Session S72.2

Integration of Standard Myocardial and Epicardial Segmentation: Validation by CT and Autopsy Studies

G Szabó, L Balkay, R Veisz, P Gergely, Z Koszegi*

Jósa András Hospital
Debrece, Hungary

The standardized myocardial segmentation recommended 17 myocardial segments which can be assigned to the 3 major coronary arteries. However, the epicardial coronary segmentations have not established the relation between the epicardial branches and the supplied myocardial segments. Our aim was to generate a correlation between the epicardial coronaries and the left ventricular segments on the basis of the coronary angiography and to validate the system by multislice CT and autopsy studies. The coronary angiograms of 37 patients were analyzed by a computer program called Holistic Coronary Care. The software registered 23 epicardial coronary segments using the modified Syntax segmentation system in 12 coronary circulation types. The supplied left ventricular segments on the standard 17-segment polar map were rendered to each coronary branch by an appropriate algorithm. The data were compared with 16-slice computed tomography (CT) examination in 11 patients in vivo, and with 26 autopsy studies in cases that died because of cardiac cause 16.1±12.2 days after the cardiac catheterization. The analysis of the coronary angiograms showed that out of the 17 left ventricular segments 9.5±1.9 (range:7-11), 3.3±2.4 (range:2-9) and 4.2±2.5 (range:0-7) were supplied by the left anterior descending, the left circumflex and the right coronary artery, respectively. In the 11 patients the numbers of the myocardial segments associated to the main coronary branches were 10.9±0.16, 2.6±1.6 and 2.7±1.2 on the CT, while in the 26 autopsy studies they were 9±1.9, 3.1±2.4 and 4.9±2.5, respectively. The myocardial segments predicted by the invasive coronary angiography overlapped the CT and the autopsy studies in 96%, 82%, 83% and in 93%, 91%, 84%, respectively. A highly significant correlation was found between the angiographic and both the CT and the autopsy determination of the number of left ventricular segments (r=0.97 and 0.94, p<0.001). Coronary angiography from multiple projections can determine accurately the supplied left ventricular segments of the 3 main coronary branches.

(Abstract Control Number: 254)