Cardiac Computed Tomography (CT) Evaluation of Valvular Heart Disease in Transcatheter Interventions

Computed tomography (CT) has become an important imaging tool to evaluate cardiac anatomy. This three-dimensional, isotropic imaging technique provides volumetric datasets with submillimetre tissue resolution that can be post-processed to define the cardiac structures. CT has become the mainstay imaging technique for selection of patients for, and planning of, transcatheter interventions for structural heart disease. Electrocardiographic-gated CT permits acquisition of cardiac datasets along the cardiac cycle enabling assessment of left and right ventricular function and valvular heart disease. In addition, the advent of three-dimensional printing technologies, which use three-dimensional patient-specific models frequently obtained from CT datasets, has opened a myriad of possibilities in terms of development of anatomical teaching tools, functional models to assess vessel and valve function, planning surgical or transcatheter interventions, and designing of transcatheter cardiac devices. This chapter reviews the role of CT in assessing cardiac morphology and function and valvular heart disease.

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Abstract 11726: Novel Non-Invasive Method to Estimate Myocardial Mass at Risk Calculated From Cardiac Computed Tomography Data: Validation Study Using Angiographic Myocardial Jeopardy Scores in Patients With Single Vessel Disease

Circulation ◽

10.1161/circ.130.suppl_2.11726 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Seiko IDE ◽

Satoru Sumitsuji ◽

Kensuke Yokoi ◽

Masatoki Yoshida ◽

Isamu Mizote ◽

...

Keyword(s):

Computed Tomography ◽

At Risk ◽

Heart Disease ◽

Coronary Artery ◽

Cardiac Computed Tomography ◽

Myocardial Mass ◽

Non Invasive ◽

Vessel Disease ◽

Single Vessel ◽

Single Vessel Disease

Background: The myocardial mass at risk (MMAR), representing volume of myocardium distal to culprit lesion, is one of important factors for predicting adverse cardiac event in ischemic heart disease. However, current non-invasive cardiac imaging fails to quantify MMAR in patients with stable coronary artery disease. We have developed a new software calculating MMAR of any designated coronary artery by reconstructing the 3-dimensional-volume-data of cardiac computed tomography (CCT). The novel index, ratio of MMAR to whole left ventricular volume (%LV-MMAR), calculated with this software would be appealing to obtain MMAR objectively. This study aims to compare the %LV-MMAR with Bypass Angioplasty Revascularization Investigation (BARI) and modified Albert Provincial Project for Outcome Assessment in Coronary Heart Disease (APPROACH) scores, both of which are invasive angiographic methods widely used to estimate MMAR, in patients with single-vessel disease. Methods: Between April 2008 and March 2014, patients suspected of effort angina pectoris without history of previous myocardial infarction were assessed with CCT and invasive coronary angiography. Of those, 48 patients who were revealed single-vessel disease (left anterior descending artery (LAD): n=22, left circumflex artery (LCX): n=11 and right coronary artery (RCA): n=15) were included in this study. %LV-MMAR was calculated on the software. BARI and modified APPROACH score were calculated and compared with %LV-MMAR. Results: Mean %LV-MMAR was 27.6 [18.2-37.1] %. BARI and APPROACH scores showed a significant correlation (r=0.92, p<0.0001). Also, a significant correlation was observed between %LV-MMAR versus BARI and %LV-MMAR versus APPROACH (r=0.95, p<0.0001 and r=0.9, p<0.0001, respectively). %LV-MMAR showed significant correlation with BARI and APPROACH scores in all vessels; LAD (r=0.95, p<0.0001 and r=0.91, p<0.0001, respectively), LCX (r=0.91, p=0.0001 and r=0.83, p=0.0002, respectively) and RCA (r=0.92, p<0.0001 and r=0.85, p<0.0001, respectively). Conclusions: This study revealed %LV-MMAR, calculated from CCT data on novel software, to be a promising index for estimating perfusion territory noninvasively in good agreement with BARI and modified APPROACH score.

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