Objective The prognostic importance of a coronary stenosis depends on its functional severity and its depending myocardial mass. Functional severity can be assessed by fractional flow reserve (FFR), estimated non-invasively by a specific validated CT algorithm (FFRCT). Calculation of myocardial mass at risk by that same set of CT data (CTmass), however, has not been prospectively validated so far. The aim of the present study was to compare relative territorial-based CTmass assessment with relative flow distribution, which is closely linked to true myocardial mass.
Methods In this exploratory study, 35 patients with (near) normal coronary arteries underwent CT scanning for computed flow-based CTmass assessment and underwent invasive myocardial perfusion measurement in all 3 major coronary arteries by continuous thermodilution. Next, the mass and flows were calculated as relative percentages of total mass and perfusion.
Results The mean difference between CTmass per territory and invasively measured myocardial perfusion, both expressed as percentage of total mass and perfusion, was 5.3±6.2% for the left anterior descending territory, −2.0±7.4% for the left circumflex territory and −3.2±3.4% for the right coronary artery territory. The intraclass correlation between the two techniques was 0.90.
Conclusions Our study shows a close relationship between the relative mass of the perfusion territory calculated by the specific CT algorithm and invasively measured myocardial perfusion. As such, these data support the use of CTmass to estimate territorial myocardium-at-risk in proximal coronary arteries.
- Cardiac catheterisation and angiography
- cardiac computed tomographic (CT) imaging
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DCJK and SF contributed equally.
Contributors DCJK: planning, conducting; patient enrolment, data collection and reporting; article writing, submission. SF: conducting; patient enrolment, data collection. MvV: reporting; article writing, data check, statistical check. IC: conducting; patient enrolment, reporting; data collection. JMZ: conducting; patient enrolment, reporting; article check, statistical analysis. MEF: conducting; patient enrolment, reporting; article check. FZ: conducting; patient enrolment, reporting; article check. CC: reporting; data check, statistical check. BDB: reporting; article writing, data check. NHJP: planning; principal investigator, reporting; article writing.
Funding Myomass was an investigator-initiated study supported by an unrestricted educational grant from HeartFlow.
Competing interests SF: institutional consultance/speaker fees from Bayer and Cathworks. CC: grants from HeartFlow, Abbott Vascular, Biosensors, Pie Medical and consultancy fees from HeartFlow and Philips. Member of the advisory board of Abbott Vascular, Pie Medical and Opsens. BDB: institutional grant; Abbott, Boston Scientific, Biotronik AG. Institutional consultance fees; Abbott, Opsens and Boston Scientific outside of the submitted work. Minor equities: Siemens, GE, Bayer, Philips, HeartFlow, Edwards Life Sciences and Ceyliad. NHJP: institutional grant; Abbott, Hexacath. Consultant; Abbott, Opsens. Minor equities Philips, GE, ASML, HeartFlow. Consultant GE and personal fees GE.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Patient consent for publication Not required.
Ethics approval The study was approved by the medical ethics committee of the hospital and all investigators adhered to the principles of the declaration of Helsinki.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data are available on reasonable request.
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