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Malkasian S, Hubbard L, Dertli B, Kwon J, Molloi S. Quantification of vessel-specific coronary perfusion territories using minimum-cost path assignment and computed tomography angiography: Validation in a swine model. J Cardiovasc Comput Tomogr 2018; 12:425-435. [PMID: 30042078 DOI: 10.1016/j.jcct.2018.06.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 05/25/2018] [Accepted: 06/15/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND As combined morphological and physiological assessment of coronary artery disease (CAD) is necessary to reliably resolve CAD severity, the objective of this study was to validate an automated minimum-cost path assignment (MCP) technique which enables accurate, vessel-specific assignment of the left (LCA) and right (RCA) coronary perfusion territories using computed tomography (CT) angiography data for both left and right ventricles. METHODS Six swine were used to validate the MCP technique. In each swine, a dynamic acquisition comprised of twenty consecutive volume scans was acquired with a 320-slice CT scanner following peripheral injection of contrast material. From this acquisition the MCP technique was used to automatically assign LCA and RCA perfusion territories for the left and right ventricles, independently. Each animal underwent another dynamic CT acquisition following direct injection of contrast material into the LCA or RCA. Using this acquisition, reference standard LCA and RCA perfusion territories were isolated from the myocardial blush. The accuracy of the MCP technique was evaluated by quantitatively comparing the MCP-derived LCA and RCA perfusion territories to these reference standard territories. RESULTS All MCP perfusion territory masses (MassMCP) and all reference standard perfusion territory masses (MassRS) in the left ventricle were related by MassMCP = 0.99MassRS+0.35 g (r = 1.00). MassMCP and MassRS in the right ventricle were related by MassMCP = 0.94MassRS+0.39 g (r = 0.96). CONCLUSION The MCP technique was validated in a swine animal model and has the potential to be used for accurate, vessel-specific assignment of LCA and RCA perfusion territories in both the left and right ventricular myocardium using CT angiography data.
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Affiliation(s)
- Shant Malkasian
- Department of Radiological Sciences, University of California Irvine, Irvine, CA, 92697, USA
| | - Logan Hubbard
- Department of Radiological Sciences, University of California Irvine, Irvine, CA, 92697, USA
| | - Brian Dertli
- Department of Radiological Sciences, University of California Irvine, Irvine, CA, 92697, USA
| | - Jungnam Kwon
- Department of Radiological Sciences, University of California Irvine, Irvine, CA, 92697, USA
| | - Sabee Molloi
- Department of Radiological Sciences, University of California Irvine, Irvine, CA, 92697, USA.
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Choi JH, Chang SA, Choi JO, Song YB, Hahn JY, Choi SH, Lee SC, Lee SH, Oh JK, Choe Y, Gwon HC. Frequency of Myocardial Infarction and Its Relationship to Angiographic Collateral Flow in Territories Supplied by Chronically Occluded Coronary Arteries. Circulation 2013; 127:703-9. [DOI: 10.1161/circulationaha.112.092353] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Despite complete interruption of antegrade coronary artery flow in the setting of a chronic total occlusion (CTO), clinical recognition of myocardial infarction is often challenging. Using cardiac MRI, we investigated the frequency and extent of myocardial infarction in patients with CTO, and assessed their relationship with regional systolic function and the extent of angiographic collateral flow.
Methods and Results—
We included 170 consecutive patients (median age, 62 years) with angiographically documented CTO. Regional late gadolinium enhancement and wall motion score index were assessed by cardiac MRI with the use of a 17-segment model. Angiographic collateral flow was assessed by the collateral connection grade and the Rentrop score. Evidence of previous myocardial infarction was found in 25% of patients by ECG Q waves, in 69% by regional wall motion abnormality, and in 86% of patients by late gadolinium enhancement. Increased angiographic collateral flow was associated with a lower frequency of Q waves on ECG, and a lower regional wall motion score index, late gadolinium enhancement volume (%), and degree of late gadolinium enhancement transmurality (all
P
<0.001), as well.
Conclusions—
The frequency of myocardial infarction in territories subtended by CTO is significantly higher than previously recognized. The degree of myocardial injury downstream epicardial CTO is inversely correlated with the degree of angiographic collaterals.
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Affiliation(s)
- Jin-Ho Choi
- From Department of Medicine (J.-H.C., S.-A.C., J.-.O.C., Y.B.S., J.-Y.H., S.H.C., S.-C.L., S.-H.L., J.K.O., Y.H.C., H.C.G.); Department of Emergency Medicine (J.-H.C); Department of Radiology (Y.-H.C.), Cardiovascular Imaging Center, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; and Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN (J.K.O.)
| | - Sung-A Chang
- From Department of Medicine (J.-H.C., S.-A.C., J.-.O.C., Y.B.S., J.-Y.H., S.H.C., S.-C.L., S.-H.L., J.K.O., Y.H.C., H.C.G.); Department of Emergency Medicine (J.-H.C); Department of Radiology (Y.-H.C.), Cardiovascular Imaging Center, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; and Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN (J.K.O.)
| | - Jin-Oh Choi
- From Department of Medicine (J.-H.C., S.-A.C., J.-.O.C., Y.B.S., J.-Y.H., S.H.C., S.-C.L., S.-H.L., J.K.O., Y.H.C., H.C.G.); Department of Emergency Medicine (J.-H.C); Department of Radiology (Y.-H.C.), Cardiovascular Imaging Center, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; and Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN (J.K.O.)
| | - Young Bin Song
- From Department of Medicine (J.-H.C., S.-A.C., J.-.O.C., Y.B.S., J.-Y.H., S.H.C., S.-C.L., S.-H.L., J.K.O., Y.H.C., H.C.G.); Department of Emergency Medicine (J.-H.C); Department of Radiology (Y.-H.C.), Cardiovascular Imaging Center, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; and Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN (J.K.O.)
| | - Joo-Yong Hahn
- From Department of Medicine (J.-H.C., S.-A.C., J.-.O.C., Y.B.S., J.-Y.H., S.H.C., S.-C.L., S.-H.L., J.K.O., Y.H.C., H.C.G.); Department of Emergency Medicine (J.-H.C); Department of Radiology (Y.-H.C.), Cardiovascular Imaging Center, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; and Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN (J.K.O.)
| | - Seung Hyuk Choi
- From Department of Medicine (J.-H.C., S.-A.C., J.-.O.C., Y.B.S., J.-Y.H., S.H.C., S.-C.L., S.-H.L., J.K.O., Y.H.C., H.C.G.); Department of Emergency Medicine (J.-H.C); Department of Radiology (Y.-H.C.), Cardiovascular Imaging Center, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; and Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN (J.K.O.)
| | - Sang-Chol Lee
- From Department of Medicine (J.-H.C., S.-A.C., J.-.O.C., Y.B.S., J.-Y.H., S.H.C., S.-C.L., S.-H.L., J.K.O., Y.H.C., H.C.G.); Department of Emergency Medicine (J.-H.C); Department of Radiology (Y.-H.C.), Cardiovascular Imaging Center, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; and Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN (J.K.O.)
| | - Sang-Hoon Lee
- From Department of Medicine (J.-H.C., S.-A.C., J.-.O.C., Y.B.S., J.-Y.H., S.H.C., S.-C.L., S.-H.L., J.K.O., Y.H.C., H.C.G.); Department of Emergency Medicine (J.-H.C); Department of Radiology (Y.-H.C.), Cardiovascular Imaging Center, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; and Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN (J.K.O.)
| | - Jae K. Oh
- From Department of Medicine (J.-H.C., S.-A.C., J.-.O.C., Y.B.S., J.-Y.H., S.H.C., S.-C.L., S.-H.L., J.K.O., Y.H.C., H.C.G.); Department of Emergency Medicine (J.-H.C); Department of Radiology (Y.-H.C.), Cardiovascular Imaging Center, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; and Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN (J.K.O.)
| | - YeonHyeon Choe
- From Department of Medicine (J.-H.C., S.-A.C., J.-.O.C., Y.B.S., J.-Y.H., S.H.C., S.-C.L., S.-H.L., J.K.O., Y.H.C., H.C.G.); Department of Emergency Medicine (J.-H.C); Department of Radiology (Y.-H.C.), Cardiovascular Imaging Center, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; and Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN (J.K.O.)
| | - Hyeon-Cheol Gwon
- From Department of Medicine (J.-H.C., S.-A.C., J.-.O.C., Y.B.S., J.-Y.H., S.H.C., S.-C.L., S.-H.L., J.K.O., Y.H.C., H.C.G.); Department of Emergency Medicine (J.-H.C); Department of Radiology (Y.-H.C.), Cardiovascular Imaging Center, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; and Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN (J.K.O.)
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