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Published on: February 16, 2016
Culprit lesion and jeopardized myocardium: correlation between coronary angiography and single-photon emission
J Candell-Riera1, C Santana-Boado, J Castell-Conesa
1Servei de Cardiologia, Hospital General Universitari Vall d'Hebron, Barcelona, Spain.
Insights
Coronary angiography and myocardial SPECT show 84% agreement in identifying the culprit lesion in coronary artery disease patients. Correlation for jeopardized myocardium improved significantly when focusing on the culprit lesion alone.
Area of Science:
- Cardiology
- Medical Imaging
Background:
- The "culprit lesion" is the coronary stenosis causing symptoms in patients with coronary artery disease.
- Accurate detection is crucial for partial revascularization strategies.
- Jeopardized myocardium quantification requires precise identification of the responsible stenosis.
Purpose of the Study:
- To assess agreement between coronary angiography and myocardial single-photon emission computed tomography (SPECT) in identifying the culprit lesion.
- To evaluate the correlation between these techniques in quantifying jeopardized myocardium.
Main Methods:
- 159 patients with coronary artery disease and no prior myocardial infarction were studied.
- Myocardial SPECT scores were correlated with established angiographic scoring systems (Califf, Gensini) and a custom score.
- The custom score included adjustments for collateral circulation.
Main Results:
- Coronary angiography and SPECT demonstrated 84% agreement in diagnosing the culprit lesion.
- Initial correlations for overall jeopardized myocardium were significant but suboptimal (r=0.48-0.65).
- Correlation for jeopardized myocardium specifically from the culprit lesion showed significant improvement (r=0.85).
Conclusions:
- A high agreement (84%) exists between coronary angiography and myocardial SPECT for culprit lesion diagnosis in multivessel disease.
- The correlation for quantifying jeopardized myocardium from the culprit lesion using these methods is satisfactory.
Background:
The term "culprit lesion" is used to designate the coronary stenosis responsible for the symptoms of the patient with coronary artery disease. Its detection is essential when partial revascularization is contemplated. The term "jeopardized myocardium" is commonly used to mean the amount of myocardium put in danger by all the stenotic lesions; however, it should be restricted to the amount of myocardium that could become infarcted if only the most severe stenoses were occluded.
Hypothesis:
The aim of this study was to investigate (1) the agreement between coronary myocardial single-photon emission computed tomography (SPECT) and coronary angiography for the identification of the culprit lesion, and (2) the correlation of the two studies in the quantification of jeopardized myocardium.
Methods:
In all, 159 patients with coronary artery disease without previous myocardial infarction were included in the study. A score for myocardial SPECT was correlated with the angiographic scores by Califf and Gensini and with the authors' score which includes adjustment for collateral circulation.
Results:
The agreement between coronary angiography and SPECT for the diagnosis of the culprit lesion was 84% (87/104). The correlations between the scores of angiography and SPECT to assess jeopardized myocardium when all coronary stenoses were taken into account were significant (p < 0.0001), but their coefficients were suboptimal (r = 0.48 for Califf, r = 0.48 for Gensini, and r = 0.65 for the authors' score). When only the jeopardized myocardium resulting from the culprit lesion was considered, the correlation clearly improved (r = 0.85).
Conclusion:
Thus, in 84% of patients with multivessel disease, an agreement between coronary angiography and myocardial SPECT for the diagnosis of the culprit lesion was observed. The correlation between these techniques for the quantification of jeopardized myocardium from the culprit lesion was satisfactory.
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