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Patient-Specific Registration of Segmental Jeopardy and Viability: Novel Method to Guide Revascularization in
Jacob Abdaem1, Dina Labib2, Rhys Beaudry2
1University of Calgary, Calgary, Alberta, Canada; Libin Cardiovascular Institute, Calgary, Alberta, Canada.
Insights
A new scoring system accurately identifies patients with ischemic cardiomyopathy who benefit from revascularization. Identifying jeopardized but viable myocardium significantly lowers mortality after the procedure.
Area of Science:
- Cardiology
- Medical Imaging
- Interventional Cardiology
Background:
- Viability testing is crucial in ischemic cardiomyopathy (ICM) but its role in guiding revascularization decisions is unclear.
- Current methods lack precise assessment of myocardial viability and vascular jeopardy.
- Accurate assessment is needed to optimize treatment strategies for ICM patients.
Purpose of the Study:
- To evaluate the association between a novel, segmentally registered viability and vascular jeopardy score and mortality after revascularization.
- To determine if identifying jeopardized but viable myocardium can predict outcomes in ICM patients.
- To assess the clinical feasibility of patient-specific coronary tree-based reporting.
Main Methods:
- Included 941 patients with ICM (obstructive coronary artery disease, LVEF <50%) undergoing cardiac MRI and coronary angiography.
- Segmental viability defined as scar transmurality ≤50% by cardiac MRI.
- Patient-specific coronary anatomy and lesion reporting algorithm used to map vascular perfusion jeopardy.
- Propensity score-adjusted time-to-event models assessed interactions between viability, jeopardy, and revascularization outcomes.
Main Results:
- A significant interaction was found for jeopardized but viable segments (interaction HR: 0.91; P = 0.008).
- Patients with ≥3 jeopardized but viable segments showed significantly lower mortality after early revascularization (propensity score-adjusted HR: 0.55; P = 0.015).
- No significant interactions were observed for overall viable segments or Duke jeopardy score alone.
Conclusions:
- Patient-specific coronary tree-based reporting to define jeopardized but viable myocardium is clinically feasible.
- This method accurately identifies ICM patients who benefit from early revascularization, experiencing lower mortality.
- The findings support integrating this novel scoring system into clinical decision-making for ICM.
Background:
Viability testing is frequently used in patients with ischemic cardiomyopathy (ICM). However, its role in guiding revascularization decisions remains unclear.
Objectives:
This study aimed to evaluate the associations between a novel, segmentally registered viability and vascular jeopardy score and mortality following revascularization.
Methods:
The study included patients with ICM, defined as obstructive coronary artery disease and LVEF <50%, undergoing cardiac magnetic resonance and invasive coronary angiography between 2015 and 2022. Segmental viability was defined as scar transmurality ≤50% detected by cardiac magnetic resonance. Spatially matched distributions of vascular perfusion jeopardy were established at the time of angiography by using a patient-specific coronary anatomy tree and lesion reporting algorithm. Interactions between viability extent, coronary artery disease severity, the novel marker of jeopardized but viable myocardium, and early revascularization were assessed using propensity score-adjusted time-to-event models for mortality.
Results:
Of 941 patients (mean age: 65 years; 81% male), 193 underwent early revascularization. During a median follow-up of 4.8 years, 168 deaths occurred. There were no interactions between the number of viable segments and revascularization (interaction HR: 1.09; P = 0.211) or between the Duke Jeopardy Score and revascularization (interaction HR: 0.93; P = 0.245) with respect to future mortality. However, a significant interaction was identified for the number of jeopardized but viable segments (interaction HR: 0.91; P = 0.008). Patients with ≥3 jeopardized but viable segments experienced significantly lower mortality following early revascularization (propensity score-adjusted HR: 0.55; P = 0.015).
Conclusions:
Patient-specific coronary tree-based reporting to define jeopardized but viable myocardium accurately is clinically feasible and identifies ICM patients who experience lower mortality from early revascularization.
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