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Concordance Between Actual and Expected Coronary Artery Distribution

^_* Cardiac MR Center, Hygeia Hospital, 4 Erythrou Stavrou Street, Maroussi Athens 15123, Greece, and Tufts University School of Medicine, Boston, Massachusetts

In a previous study assessing the accuracy of a 17-segment model widely used in the nuclear cardiology literature, we projected the actual coronary artery anatomy of 135 patients undergoing coronary angiography onto the 17-segment model (3). We found that in general the model-predicted coronary anatomy was appropriate. There was only 1 segment (the apical lateral) in which the model-predicted coronary anatomy distribution (left circumflex coronary artery) did not match the actual one (LAD). In our previous report (3), concordance between the adjusted (i.e., apical lateral segment assigned to LAD) model-predicted and actual coronary artery anatomy occurred in at least 14 of 17 segments in 90% of the study population (121 of 135 patients). In our cohort, left dominance, occurring in 8% of study subjects, accounted for the greatest number of "misassignments" by the 17-segment model.

The Ortiz-Pérez et al. (1) findings corroborate our data regarding the apical lateral segment. Furthermore, because the 17-segment model that we examined and the American Heart Association model that Ortiz-Pérez et al. (1) evaluated differ regarding the expected coronary artery distribution at the apical inferior segment, the Ortiz-Pérez et al. (1) findings and our findings are in good agreement regarding the vascular supply of this segment, which in most patients was from the LAD. One segment that Ortiz-Pérez et al. (1) and we did not fully agree on was segment 12, which in our cohort was supplied by the left circumflex coronary artery, as the model predicts, and in the study by Ortiz-Pérez et al. (1), it was more commonly supplied by the LAD. In a smaller study, Pereztol-Valdés et al. (4) reported that segment 12 can be supplied by either the left circumflex coronary artery or the LAD.

The disagreement in the 2 reports regarding blood supply of the mid anterolateral segment (segment 12) may possibly be explained by the following factors: the inherent individual variability of coronary artery anatomy, the smaller number of patients in the study by Ortiz-Pérez et al. (1), the different methodology and different segmentation models in the 2 reports, and the existence of significant coronary atherosclerosis and previous scarring in some patients in the Ortiz-Pérez et al. (1) study. However, the agreement in these two studies (1,3) and other reports (4,5) regarding the inferior apical and lateral apical segments, suggesting that the LAD usually supplies segments 15 and 16, is important and should be taken into consideration for a possible revision of the expected vascular distribution in the 17-segment American Heart Association model.

(Email: peter.danias{at}tufts.edu; pdanias{at}hygeia.gr).

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3. Aepfelbacher FC, Johnson RB, Schwartz JG, et al. Validation of a model of left ventricular segmentation for interpretation of SPET myocardial perfusion images Eur J Nucl Med 2001;28:1624-1629.[CrossRef][Web of Science][Medline]
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