Diagonal was treated with multiple balloons.

Diseased Main Vessels

Diseased main vessels statements display in the following format:

There is [stenosis value descriptive qualifier] coronary artery disease with [number of diseased vessel groups] vessel disease.

Example:

There is obstructive coronary artery disease with one vessel disease.

Lesions and Aneurysms

The diagnostic statements above are selected to be included in the summary for obstructive or worse lesions and large aneurysms.

Coronary Grafts

Coronary grafts statements display in the following format:

[Number of grafts] coronary grafts visualized: [number of patent grafts] patent, [number of diseased grafts] diseased, [number of occluded grafts], [number of treated grafts] treated.

Ventriculography

See Ventriculography Rule for details.

Ejection Fraction Statement

See Ejection Fraction rule for details.