OBJECTIVES: To introduce a novel hypothesis and method to characterise pathomechanisms underlying myocardial ischemia in chronic ischemic heart disease by local fractal analysis (FA) of the ischemic myocardial transition region in perfusion imaging. METHODS: Vascular mechanisms to compensate ischemia are regulated at various vascular scales with their superimposed perfusion pattern being hypothetically self-similar. Dedicated FA software ("FraktalWandler") has been developed. Fractal dimensions during first-pass (FDfirst-pass) and recirculation (FDrecirculation) are hypothesised to indicate the predominating pathomechanism and ischemic severity, respectively. RESULTS: Twenty-six patients with evidence of myocardial ischemia in 108 ischemic myocardial segments on magnetic resonance imaging (MRI) were analysed. The 40th and 60th percentiles of FDfirst-pass were used for pathomechanical classification, assigning lesions with FDfirst-pass ≤ 2.335 to predominating coronary microvascular dysfunction (CMD) and ≥2.387 to predominating coronary artery disease (CAD). Optimal classification point in ROC analysis was FDfirst-pass = 2.358. FDrecirculation correlated moderately with per cent diameter stenosis in invasive coronary angiography in lesions classified CAD (r = 0.472, p = 0.001) but not CMD (r = 0.082, p = 0.600). CONCLUSIONS: The ischemic transition region may provide information on pathomechanical composition and severity of myocardial ischemia. FA of this region is feasible and may improve diagnosis compared to traditional noninvasive myocardial perfusion analysis. KEY POINTS: • A novel hypothesis and method is introduced to pathophysiologically characterise myocardial ischemia. • The ischemic transition region appears a meaningful diagnostic target in perfusion imaging. • Fractal analysis may characterise pathomechanical composition and severity of myocardial ischemia.
OBJECTIVES: To introduce a novel hypothesis and method to characterise pathomechanisms underlying myocardial ischemia in chronic ischemic heart disease by local fractal analysis (FA) of the ischemic myocardial transition region in perfusion imaging. METHODS: Vascular mechanisms to compensate ischemia are regulated at various vascular scales with their superimposed perfusion pattern being hypothetically self-similar. Dedicated FA software ("FraktalWandler") has been developed. Fractal dimensions during first-pass (FDfirst-pass) and recirculation (FDrecirculation) are hypothesised to indicate the predominating pathomechanism and ischemic severity, respectively. RESULTS: Twenty-six patients with evidence of myocardial ischemia in 108 ischemic myocardial segments on magnetic resonance imaging (MRI) were analysed. The 40th and 60th percentiles of FDfirst-pass were used for pathomechanical classification, assigning lesions with FDfirst-pass ≤ 2.335 to predominating coronary microvascular dysfunction (CMD) and ≥2.387 to predominating coronary artery disease (CAD). Optimal classification point in ROC analysis was FDfirst-pass = 2.358. FDrecirculation correlated moderately with per cent diameter stenosis in invasive coronary angiography in lesions classified CAD (r = 0.472, p = 0.001) but not CMD (r = 0.082, p = 0.600). CONCLUSIONS: The ischemic transition region may provide information on pathomechanical composition and severity of myocardial ischemia. FA of this region is feasible and may improve diagnosis compared to traditional noninvasive myocardial perfusion analysis. KEY POINTS: • A novel hypothesis and method is introduced to pathophysiologically characterise myocardial ischemia. • The ischemic transition region appears a meaningful diagnostic target in perfusion imaging. • Fractal analysis may characterise pathomechanical composition and severity of myocardial ischemia.
Authors: Marc Dewey; Maria Siebes; Marc Kachelrieß; Klaus F Kofoed; Pál Maurovich-Horvat; Konstantin Nikolaou; Wenjia Bai; Andreas Kofler; Robert Manka; Sebastian Kozerke; Amedeo Chiribiri; Tobias Schaeffter; Florian Michallek; Frank Bengel; Stephan Nekolla; Paul Knaapen; Mark Lubberink; Roxy Senior; Meng-Xing Tang; Jan J Piek; Tim van de Hoef; Johannes Martens; Laura Schreiber Journal: Nat Rev Cardiol Date: 2020-02-24 Impact factor: 32.419