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Viability assessment after conventional coronary angiography using a novel cardiovascular interventional therapeutic CT system: Comparison with gross morphology in a subacute infarct swine model

 Yeonggul Jang  ;  Iksung Cho  ;  Bríain W.Ó. Hartaigh  ;  Se-Il Park  ;  Youngtaek Hong  ;  Sanghoon Shin  ;  Seongmin Ha  ;  Byunghwan Jeon  ;  Hoyup Jung  ;  Hackjoon Shim  ;  James K. Min  ;  Hyuk-Jae Chang  ;  Yangsoo Jang  ;  Namsik Chung 
 Journal of Cardiovascular Computed Tomography, Vol.9(4) : 321-328, 2015 
Journal Title
 Journal of Cardiovascular Computed Tomography 
Issue Date
Animals ; Contrast Media/administration & dosage ; Coronary Angiography/methods* ; Female ; Multidetector Computed Tomography/methods* ; Multimodal Imaging/methods* ; Myocardial Infarction/complications ; Myocardial Infarction/diagnostic imaging* ; Myocardial Infarction/pathology ; Myocardial Stunning/diagnostic imaging* ; Myocardial Stunning/etiology ; Myocardial Stunning/pathology ; Radiography, Interventional/methods* ; Reproducibility of Results ; Sensitivity and Specificity ; Swine ; Tissue Survival
Multislice computed tomography ; Myocardial contrast delayed enhancement ; Myocardial viability
BACKGROUND: Given the lack of promptness and inevitable use of additional contrast agents, the myocardial viability imaging procedures have not been used widely for determining the need to performing revascularization. OBJECTIVE: This study is aimed to evaluate the feasibility of myocardial viability assessment, consecutively with diagnostic invasive coronary angiography (ICA) without use of additional contrast agent, using a novel hybrid system comprising ICA and multislice CT (MSCT). METHODS: In all, 14 Yucatan miniature swine models (female; age, 3 months; weight, 28-30 kg) were subjected to ICA followed by balloon occlusion (90 minutes) and reperfusion of the left anterior descending coronary artery. Two weeks after induction of myocardial infarction, delayed hyperenhancement (DHE) images were obtained, using a novel combined machine comprising ICA and 320-channel MSCT scanner (Aquilion ONE, Toshiba), after 2, 5, 7, 10, 15, and 20 minutes after conventional ICA. The heart was sliced in 10-mm consecutive sections in the short-axis plane and was embedded in a solution of 1% triphenyltetrazolium chloride (TTC). Infarct size was determined as TTC-negative areas as a percentage of total left ventricular area. On MSCT images, infarct size per slice was calculated by dividing the DHE area by the total slice area (%) and compared with histochemical analyses. RESULTS: Serial MSCT scans revealed a peak CT attenuation of the infarct area (222.5 ± 36.5 Hounsfield units) with a maximum mean difference in CT attenuation between the infarct areas and normal myocardium of at 2 minutes after contrast injection (106.4; P for difference = 0.002). Furthermore, the percentage difference of infarct size by MSCT vs histopathologic specimen was significantly lower at 2 (8.5% ± 1.8%) and 5 minutes (9.5% ± 1.9%) than those after 7 minutes. Direct comparisons of slice-matched DHE area by MSCT demonstrated excellent correlation with TTC-derived infarct size (r = 0.952; P < .001). Bland-Altman plots of the differences between DHE by MSCT and TTC-derived infarct measurements plotted against their means showed good agreement between the 2 methods. CONCLUSION: The feasibility of myocardial viability assessment by DHE using MSCT after conventional ICA was proven in experimental models, and the optimal viability images were obtained after 2 to 5 minutes after the final intracoronary injection of contrast agent for conventional ICA.
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5. Research Institutes (연구소) > Cardiovascular Product Evaluation Center (심혈관제품유효성평가센터) > 1. Journal Papers
5. Research Institutes (연구소) > Yonsei Cardiovascular Research Institute (심혈관연구소) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Yonsei Biomedical Research Center (연세의생명연구원) > 1. Journal Papers
Yonsei Authors
박세일(Park, Se Il) ORCID logo https://orcid.org/0000-0002-4949-8976
심학준(Shim, Hack Joon)
장양수(Jang, Yang Soo) ORCID logo https://orcid.org/0000-0002-2169-3112
장영걸(Jang, Yeong Gul)
장혁재(Chang, Hyuck Jae) ORCID logo https://orcid.org/0000-0002-6139-7545
전병환(Jeon, Byung Hwan)
정남식(Chung, Nam Sik)
조익성(Cho, Ik Sung)
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