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Reproducibility and clinical potential of myocardial mass at risk calculated by a novel software utilizing cardiac computed tomography information

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Abstract

To select the best revascularization strategy a correct understanding of the ischemic territory and the coronary anatomy is crucial. Stress myocardial perfusion single photon emission computed tomography (SPECT) is the gold standard to assess ischemia, however, SPECT has important limitations such as lack of coronary anatomical information or false negative results due to balanced ischemia in multi-vessel disease. Angiographic scores are based on anatomical characteristics of coronary arteries but they lack information on the extent of jeopardized myocardium. Cardiac computed tomography (CCT) has the ability to evaluate the coronary anatomy and myocardium in one sequence, which is theoretically the ideal method to assess the myocardial mass at risk (MMAR) for any target lesion located at any point in the coronary tree. In this study we analyzed MMAR of the three main coronary arteries and three major side branches; diagonal (Dx), obtuse marginal (OM), and posterior descending artery (PDA) in 42 patients with normal coronary arteries using an algorithm based on the Voronoi method. The distribution of MMAR among the three main coronary arteries was 44.3 ± 5.6 % for the left anterior descending artery, 28.2 ± 7.3 % for the left circumflex artery, and 26.8 ± 8.6 % for the right coronary artery. MMAR of the three major side branches was 11.3 ± 3.9 % for the Dx, 12.6 ± 5.2 % for the OM and 10.2 ± 3.4 % for the PDA. Intra- and inter-observer analysis showed excellent correlation (r = 0.97; p < 0.0001 and r = 0.95; p < 0.0001, respectively). In conclusion, CCT-based MMAR assessment is reliable and may offer important information for selection of the optimal revascularization procedure.

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    Authors and Affiliations

    1. Department of Advanced Cardiovascular Therapeutics, Osaka University Graduate School of Medicine, 2-2 Yamada Oka, Suita, Osaka, 565-0871, Japan

      Satoru Sumitsuji, Seiko Ide, Patrick T. Siegrist, Youssef Salah, Kensuke Yokoi, Masaki Awata, Keita Yamasaki, Kouichi Tachibana & Hideaki Kaneda

    2. Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan

      Masatoki Yoshida

    3. Translational Research Informatics Center, Foundation for Biomedical Research and Innovation, Kobe, Japan

      Hideaki Kaneda

    4. Nishinomiya Municipal Central Hospital, Nishinomiya, Japan

      Shinsuke Nanto

    5. Department of Cardiology, Osaka University Graduate School of Medicine, Suita, Japan

      Yasushi Sakata

    Authors
    1. Satoru Sumitsuji
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    2. Seiko Ide
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    3. Patrick T. Siegrist
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    4. Youssef Salah
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    5. Kensuke Yokoi
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    Correspondence to Satoru Sumitsuji.

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    Conflict of interest

    Satoru Sumitsuji and Yasushi Sakata receive financial support from Toshiba Medical Systems. The remaining authors reported no conflict of interest.

    Human rights and ethical standards

    This study protocol was approved by the ethics committee at Osaka University and conducted with standard policy of human rights. Written informed consent was waived by the ethics committee.

    Additional information

    S. Sumitsuji and S. Ide contributed equally to this work.

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    Sumitsuji, S., Ide, S., Siegrist, P.T. et al. Reproducibility and clinical potential of myocardial mass at risk calculated by a novel software utilizing cardiac computed tomography information. Cardiovasc Interv and Ther 31, 218–225 (2016). https://doi.org/10.1007/s12928-015-0370-0

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    • DOI: https://doi.org/10.1007/s12928-015-0370-0

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