Hyung Yoon Kim1, Joon-Hyung Doh2, Hong-Seok Lim3, Chang-Wook Nam4, Eun-Seok Shin5, Bon-Kwon Koo6, Joo Myung Lee7, Taek Kyu Park7, Jeong Hoon Yang7, Young Bin Song7, Joo-Yong Hahn7, Seung Hyuk Choi7, Hyeon-Cheol Gwon7, Sang-Hoon Lee7, Sung Mok Kim8, Yeonhyeon Choe8, Jin-Ho Choi9. 1. Department of Medicine, Jeju University Hospital, Jeju National University School of Medicine, Jeju, Korea. 2. Department of Medicine, Inje University Ilsan-Paik Hospital, College of Medicine, Goyang, Korea. Electronic address: joon.doh@gmail.com. 3. Department of Cardiology, Ajou University School of Medicine, Suwon, Korea. 4. Department of Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea. 5. Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea. 6. Department of Medicine, Seoul National University Hospital, Seoul, Korea. 7. Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. 8. Department of Radiology, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. 9. Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Department of Emergency Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. Electronic address: jhchoimd@gmail.com.
Abstract
OBJECTIVES: The authors sought to identify whether a coronary side branch (SB) is supplying a myocardial mass that may benefit from revascularization. BACKGROUND: The amount of subtending myocardium and physiological stenosis is frequently different between the main vessel (MV) and SB. METHODS: In this multicenter registry, 482 patients who underwent coronary computed tomography angiography and fractional flow reserve (FFR) measurement were enrolled. The % fractional myocardial mass (FMM), the ratio of vessel-specific myocardial mass to whole myocardium, was assessed in 5,860 MV or SB consisting of 2,930 bifurcations. Physiological stenosis was defined by fractional flow reserve (FFR) <0.80. Myocardial mass that may benefit from revascularization was defined by %FMM ≥10%. RESULTS: In per-bifurcation analysis, MV supplied a 1.5- to 9-fold larger myocardial mass compared with SB. Unlike left main bifurcation (n = 482), only 1 of every 5 non-left main SB (n = 2,448) supplied %FMM ≥10% (97% vs. 21%; p < 0.001). SB length ≥73 mm could estimate %FMM ≥10% (c-statistic = 0.85; p < 0.001). In 604 vessels interrogated by FFR, diameter stenosis was similar (p = NS), but %FMM ≥10%, FMM/minimal luminal diameter, and frequency of FFR <0.80 was higher in MV compared with SB (p < 0.001, all). Generalized estimating equations modeling demonstrate that vessel diameter, left myocardial mass, and FFR were not (p = NS), but SB length ≥73 mm and left main bifurcation were significant predictors for %FMM ≥10% (p < 0.001). CONCLUSIONS: Compared with MV, SB supplies a smaller myocardial mass and showed less physiological severity despite similar stenosis severity. SB supplying a myocardial mass of %FMM≥10%, which may benefit revascularization could be identified by vessel length ≥73 mm. Pre-procedural recognition of these findings may guide optimal revascularization strategy for bifurcation.
OBJECTIVES: The authors sought to identify whether a coronary side branch (SB) is supplying a myocardial mass that may benefit from revascularization. BACKGROUND: The amount of subtending myocardium and physiological stenosis is frequently different between the main vessel (MV) and SB. METHODS: In this multicenter registry, 482 patients who underwent coronary computed tomography angiography and fractional flow reserve (FFR) measurement were enrolled. The % fractional myocardial mass (FMM), the ratio of vessel-specific myocardial mass to whole myocardium, was assessed in 5,860 MV or SB consisting of 2,930 bifurcations. Physiological stenosis was defined by fractional flow reserve (FFR) <0.80. Myocardial mass that may benefit from revascularization was defined by %FMM ≥10%. RESULTS: In per-bifurcation analysis, MV supplied a 1.5- to 9-fold larger myocardial mass compared with SB. Unlike left main bifurcation (n = 482), only 1 of every 5 non-left main SB (n = 2,448) supplied %FMM ≥10% (97% vs. 21%; p < 0.001). SB length ≥73 mm could estimate %FMM ≥10% (c-statistic = 0.85; p < 0.001). In 604 vessels interrogated by FFR, diameter stenosis was similar (p = NS), but %FMM ≥10%, FMM/minimal luminal diameter, and frequency of FFR <0.80 was higher in MV compared with SB (p < 0.001, all). Generalized estimating equations modeling demonstrate that vessel diameter, left myocardial mass, and FFR were not (p = NS), but SB length ≥73 mm and left main bifurcation were significant predictors for %FMM ≥10% (p < 0.001). CONCLUSIONS: Compared with MV, SB supplies a smaller myocardial mass and showed less physiological severity despite similar stenosis severity. SB supplying a myocardial mass of %FMM≥10%, which may benefit revascularization could be identified by vessel length ≥73 mm. Pre-procedural recognition of these findings may guide optimal revascularization strategy for bifurcation.
Authors: Dobrin Vassilev; Niya Mileva; Carlos Collet; Pavel Nikolov; Katerina Sokolova; Kiril Karamfiloff; Vladimir Naunov; Jeroen Sonck; Gianluca Rigatelli; Ghassan S Kassab; Robert J Gil Journal: Sci Rep Date: 2021-12-21 Impact factor: 4.379