Wei Dong1, Jianan Li2, Hongzhi Mi3, Xiantao Song4, Jian Jiao1, Quan Li1. 1. Department of Nuclear Medicine, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen road, Chaoyang District, Beijing, 100029, China. 2. Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen road, Chaoyang District, Beijing, 100029, China. 3. Department of Nuclear Medicine, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen road, Chaoyang District, Beijing, 100029, China. hongzhim3256@sina.com. 4. Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen road, Chaoyang District, Beijing, 100029, China. songxiantao@medmail.com.cn.
Abstract
OBJECTIVE: To analyze the relationship between the collateral flow of coronary chronic total occlusion (CTO) and myocardial viability detected by 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) imaging. METHODS: A prospective analysis of 104 patients diagnosed by coronary angiography. All patients underwent resting myocardial perfusion imaging and PET/CT within 1 week. The collateral circulation was graded with Rentrop classification as no or poor collateral circulation in 16 CTO vessels, moderate collateral circulation in 34 CTO vessels, and good collateral circulation in 69 CTO vessels. Myocardial viability was determined with myocardial perfusion imaging and PET. The patterns were interpreted as mismatch, match and normal perfusion and 18F-FDG uptake. RESULTS: There was no significant correlation between the severity and extent of perfusion defect, myocardial viability and collateral circulation grade. The myocardial viability was normal in mild and moderate hypokinetic regions and decreased in severe hypokinetic and akinesis-dyskinesis regions. The presence of collateral circulation was a sensitive (89%) but not a specific (31%) sign of myocardial viability. CONCLUSIONS: In patients with CTO, collateral circulation does not seem to be an effective way for predicting myocardial viability. Further analysis of PET patterns of viable myocardium is needed to guide further revascularization and predict functional improvement and survival benefit.
OBJECTIVE: To analyze the relationship between the collateral flow of coronary chronic total occlusion (CTO) and myocardial viability detected by 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) imaging. METHODS: A prospective analysis of 104 patients diagnosed by coronary angiography. All patients underwent resting myocardial perfusion imaging and PET/CT within 1 week. The collateral circulation was graded with Rentrop classification as no or poor collateral circulation in 16 CTO vessels, moderate collateral circulation in 34 CTO vessels, and good collateral circulation in 69 CTO vessels. Myocardial viability was determined with myocardial perfusion imaging and PET. The patterns were interpreted as mismatch, match and normal perfusion and 18F-FDG uptake. RESULTS: There was no significant correlation between the severity and extent of perfusion defect, myocardial viability and collateral circulation grade. The myocardial viability was normal in mild and moderate hypokinetic regions and decreased in severe hypokinetic and akinesis-dyskinesis regions. The presence of collateral circulation was a sensitive (89%) but not a specific (31%) sign of myocardial viability. CONCLUSIONS: In patients with CTO, collateral circulation does not seem to be an effective way for predicting myocardial viability. Further analysis of PET patterns of viable myocardium is needed to guide further revascularization and predict functional improvement and survival benefit.