Quantification of vessel-specific coronary perfusion territories using minimum-cost path assignment and computed tomography angiography: Validation in a swine model

Malkasian, Shant; Hubbard, Logan; Dertli, Brian; Kwon, Jungnam; Molloi, Sabee

doi:10.1016/j.jcct.2018.06.006

Cited by 19 publications

(21 citation statements)

References 35 publications

(50 reference statements)

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“…Transit time flow probes (Transonic Systems, Ithaca, NY) were positioned around the ascending aorta to measure cardiac output and around the right coronary artery to determine RV CBF. The right coronary artery perfuses the majority of the RV free wall as well as part of the posterior LV and the interventricular septum (27). Fluid status was maintained with an intravenous glucose drip (5%, 100 mL/h).…”

Section: Methodsmentioning

confidence: 99%

Right ventricular oxygen delivery as a determinant of right ventricular functional reserve during exercise in juvenile swine with chronic pulmonary hypertension

Cai

Duin

Stam

et al. 2019

American Journal of Physiology-Heart and Circulatory Physiology

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Assessing right ventricular (RV) functional reserve is important for determining clinical status and prognosis in patients with pulmonary hypertension (PH). In this study, we aimed to establish RV oxygen (O2) delivery as a determinant for RV functional reserve during exercise in swine with chronic PH. Chronic PH was induced by pulmonary vein banding (PVB), with sham operation serving as control. RV function and RV O2 delivery were measured over time in chronically instrumented swine, up to 12 wk after PVB at rest and during exercise. At rest, RV afterload (pulmonary artery pressure and arterial elastance) and contractility ( Ees and dP/d tmax) were higher in PH compared with control with preserved cardiac index and RV O2 delivery. However, RV functional reserve, as measured by the exercise-induced relative change (Δ) in cardiac index, dP/d tmax, and end-systolic elastance ( Ees), was decreased in PH, and RV pulmonary arterial coupling was lower both at rest and during exercise in PH. Furthermore, the increase in RV O2 delivery was attenuated in PH during exercise principally due to a lower systolic coronary blood flow in combination with an attenuated increase in aorta pressure while arterial O2 content was not significantly altered in PH. Moreover, RV O2 delivery reserve correlated with RV functional reserve, Δcardiac index ( r2 = 0.85), ΔdP/d tmax ( r2 = 0.49), and Δ Ees ( r2 = 0.70), all P < 0.05. The inability to sufficiently increase RV O2 supply to meet the increased O2 demand during exercise is principally due to the reduced RV perfusion relative to healthy control values and likely contributes to impaired RV contractile function and thereby to the limited exercise capacity that is commonly observed in patients with PH. NEW & NOTEWORTHY Impaired right ventricular (RV) O2 delivery reserve is associated with reduced RV functional reserve during exercise in a swine model of pulmonary hypertension (PH) induced by pulmonary vein banding. Our data suggest that RV function and exercise capacity might be improved by improving RV O2 delivery.

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Section: Methodsmentioning

confidence: 99%

Right ventricular oxygen delivery as a determinant of right ventricular functional reserve during exercise in juvenile swine with chronic pulmonary hypertension

Cai

Duin

Stam

et al. 2019

American Journal of Physiology-Heart and Circulatory Physiology

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“…The average compartmental perfusion was then combined with the average and per-voxel changes in HU (ΔHU AVE and ΔHU) between volume scans to yield voxel-by-voxel rest perfusion, stress perfusion, and CFR measurements. Finally, Vitrea was used for accurate semi-automatic extraction of the LAD, LCx, and RCA centerlines from the V2 REST CTA volume scan (Vitrea fX version 6.0, Vital Images, Inc., Minnetonka, MN) [26,27], and minimum-cost-path myocardial assignment was performed, yielding three separate coronary perfusion territories, with the LAD territory further partitioned distal to each stenoses, as previously reported [18][19][20]28]. The average rest perfusion, stress perfusion, and CFR within each territory was then calculated, and quantitative comparisons were made between the low-dose and reference standard retrospective measurements.…”

Section: Low-dose and Reference Standard Cardiac Ct Image Processingmentioning

confidence: 99%

“…The low-dose cardiac CT technique was shown to enable accurate, vessel-specific rest perfusion, stress perfusion, and CFR measurement, with simultaneously acquired coregistered CTA data using only four volume scans and two contrast injections, respectively, where such a protocol had not been fully realized by our prior work [18][19][20][21].…”

Section: Implications and Practical Applications Of The Present Studymentioning

confidence: 99%

“…Nevertheless, despite these data, accurate, vessel-specific stress perfusion, CFR, and CTA measurement remained to be combined and validated as a true low-dose cardiac CT technique. Hence, the purpose of this study was to assess the accuracy of a new low-dose cardiac CT technique, using our previously validated retrospective technique as the reference standard for perfusion measurement [18][19][20][21]. The central hypothesis was that accurate, low-dose, vessel-specific rest perfusion, stress perfusion, and CFR measurement is feasible, with simultaneously acquired co-registered CTA data, using a total of only four volume scans and two contrast injections.…”

Section: Introductionmentioning

confidence: 99%

“…First, we developed a new dynamic CT perfusion technique, validating that global perfusion measurement was feasible in an idealized phantom model of the heart using only two volume scans, with an ultrasonic flow probe as the reference standard [ 17 ]. Next, we retrospectively developed this technique in a swine model of ischemic coronary artery disease, validating vessel-specific [ 18 ] perfusion measurement as compared with invasive fractional flow reserve (FFR) and quantitative microsphere perfusion measurement, respectively [ 19 , 20 ]. Finally, we determined that accurate retrospective and prospective assessment of global stress perfusion is feasible at a tube current as low as 50 mA [ 21 ].…”

Section: Introductionmentioning

confidence: 99%

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Combining perfusion and angiography with a low-dose cardiac CT technique: a preliminary investigation in a swine model

Hubbard

Malkasian

Zhao

et al. 2021

Int J Cardiovasc Imaging

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Morphological and physiological assessment of coronary artery disease (CAD) is necessary for proper stratification of CAD risk. The objective was to evaluate a low-dose cardiac CT technique that combines morphological and physiological assessment of CAD. The low-dose technique was evaluated in twelve swine, where three of the twelve had coronary balloon stenosis. The technique consisted of rest perfusion measurement combined with angiography followed by stress perfusion measurement, where the ratio of stress to rest was used to derive coronary flow reserve (CFR). The technique only required two volume scans for perfusion measurement in mL/min/g; hence, four volume scans were acquired in total; two for rest with angiography and two for stress. All rest, stress, and CFR measurements were compared to a previously validated reference technique that employed 20 consecutive volume scans for rest perfusion measurement combined with angiography, and stress perfusion measurement, respectively. The 32 cm diameter volumetric CT dose index ($${\text{CTDI}}_{\text{vol}}^{32}$$ CTDI vol 32 ) and size-specific dose estimate (SSDE) of the low-dose technique were also recorded. All low-dose perfusion measurements (PLOW) in mL/min/g were related to reference perfusion measurements (PREF) through regression by PLOW = 1.04 PREF − 0.08 (r = 0.94, RMSE = 0.32 mL/min/g). The $${\text{CTDI}}_{\text{vol}}^{32}$$ CTDI vol 32 and SSDE of the low-dose cardiac CT technique were 8.05 mGy and 12.80 mGy respectively, corresponding to an estimated effective dose and size-specific effective dose of 1.8 and 2.87 mSv, respectively. Combined morphological and physiological assessment of coronary artery disease is feasible using a low-dose cardiac CT technique.

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Vessel-specific coronary perfusion territories using a CT angiogram with a minimum cost path technique and its direct comparison to the American Heart Association 17-segment model

et al. 2020

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Quantification of vessel-specific coronary perfusion territories using minimum-cost path assignment and computed tomography angiography: Validation in a swine model

Abstract: The MCP technique was validated in a swine animal model and has the potential to be used for accurate, vessel-specific assignment of LCA and RCA perfusion territories in both the left and right ventricular myocardium using CT angiography data.

Cited by 19 publications

References 35 publications

Right ventricular oxygen delivery as a determinant of right ventricular functional reserve during exercise in juvenile swine with chronic pulmonary hypertension

Right ventricular oxygen delivery as a determinant of right ventricular functional reserve during exercise in juvenile swine with chronic pulmonary hypertension

Combining perfusion and angiography with a low-dose cardiac CT technique: a preliminary investigation in a swine model

Vessel-specific coronary perfusion territories using a CT angiogram with a minimum cost path technique and its direct comparison to the American Heart Association 17-segment model

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