TY - JOUR
T1 - Percentage of left ventricular myocardial blood flow distribution and revascularization completeness in FASTTRACK CABG
AU - Serruys, Patrick W.
AU - Tsai, Tsung Ying
AU - Kageyama, Shigetaka
AU - Revaiah, Pruthvi Chenniganahosahalli
AU - Keulards, Daniëlle C.J.
AU - Updegrove, Adam
AU - Taylor, Charles A.
AU - Sinclair, Matthew
AU - Mullen, Sarah
AU - Rogers, Campbell
AU - Thomsen, Brian
AU - Garg, Scot
AU - Chinhenzva, Albert
AU - Puskas, John D.
AU - Narula, Jagat
AU - Gupta, Himanshu
AU - Agarwal, Vikram
AU - Tanaka, Kaoru
AU - De Mey, Johan
AU - La Meir, Mark
AU - Schneider, Ulrich
AU - Kirov, Hristo
AU - Doenst, Torsten
AU - Teighgräber, Ulf
AU - Mushtaq, Saima
AU - Pompilio, Giulio
AU - Pontone, Gianluca
AU - Andreini, Daniele
AU - Morel, Marie Angele
AU - Onuma, Yoshinobu
N1 - Publisher Copyright:
© 2025 Society of Cardiovascular Computed Tomography
PY - 2026/1/1
Y1 - 2026/1/1
N2 - Background: Complete coronary revascularization has significant clinical outcome implications; however, there is no objective, quantitative, or universal definition. Aim: To provide a quantitative personalized assessment of myocardium at risk before and after coronary artery bypass grafting (CABG) surgery. Methods: Percent left ventricular myocardial blood flow distribution (LV%MYO) was derived from coronary CT angiography (CCTA) and used to quantify the myocardium at risk of ischemia in the 16 SYNTAX coronary segments of the 114 patients in the multicenter, prospective FASTTRACK CABG trial. Given each point of the fixed SYNTAX myocardial weighting factor represents 16.7 % (1/6) of myocardial blood flow, the myocardial weighting factor of each coronary segment was calculated as 6 × LV%MYO. The patency of bypass grafts was assessed on 30-day follow-up CCTA, and the residual LV%MYO was obtained by subtracting the LV%MYO in segments anastomosed with non-stenotic grafts from the pre-CABG global LV%MYO. Results: LV%MYO were analyzable in 106 patients (mean age 65.6 (8.9) years, 87 % male); 53 had ≥1 total occlusion. The fixed myocardial weighting factor for most SYNTAX coronary segments differs significantly from the weighting factor derived from LV%MYO. The pre-CABG global LV%MYO, and the residual LV%MYO in 96 patients with post-CABG CCTA were 70.1 (18.8)% and 14.0 (15.3)%, respectively. Complete revascularization (residual LV%MYO ≤10 %) was achieved in 42 patients (43.8 %). The operator's discretion not to graft was the main reason that 106 coronary segments were not revascularized, with graft occlusion accounting for 22.6 %. Conclusion: CCTA-derived LV%MYO allows an objective and individualized quantification of the myocardium at risk, facilitating prospective prediction and retrospective assessment of the completeness of revascularization in CABG patients.
AB - Background: Complete coronary revascularization has significant clinical outcome implications; however, there is no objective, quantitative, or universal definition. Aim: To provide a quantitative personalized assessment of myocardium at risk before and after coronary artery bypass grafting (CABG) surgery. Methods: Percent left ventricular myocardial blood flow distribution (LV%MYO) was derived from coronary CT angiography (CCTA) and used to quantify the myocardium at risk of ischemia in the 16 SYNTAX coronary segments of the 114 patients in the multicenter, prospective FASTTRACK CABG trial. Given each point of the fixed SYNTAX myocardial weighting factor represents 16.7 % (1/6) of myocardial blood flow, the myocardial weighting factor of each coronary segment was calculated as 6 × LV%MYO. The patency of bypass grafts was assessed on 30-day follow-up CCTA, and the residual LV%MYO was obtained by subtracting the LV%MYO in segments anastomosed with non-stenotic grafts from the pre-CABG global LV%MYO. Results: LV%MYO were analyzable in 106 patients (mean age 65.6 (8.9) years, 87 % male); 53 had ≥1 total occlusion. The fixed myocardial weighting factor for most SYNTAX coronary segments differs significantly from the weighting factor derived from LV%MYO. The pre-CABG global LV%MYO, and the residual LV%MYO in 96 patients with post-CABG CCTA were 70.1 (18.8)% and 14.0 (15.3)%, respectively. Complete revascularization (residual LV%MYO ≤10 %) was achieved in 42 patients (43.8 %). The operator's discretion not to graft was the main reason that 106 coronary segments were not revascularized, with graft occlusion accounting for 22.6 %. Conclusion: CCTA-derived LV%MYO allows an objective and individualized quantification of the myocardium at risk, facilitating prospective prediction and retrospective assessment of the completeness of revascularization in CABG patients.
KW - Coronary computed tomography angiography (CCTA)
KW - Fractional flow reserve derived from CCTA (FFR)
KW - Non-invasive coronary angiography
KW - Percent left ventricular myocardial blood flow distribution (LV%MYO)
KW - SYNTAX score
UR - https://www.scopus.com/pages/publications/105021124031
U2 - 10.1016/j.jcct.2025.10.017
DO - 10.1016/j.jcct.2025.10.017
M3 - Article
C2 - 41203541
AN - SCOPUS:105021124031
SN - 1934-5925
VL - 20
SP - 50
EP - 62
JO - Journal of Cardiovascular Computed Tomography
JF - Journal of Cardiovascular Computed Tomography
IS - 1
ER -