The Official Journal of EuroPCR and the European Association of Percutaneous Coronary Interventions (EAPCI)

Anatomical Attributes of Clinically Relevant Diagonal Branches in Patients with Left Anterior Descending Coronary Artery Bifurcation Lesions

DOI: 10.4244/EIJ-D-19-00534

1. Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
2. Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
3. Department of Internal Medicine and Cardiovascular Centre, Seoul National University Hospital, Seoul, Korea, Korea, Republic Of
4. Department of Nuclear Medicine, Seoul National University Hospital, Seoul, Korea
5. Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
6. Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
7. Department of Medicine, Samsung Medical Center, Seoul, Korea
8. Department of Internal Medicine, Ewha Womans University Medical Center, Seoul, Korea
9. Department of Medicine, Samsung Medical Center, Seoul, Korea; Department of Emergency Medicine, Samsung Medical Center, Seoul, Korea
10. Department of Cardiology, Ajou University Hospital, Suwon, Korea
11. Department of Nuclear Medicine, Seoul National University Hospital, Seoul, Korea
12. Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
13. Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
14. Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
15. Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
16. Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
17. Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
18. Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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Aims: This study aimed to investigate the anatomical attributes determining myocardial territory of diagonal branches and to develop prediction models for clinically relevant branches using myocardial perfusion imaging (MPI) and coronary CT angiography (CCTA). 

Methods and results: The amount of ischemia and subtended myocardial mass of diagonal branches were quantified using MPI by percent ischemic myocardium (%ischemia) and CCTA by percent fractional myocardial mass (%FMM), respectively. In 49 patients with isolated diagonal branch disease, the mean %ischemia by MPI was 6.8±4.0% whereas in patients with total occlusion or severe disease of all diagonal branches, it was 8.4±3.3%. %ischemia was different according to the presence of non-diseased diagonal branches and dominant left circumflex artery (LCx). In CCTA cohort (306 patients, 564 diagonal branches), mean %FMM was 5.9±4.4% and 86 branches (15.2%) had %FMM ≥10%. %FMM was different according to LCx dominance, number of branches, vessel size, and relative dominance between 2 diagonal branches. The diagnostic accuracies of prediction models for %FMM ≥10% based on logistic regression and decision tree were 0.92 (95% CI 0.85-0.96) and 0.91 (95% CI 0.84-0.96), respectively. There was no difference in the diagnostic performance of models with and without size criterion. 

Conclusions: LCx dominance, number of branches, vessel size, and dominance among diagonal branches determined the myocardial territory of diagonal branches. Clinical application of prediction models based on these anatomical attributes can help determine the clinically relevant diagonal branches in the cardiac catheterization laboratory.

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