Korean J Radiol.  2018 Feb;19(1):101-110. 10.3348/kjr.2018.19.1.101.

Findings of Single-Photon Emission Computed Tomography and Its Relation with Quantitative Coronary Angiography in Patients with Significant Stenosis of the Left Main Coronary Artery

Affiliations
  • 1Division of Cardiology, Department of Internal Medicine, Boramae Medical Center, Seoul National University College of Medicine, Seoul 07061, Korea. jooheezo@hanmail.net
  • 2Department of Nuclear Medicine, Boramae Medical Center, Seoul National University College of Medicine, Seoul 07061, Korea.
  • 3Cardiovascular Center, Boramae Hospital, Seoul 07061, Korea.

Abstract


OBJECTIVE
Unrecognized left main coronary artery disease (LMCD) is often fatal; however, accuracy of non-invasive tests for diagnosing LMCD is still unsatisfactory. This study was performed to elucidate single-photon emission computed tomography (SPECT) detection of LMCD using quantitative coronary angiography (QCA) data.
MATERIALS AND METHODS
Fifty-five patients (39 men; mean age, 68.1 ± 10.9 years) diagnosed with significant left main (LM) stenosis (≥ 50%) by invasive coronary angiography (ICA) were retrospectively reviewed. All study patients underwent SPECT with pharmacologic stress within 30 days of ICA. All coronary lesions were quantified via QCA, and SPECT findings were compared with QCA results.
RESULTS
Only four patients (7.3%) had isolated LMCD; all others had combined significant stenosis (≥ 70%) of one or more other epicardial coronary arteries. Patients with more severe coronary artery disease tended to have higher values for summed difference scores in a greater number of regions, but the specific pattern was not clearly defined. Summed stress score of SPECT did not differ according to LM stenosis severity. Only three patients (5.4%) had a typical LM pattern of reversible perfusion defect on SPECT. A significant negative linear correlation between stenosis severity and stress perfusion percent was found in the left anterior descending artery region (r = −0.455, p < 0.001) but not in the left circumflex artery.
CONCLUSION
Single-photon emission computed tomography findings were heterogeneous, not specific and poorly correlated to QCA data in patients with significant LMCD. This may be due to highly prevalent significant stenosis of other epicardial coronary arteries.

Keyword

Ischemic heart disease; Left main coronary artery disease; Quantitative coronary angiography; Single-photon emission computed tomography

MeSH Terms

Arteries
Constriction, Pathologic*
Coronary Angiography*
Coronary Artery Disease
Coronary Vessels*
Humans
Male
Myocardial Ischemia
Perfusion
Retrospective Studies
Tomography, Emission-Computed*
Tomography, Emission-Computed, Single-Photon

Figure

  • Fig. 1 Perfusion defect patterns according to coronary stenosis severity.LMCD = left main coronary artery disease, VD = vessel disease

  • Fig. 2 Myocardial ischemia according to severity of LM stenosis.LM = left main

  • Fig. 3 Linear correlations between coronary artery stenosis and myocardial perfusion percent.LAD = left anterior descending artery, LCX = left circumflex artery

  • Fig. 4 Myocardial stress perfusion according to presence of stenosis ≥ 70% in epicardial coronary arteries other than LM.*p < 0.05 compared to none.


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