title: Reproducibility and clinical potential of myocardial mass at risk calculated by a novel software utilizing cardiac computed tomography information.
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.
authors.affiliation: Department of Advanced Cardiovascular Therapeutics, Osaka University Graduate School of Medicine, 2-2 Yamada Oka, Suita, Osaka, 565-0871, Japan. satoru@sumi2g.sakura.ne.jp.
authors.forename: Satoru
authors.initials: S
authors.lastname: Sumitsuji
authors.affiliation: Department of Advanced Cardiovascular Therapeutics, Osaka University Graduate School of Medicine, 2-2 Yamada Oka, Suita, Osaka, 565-0871, Japan.
authors.forename: Seiko
authors.initials: S
authors.lastname: Ide
authors.affiliation: Department of Advanced Cardiovascular Therapeutics, Osaka University Graduate School of Medicine, 2-2 Yamada Oka, Suita, Osaka, 565-0871, Japan.
authors.forename: Patrick T
authors.initials: PT
authors.lastname: Siegrist
authors.affiliation: Department of Advanced Cardiovascular Therapeutics, Osaka University Graduate School of Medicine, 2-2 Yamada Oka, Suita, Osaka, 565-0871, Japan.
authors.forename: Youssef
authors.initials: Y
authors.lastname: Salah
authors.affiliation: Department of Advanced Cardiovascular Therapeutics, Osaka University Graduate School of Medicine, 2-2 Yamada Oka, Suita, Osaka, 565-0871, Japan.
authors.forename: Kensuke
authors.initials: K
authors.lastname: Yokoi
authors.affiliation: Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
authors.forename: Masatoki
authors.initials: M
authors.lastname: Yoshida
authors.affiliation: Department of Advanced Cardiovascular Therapeutics, Osaka University Graduate School of Medicine, 2-2 Yamada Oka, Suita, Osaka, 565-0871, Japan.
authors.forename: Masaki
authors.initials: M
authors.lastname: Awata
authors.affiliation: Department of Advanced Cardiovascular Therapeutics, Osaka University Graduate School of Medicine, 2-2 Yamada Oka, Suita, Osaka, 565-0871, Japan.
authors.forename: Keita
authors.initials: K
authors.lastname: Yamasaki
authors.affiliation: Department of Advanced Cardiovascular Therapeutics, Osaka University Graduate School of Medicine, 2-2 Yamada Oka, Suita, Osaka, 565-0871, Japan.
authors.forename: Kouichi
authors.initials: K
authors.lastname: Tachibana
authors.affiliation: Department of Advanced Cardiovascular Therapeutics, Osaka University Graduate School of Medicine, 2-2 Yamada Oka, Suita, Osaka, 565-0871, Japan.|Translational Research Informatics Center, Foundation for Biomedical Research and Innovation, Kobe, Japan.
authors.forename: Hideaki
authors.initials: H
authors.lastname: Kaneda
authors.affiliation: Nishinomiya Municipal Central Hospital, Nishinomiya, Japan.
authors.forename: Shinsuke
authors.initials: S
authors.lastname: Nanto
authors.affiliation: Department of Cardiology, Osaka University Graduate School of Medicine, Suita, Japan.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Sakata
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008297:Male; D017202:Myocardial Ischemia / Q000175:diagnosis*; D015203:Reproducibility of Results; D012984:Software; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000379:methods*
keywords: Cardiac computed tomography; Myocardial mass at risk; Voronoi method