Correspondence between left ventricular 17 myocardial segments and coronary anatomy obtained by multi-detector computed tomography: an ex vivo contribution

Abstract

In our experiment, LAD territory was larger than the AHA-proposed 17-segment model. The most specific segments were located at the anterior wall and supplied exclusively by LAD. No specific segment could be exclusively attributed to RCA or to LCx. Sometimes, LCx can be the most important artery for the blood supply of the inferior wall even if the origin of the posterior descending artery is the RCA.

Myocardial Blood Flow and Flow Reserve in Proximal and Mid-to-Distal Lesions of Left Anterior Descending Artery Measured By N-13 Ammonia PET/CT

“…Considering the report by Donato et al [2], which emphasized an exclusive predominance (>95 %) by LAD in basal segments of anterior and anteroseptal wall, the normal perfusion in basal segments in the pLAD group might have been resulted from preserved perfusion from left main branch. The perfusion defect in the lateral portion of basal anterior segment in a patient with mid-LAD stenosis can be associated with combined stenosis of the first diagonal branch ( Supplementary Fig.…”

“…Our data from multi-vessel disease patients were directly compared with other studies derived from subjects with single-vessel diseases. But we chose the LAD territory because it was demonstrated to be LAD-dominant in several studies [2,26]. Hemodynamic change can still be a problem because multi-vessel disease induces coronary steal phenomenon via collateral circulation [27], which was not definitely observed in our patients.…”

“…By using an automated software package (PMOD; PMOD Technologies, Zurich, Switzerland), myocardium was reoriented into short-axis images and segmentation was performed according to a 17-myocardial segment model [2,16] as shown in Fig. 1.…”

“…Myocardial perfusion imaging (MPI) possesses an essential role as a gatekeeper to discriminate those lesions needed to be invasively approached, because unnecessary invasive treatment for coronary stenosis with normal perfusion may lead to unexpected adverse events [1]. In such perspective, many studies to establish the way to find the "culprit" vessel or lesion have been conducted and various assignments of vascular territory to myocardial segments have been introduced [2][3][4][5].…”

Patient‐specific 17‐segment myocardial modeling on a bull's‐eye map

“…However, the AHA noted that the name of the segments should define the location relative to the long axis of the heart and the circumferential location, and individual myocardial segments can be assigned to the three major coronaries by considering their anatomic variabilities (2) . In addition, contrary to the conventional 17‐segment model, several studies have reported, using single‐photon emission computed tomography (SPECT), cardiac magnetic resonance (CMR), and CT, that there are variations in the mapping of segments to left ventricular territories, due to their anatomic variations 3 , 4 , 5 . Therefore, they proposed a revised mapping of segments considering anatomic variations, where some segments were assigned to multiple territories due to per‐patient variability.…”