Dual-phase multi-detector computed tomography assesses jeopardised and infarcted myocardium subtending infarct-related artery early after acute myocardial infarction

Abstract

Objectives: To investigate dual-phase multi-detector computed tomography (MDCT) for assessing extent and severity of jeopardised and infarcted myocardium subtended by infarct-related artery (IRA), and its indication for revascularisation after acute myocardial infarction (AMI). Designs, setting and patients: Prospective, singlecentre 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 jeopardised/infarcted myocardium were assessed by three-dimensional (3D) volume-rendered images with myocardium maps and computed tomography angiography (CTA), compared with stress-redistribution thallium-201 single-photon emission computed tomography (SPECT) plus conventional coronary angiography (CCA). MDCT-jeopardised score (severity of jeopardised myocardium) was defined as extent of jeopardised myocardium multiplied by the weighted factor dependent on culprit lesion severity compared with SPECT-SRS (summation of segmental reversible score). The IRA indication for revascularisation was evaluated by MDCT-jeopardised score plus CTA. SPECT-SRS >2 plus CCA-culprit lesion >50% was the standard reference. Results: The presence of MDCT-delayed enhancement was found in 101 (94.4%) patients. The IRA and culprit lesion were identified in 99 (92.5%) patients by MDCTmyocardium maps plus CTA. The concordance between MDCT and SPECT for detecting infarcted myocardium was good (kappa = 0.702). The correlation between MDCTjeopardised score and SPECT-SRS was 0.741. The correlation between CTA and CCA for culprit lesion severity was 0.85. The sensitivity, specificity, negative and positive predictive values of MDCT-jeopardised score >2.5 plus CTA for indicating revascularisation were 90.2%, 80.4%, 86.0% and 85.9%, respectively. Conclusions: Dual-phase MDCT has good accuracy for identifying IRA, and assessing infarcted and jeopardised myocardium for clinical relevance. It provides an alternative for triage and therapeutic planning in post-AMI.Appropriate risk triage and therapeutic decisionmaking in patients with acute myocardial infarction (AMI) who have not undergone primary or rescue angioplasty requires information about the status of infarct-related territory regarding the area of irreversibly injured myocardium (infarcted myocardium) and the area at risk for post-infarct ischaemia (jeopardised myocardium).1 2 Currently, single-photon emission computed tomography (SPECT) is widely accepted as the reference standard in physiologically recognising jeopardised and infarcted myocardium. If revascularisation is necessary, invasive conventional coronary angiography (CCA) is added for assigning the infarct-related artery (IRA) and evaluating culprit lesion severity.Technological advances in multi-detector computed tomography (MDCT) provide computed tomography angiography (CTA) with high accuracy in detecting significant coronary artery disease in comparison with CCA 3-5 and robust quality for evaluating left ventricular (LV) function. 6 ...

CT Attenuation Features of Individual Calcified Coronary Plaque: Differences among Asymptomatic, Stable Angina Pectoris, and Acute Coronary Syndrome Groups

“…The diagnoses of ACS and SAP were made by cardiologists with 15 and 20 years of experience [K.R.C, G.Y.M. ], according to the guidelines of the European Society of Cardiology and the American College of Cardiology/American Heart Association on the basis of clinical presentation, ECG finding, serum biomarkers, and coronary CT angiography [ 23 , 24 ]. Conventional risk factors, including sex, age, body mass index, diabetes mellitus, hypertension, dyslipidemia, and history of smoking were acquired from questionnaires, referral sheets, laboratory data and medical records, and determined according to published criteria [ 25 ].The history of smoking included current smoker (defined as persons who smoked regularly during the previous 12 months) and ex-smokers.…”

Myocardial infarction

“…Roes et al [123] prospectively analyzed a cohort of 231 patients with previous MI referred for a clinical CMR study. LGE is not a simple measure of presence or absence of viability; it can also identify microvascular obstruction, a robust marker of poor prognosis [37,124]. LGE is not a simple measure of presence or absence of viability; it can also identify microvascular obstruction, a robust marker of poor prognosis [37,124].…”

ASCI 2010 appropriateness criteria for cardiac computed tomography: a report of the Asian Society of Cardiovascular Imaging cardiac computed tomography and cardiac magnetic resonance imaging guideline Working Group

“…The indications of using cardiac CT for preoperative evaluation such as valve surgery, a percutaneous device, and for a complex lesion before PCI (ASCI indication no. [27][28][29] and ARVD evaluation (ASCI indication no. 41) were rated as appropriate.…”

“…Some practitioners consider a cardiac CT to be CT coronary angiography, while others think a cardiac CT should include motion and viability assessment [28][29][30][31]. Also, there is debate with regard to the scanning mode (sequential vs. spiral), ECG-gating technique (full dose, ECG-pulsing, or prospective [13,27,[29][30][31][32]) and post-processing technique [33].…”

“…The indications for common Asian diseases were added [6][7][8]24], and the top five proposed indications from the 2009 appropriateness criteria international update published in the Journal of Cardiovascular Computed Tomography (JCCT) [12] were also added. The important clinical applications proposed by Asian investigators were also included, such as congenital heart diseases [13][14][15][16][17][18], structural heart diseases [25,26], valvular heart diseases [27], and the detection of myocardial infarction [28][29][30]. After integration of the results, there were 51 indications approved by the Working Group.…”