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Quantification of Myocardial Mass Subtended by a Coronary Stenosis Using Intracoronary Physiology.
Circulation: Cardiovascular Interventions ( IF 5.6 ) Pub Date : 2019-08-06 , DOI: 10.1161/circinterventions.118.007322
Tadashi Murai 1 , Tim P van de Hoef 1 , Thomas P W van den Boogert 1, 2 , Gilbert W M Wijntjens 1 , Valérie E Stegehuis 1 , Mauro Echavarria-Pinto 3 , Masahiro Hoshino 4 , Taishi Yonetsu 4 , R Nils Planken 2 , José P S Henriques 1 , Javier Escaned 5 , Tsunekazu Kakuta 4 , Jan J Piek 1
Affiliation  

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×D2×π/(1.24×103×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.

中文翻译:

使用冠状动脉内生理学定量分析冠状动脉狭窄所致的心肌质量。

背景:在患有稳定的冠状动脉疾病的患者中,冠状动脉狭窄所累及的心肌量是决定预后以及决定冠状动脉血运重建获益的主要因素。我们设计了一种新颖的方法来估计在生理性狭窄询问期间的部分心肌质量(PMM;即,狭窄所占的心肌量)。随后,我们对将Voronoi算法应用到冠状动脉计算机断层扫描血管造影术中得出的等效PMM值进行了验证。方法:基于心肌的代谢需求和血液供应,PMM的计算公式如下:PMM(g)= APV×D 2 × π/(1.24×10 - 3×HR×sBP + 1.6),其中APV表示平均峰值血流速度;D,容器直径;心率,心率;和sBP,收缩压。我们计算了43例受压力和多普勒导丝询问的冠状动脉(32例患者)的PMM,并将其与基于计算机断层扫描的PMM进行了比较。结果:基于生理的PMM的中值PMM为15.8 g(Q1,Q3:11.7、28.4 g) ,对于基于计算机断层扫描的PMM,则为17.0 g(Q1,Q3:12.5、25.9 g)(P = 0.84)。Spearman等级相关系数为0.916(P<0.001),Passing-Bablok分析显示不存在常数和比例差异(系数A:-0.9; 95%CI,-4.5至0.9;系数B,1.00; 95%CI,0.91至1.25)。奥特曼(Altman)分析记录的平均偏差为0.5 g(一致性极限:−9.1至10.2 g)。结论:在导管实验室中,基于生理的PMM计算是可行的,并且可以作为功能性狭窄评估的一部分准确进行。
更新日期:2019-08-06
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