Electromechanical Myocardial Mapping in Patients with Severe Coronary Artery Disease: Feasibility and Diagnostic Accuracy

Since the introduction of percutaneous transluminal angioplasty in the late 1970s the question remains whether myocardial tissue behind an obstruction will benefit from renewed blood supply and if an intervention will contribute to a better myocardial function. Positron emission tomography is recognized to be the golden standard in myocardial viability assessment. Recently the three‐dimensional electromechanical NOGA endocardial mapping system was introduced. The system measures myocardial unipolar voltage and linear local shortening. In theory a matched decrease indicates scar tissue, whereas reduced linear local shortening with normal unipolar voltage indicates tissue hibernation. The main advantage of this system is its ability to assess myocardial viability online, thus allowing the intervention cardiologist to proceed with treatment in the same session. Few studies have been conducted on the diagnostic accuracy of the NOGA system and their results vary. We compared NOGA and PET measurements in patients suffering from severe coronary artery disease. In this patient group we could not reproduce the sensitivity and specificity levels reported in earlier studies. This may in part be explained by the diffuse and extensive nature of coronary artery disease in the study group. However, the advantage of having an online assessment tool remains evident.