Nucl Med Mol Imaging.  2016 Mar;50(1):54-62. 10.1007/s13139-015-0365-x.

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

• Cho SG
• Park KS
• Kang SR
• Kim J
• Jun HM
• Cho JY
• Jeong HC
• Kim JH
• Jeong GC
• Park HJ
• Kwon SY
• Min JJ
• Bom HH
• Song HC

• KMID: 2313275
• DOI: http://doi.org/10.1007/s13139-015-0365-x

Abstract

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<0.001) and showed higher SSS (0.0±0.0, 1.3 ±1.6 and 2.1±1.1 for Rentrop 0, Rentrop 1-2 and Rentrop 3, respectively; p=0.001) and SRS (0.0±0.0, 1.0±1.4 and 1.7± 1.2; p=0.003) at higher Rentrop grades, but their patterns were variable.
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.

Keyword

Coronary occlusion; Collateral circulation; Angina pectoris; Myocardial perfusion imaging

MeSH Terms

Angina Pectoris*
Arteries
Collateral Circulation*
Constriction, Pathologic
Coronary Angiography
Coronary Occlusion
Humans
Ischemia
Myocardial Perfusion Imaging
Myocardium
Perfusion*
Tissue Donors
Tomography, Emission-Computed*