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Dual-phase multi-detector computed tomography assesses jeopardized and infarcted myocardium subtending infarct-related artery early after acute myocardial infarction
  1. Kuan-Rau Chiou (krchiou{at}isca.vghks.gov.tw)
  1. Department of Internal Medicine, Kaohsiung Veterans General Hospital, Taiwan
    1. Wei-Chun Huang (w.c.huang{at}yahoo.com.tw)
    1. Department of Internal Medicine, Kaohsiung Veterans General Hospital, Taiwan
      1. Nan-Jing Peng (njpeng{at}vghks.gov.tw)
      1. Department of Nuclear Medicine, Kaohsiung Veterans General Hospital, Taiwan
        1. Yi-Luan Huang (yylhuang{at}vghks.gov.tw)
        1. Department of Radiology, Kaohsiung Veterans General Hospital, Taiwan
          1. Shih-Hung Hsiao (a841120{at}ms3.hinet.net)
          1. Department of Internal Medicine, Kaohsiung Veterans General Hospital, Taiwan
            1. Kuen-Huang Chen (ckhc{at}isca.vghks.gov.tw)
            1. Department of Radiology, Kaohsiung Veterans General Hospital, Taiwan
              1. Ming-Ting Wu (wu.mingting{at}gmail.com)
              1. Department of Radiology, Kaohsiung Veterans General Hospital, Taiwan

                Abstract

                Objectives: To investigate dual-phase multi-detector computed tomography (MDCT) for assessing extent and severity of jeopardized and infarcted myocardium subtended by infarct-related artery (IRA), and its functional relevance after acute myocardial infarction (AMI).

                Designs, setting and patients: Prospective, single centre study included 107 patients with uncomplicated post-AMI 3-7 days, who met criteria and underwent dual-phase 64-slice MDCT. IRA, culprit lesion and extent of jeopardized/infarcted myocardium were assessed by 3-D volume rendered images with myocardium maps and CT angiography (CTA), compared with stress-redistribution thallium-201 single-photon emission computed tomography (SPECT) plus conventional coronary angiography (CCA). MDCT-jeopardized score (severity of jeopardized myocardium) was defined as extent of jeopardized myocardium multiplied by the weighted factor dependent on culprit lesion severity compared with SPECT-SRS (summation of segmental reversible score). Functional relevance of IRA indicating for revascularization was evaluated by MDCT-jeopardized score plus CTA. SPECT-SRS≥2 plus CCA-culprit lesion≥50% was standard reference.

                Results: Presence of MDCT-delayed enhancement was found in 101 (94.4%) patients. IRA and culprit lesion was identified in 99 (92.5%) by MDCT-myocardium maps plus CTA. Concordance between MDCT and SPECT for detecting infarcted myocardium was good (kappa=0.702). Correlation between MDCT-jeopardized score and SPECT-SRS was 0.741. Correlation between CTA and CCA for culprit lesion severity was 0.85. Sensitivity, specificity, negative and positive predictive values of CTA plus MDCT-jeopardized score≥2.5 for indicating revascularization were 90.2%, 80.4%, 86.0%, and 85.9%.

                Conclusions: Dual-phase MDCT has good accuracy for assigning IRA, assessing infarcted/jeopardized myocardium, and functional relevance. It provides an alternative for triage and therapeutic planning in post-AMI.

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