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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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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.

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Acknowledgments

This work was supported by the Nuclear Safety Research Program through the Korea Radiation Safety Foundation (KORSAFe) and the Nuclear Safety and Security Commission (NSSC), Republic of Korea (grant no. 1305033).

Conflict of Interest

Sang-Geon Cho, Ki Seong Park, Sae-Ryung Kang, Jahae Kim, Haeng Man Jun, Jae Yeong Cho, Hae Chang Jeong, Ju Han Kim, Geum-Cheol Jeong, Hee Jeong Park, Seong Young Kwon, Jung-Joon Min and Henry Hee-Seung Bom declare that they have no conflict of interest.

Ho-Chun Song has received research grants from the Nuclear Safety Research Program through the Korea Radiation Safety Foundation (KORSAFe) and the Nuclear Safety and Security Commission (NSSC), Republic of Korea (grant no. 1305033).

*The manuscript has not been published before, is not under consideration for publication anywhere else and has been approved by all co-authors.

Ethical Statement

The study was approved by the Chonnam National University Hospital Institutional Review Board (IRB no. CNUH-2014-153) and has been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. The institutional review board waived the need to obtain informed consent.

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Authors and Affiliations

  1. Department of Nuclear Medicine, Chonnam National University Hospital, Gwang-ju, Korea

    Sang-Geon Cho, Ki Seong Park, Sae-Ryung Kang, Jahae Kim, Haeng Man Jun & Ho-Chun Song

  2. Department of Cardiology, Chonnam National University Hospital, Gwang-ju, Korea

    Jae Yeong Cho, Hae Chang Jeong & Ju Han Kim

  3. Department of Nuclear Medicine, Chonnam National University Hwasun Hospital, 42 Jebong-ro, Dong-gu, Gwang-ju, Korea, 501-757

    Geum-Cheol Jeong, Hee Jeong Park, Seong Young Kwon, Jung-Joon Min & Henry Hee-Seung Bom

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  1. Sang-Geon Cho
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Correspondence to Ho-Chun Song.

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Cho, SG., Park, K.S., Kang, SR. et al. 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. Nucl Med Mol Imaging 50, 54–62 (2016). https://doi.org/10.1007/s13139-015-0365-x

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