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Stress-rest myocardial perfusion SPECT for functional assessment of coronary arteries with anomalous origin or course
Leonardo De Luca1, Francesco Bovenzi, Domenico Rubini
1Department of Cardiology, Azienda Policlinico, Bari, Italy. leodeluca@virgilio.it
Insights
Anomalous coronary arteries (ACAs) coursing between the aorta and pulmonary artery are linked to myocardial perfusion defects. This study highlights the importance of evaluating ACA anatomy and function for patient management.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Vascular Anatomy
Background:
- Anomalous coronary arteries (ACAs) present a spectrum of clinical outcomes, from asymptomatic to life-threatening.
- The anatomical course of ACAs, particularly their inter-arterial trajectory, is critical for risk stratification.
Purpose of the Study:
- To assess the anatomical course of ACAs using transesophageal echocardiography (TEE).
- To evaluate the functional significance of ACAs via stress-rest myocardial perfusion SPECT.
Main Methods:
- Retrospective analysis of 14 patients with ACAs and no coronary artery disease (CAD).
- Utilized TEE for anatomical assessment and stress-rest (99m)Tc-MIBI SPECT for functional evaluation.
Main Results:
- TEE accurately identified ACA origins and inter-arterial courses in 5 patients.
- Four of these 5 patients (80%) exhibited reversible myocardial perfusion defects on SPECT, all with an inter-arterial ACA course.
Conclusions:
- A significant association exists between inter-arterial ACA courses and reversible perfusion defects.
- Integrating anatomical and functional assessments aids in managing patients with anomalous coronary arteries.
Unlabelled:
Anomalous coronary arteries (ACAs) may be clinically silent and totally benign or associated with catastrophic and fatal presentations. It has been postulated that the proximal course of an ACA is a decisive factor in risk stratification and surgical approach. Particularly, a course between the aorta and pulmonary trunk carries a high risk of major adverse events. We sought to evaluate the anatomic course of documented ACAs by transesophageal echocardiography (TEE) and to study their functional importance using stress-rest (99m)Tc-sestamibi ((99m)Tc-MIBI) myocardial perfusion SPECT.
Methods:
From a cohort of patients undergoing coronary angiography in our department between January 1997 and April 2003, we selected 14 with ACAs but without CAD (9 men and 5 women; mean age, 50.7 +/- 14.6 y). All patients underwent TEE and stress-rest (99m)Tc-MIBI myocardial perfusion SPECT.
Results:
TEE correctly identified the origin of all ACAs and revealed an anomalous course between the great vessels in 5 patients. At exercise myocardial perfusion SPECT, 4 of 14 patients demonstrated a reversible myocardial perfusion defect. All these patients had an anomalous course between the aorta and pulmonary artery.
Conclusion:
In this study, 4 of 5 (80%) anomalous courses between the aorta and pulmonary artery were associated with the finding of a reversible perfusion defect on stress-rest SPECT. An integrated evaluation of anatomic course and hemodynamic importance could be useful in the management of ACA.
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