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Severity and extent of perfusion defects provoked by transient coronary occlusion compared with myocardial damage
L Bontemps1, M Gabain, A Doudouh
1Department of Nuclear Medicine, Cardiovascular Hospital, Lyon, France.
Insights
Injecting a perfusion tracer during percutaneous transluminal coronary angioplasty (PTCA) accurately identifies the myocardial area at risk. This method shows excellent agreement with scintigraphic defects seen in myocardial infarction (MI) patients.
Area of Science:
- Cardiovascular imaging
- Nuclear cardiology
- Interventional cardiology
Background:
- The myocardial 'area at risk' following coronary occlusion is crucial for assessing outcomes.
- Percutaneous transluminal coronary angioplasty (PTCA) involves temporary coronary artery occlusion.
- Assessing the area at risk during PTCA can guide treatment and predict outcomes.
Purpose of the Study:
- To evaluate the utility of peripheral perfusion tracer injection during PTCA for delineating the myocardial area at risk.
- To compare scintigraphic defect characteristics (location, size, severity) between PTCA and myocardial infarction (MI) patients.
- To assess the correlation between imaging findings in PTCA and MI groups.
Main Methods:
- Prospective study of 36 patients undergoing single-vessel PTCA with 99Tcm-sestamibi injection during occlusion, followed by SPET.
- Comparison with a reference group of 36 MI patients matched for vascular territories, assessed with 201Tl SPET (stress/reinjection).
- Analysis of scintigraphic defect topography, extent, and a defect index incorporating size and severity.
Main Results:
- Excellent agreement was observed in imaging characteristics and defect uptake between PTCA and MI groups.
- Defect index values were comparable: LAD vs. anterior (28.4% PTCA vs. 27.1% MI-stress/24.2% MI-reinjection) and RCA vs. inferior (15.5% PTCA vs. 14.7% MI-stress/13.2% MI-reinjection).
- Highly significant sectoral correlations were found between PTCA and MI patient groups.
Conclusions:
- Peripheral perfusion tracer injection during PTCA is a reliable method to delineate the myocardial area at risk.
- The scintigraphic defects observed during PTCA closely mirror those seen in early myocardial infarction.
- This technique provides valuable insights into myocardial jeopardy during interventional procedures.
Abstract:
A peripheral perfusion tracer injection at the time of coronary occlusion during percutaneous transluminal coronary angioplasty (PTCA) may delineate the myocardial 'area at risk' related to a given artery. To evaluate the location, size and severity of the corresponding scintigraphic defects, we conducted a prospective study of 36 patients who received a 99Tcm-sestamibi injection during single-vessel coronary angioplasty (PTCA = 18 LAD, 16 RCA and 2 LCX) followed by SPET. For comparison, a reference group of 36 successive patients examined during the early phase of myocardial infarction (MI), matched for the same vascular territories (18 anterior, 16 inferior and 2 lateral), were analysed in the same way after standard stress/reinjection 201Tl SPET. The imaging characteristics of both groups showed excellent agreement as well degree of uptake defects, in terms of topography and extent. A defect index, taking into account both size and severity, was in the same range for PTCA and MI patients (mean +/- standard deviation): for LAD vs anterior = 28.4 +/- 13.5% (PTCA), 27.1 +/- 12.2% (MI-stress) and 24.2 +/- 10.0% (MI-reinjection); for RCA vs inferior = 15.5 +/- 10.2% (PTCA), 14.7 +/- 9.7% (MI-stress) and 13.2 +/- 8.2% (MI-reinjection). Sectoral correlations between PTCA and MI groups were also highly significant.