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KMID : 1148920160500010054
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Nuclear Medicine and Molecular Imaging
2016 Volume.50 No. 1 p.54 ~ p.62
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Correlation of Angina Pectoris and Perfusion Decrease by Collateral Circulation in Single-Vessel Coronary Chronic Total Occlusion Using Myocardial Perfusion Single-Photon Emission Computed Tomography
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Cho Sang-Geon
Park Ki-Seong
Kang Sae-Ryung
Kim Ja-Hae
Jun Haeng-Man
Cho Jae-Yeong
Jeong Hae-Chang
Kim Ju-Han
Jeong Geum-Cheol
Park Hee-Jeong
Kwon Seong-Young
Min Jung-Joon
Bom Henry Hee-Seung
Song Ho-Chun
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Abstract
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Purpose: To evaluate the perfusion decrease in donor myocardium by collateral circulation and its correlation with angina pectoris in patients with chronic total occlusion (CTO) using myocardial perfusion single-photon emission computed tomography (MPS).
Materials and Methods: Thirty-six patients with single-vessel CTO without any other stenosis were included. All patients underwent MPS and coronary angiography (CAG) within 2 months. Total 72 donor arteries were evaluated for the grades of collaterals to the CTO artery using the Rentrop grading system on CAG. Perfusion defects and perfusion scores in donor and CTO territories were analyzed on MPS. Myocardial perfusion of donor and CTO territories were evaluated according to the presence of angina pectoris and the grades of collateral circulation.
Results: When the CTO territory was ischemic, symptomatic patients showed higher summed difference scores in the CTO territory compared to asymptomatic patients (3.5?±?2.4 vs. 1.5?±?0.8 for symptomatic and asymptomatic groups respectively; p?=?0.034). However, when the CTO territory was nonischemic, symptomatic patients showed higher summed stress scores (SSS, 4.3?±?2.9 vs. 1.6?±?1.2; p?=?0.032) and summed rest scores (SRS, 4.2?±?2.5 vs. 1.5?±?1.1; p?=?0.003) in the donor territories. On the per-vessel analysis, perfusion defects in donor territories were more frequent (0 % vs. 53 % vs. 86 % for Rentrop 0, Rentrop 1?2 and Rentrop 3, respectively; p?
Conclusion: Angina pectoris was related to either ischemia of the myocardium beyond CTO or a perfusion decrease in the donor myocardium. The perfusion decrease in donor myocardium positively correlated with the collateral grades.
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KEYWORD
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Coronary occlusion, Collateral circulation, Angina pectoris, Myocardial perfusion imaging
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