1. Quantification of Myocardial Mass Subtended by a Coronary Stenosis Using Intracoronary Physiology.
- Author
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Murai T, van de Hoef TP, van den Boogert TPW, Wijntjens GWM, Stegehuis VE, Echavarria-Pinto M, Hoshino M, Yonetsu T, Planken RN, Henriques JPS, Escaned J, Kakuta T, and Piek JJ
- Subjects
- Aged, Blood Flow Velocity, Cardiac Catheterization, Computed Tomography Angiography, Coronary Angiography, Coronary Artery Disease metabolism, Coronary Artery Disease physiopathology, Coronary Stenosis metabolism, Coronary Stenosis physiopathology, Coronary Vessels diagnostic imaging, Feasibility Studies, Female, Humans, Japan, Male, Middle Aged, Netherlands, Oxygen Consumption, Predictive Value of Tests, Reproducibility of Results, Coronary Artery Disease diagnosis, Coronary Circulation, Coronary Stenosis diagnosis, Coronary Vessels physiopathology, Energy Metabolism, Models, Biological, Myocardium metabolism
- Abstract
Background: In patients with stable coronary artery disease, the amount of myocardium subtended by coronary stenoses constitutes a major determinant of prognosis, as well as of the benefit of coronary revascularization. We devised a novel method to estimate partial myocardial mass (PMM; ie, the amount of myocardium subtended by a stenosis) during physiological stenosis interrogation. Subsequently, we validated the index against equivalent PMM values derived from applying the Voronoi algorithm on coronary computed tomography angiography., Methods: Based on the myocardial metabolic demand and blood supply, PMM was calculated as follows: PMM (g)=APV×D
2 ×π/(1.24×10- 3 ×HR×sBP+1.6), where APV indicates average peak blood flow velocity; D, vessel diameter; HR, heart rate; and sBP, systolic blood pressure. We calculated PMM to 43 coronary vessels (32 patients) interrogated with pressure and Doppler guidewires, and compared it with computed tomography-based PMM., Results: Median PMM was 15.8 g (Q1, Q3: 11.7, 28.4 g) for physiology-based PMM, and 17.0 g (Q1, Q3: 12.5, 25.9 g) for computed tomography-based PMM ( P =0.84). Spearman rank correlation coefficient was 0.916 ( P <0.001), and Passing-Bablok analysis revealed absence of both constant and proportional differences (coefficient A: -0.9; 95% CI, -4.5 to 0.9; and coefficient B, 1.00; 95% CI, 0.91 to 1.25]. Bland-Altman analysis documented a mean bias of 0.5 g (limit of agreement: -9.1 to 10.2 g)., Conclusions: Physiology-based calculation of PMM in the catheterization laboratory is feasible and can be accurately performed as part of functional stenosis assessment.- Published
- 2019
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