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Updated: Oct 13, 2025
In Vivo Quantitative Assessment of Myocardial Structure, Function, Perfusion and Viability Using Cardiac Micro-computed Tomography
Published on: February 16, 2016
Predictive value of SPECT myocardial perfusion imaging in patients with unrevascularized coronary chronic total
Xinghong Ma1, Lin Guo1, Hailong Zhang1
1Department of Nuclear Medicine, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 North Lishi Road, Xicheng District, Beijing, 100037, China.
Insights
Myocardial ischemia detected by single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) is a significant predictor of adverse events in unrevascularized coronary chronic total occlusion (CTO) patients. Identifying ischemia, particularly CTO-related ischemia, aids risk stratification and may guide intervention decisions.
Area of Science:
- Cardiology
- Nuclear Cardiology
- Diagnostic Imaging
Background:
- Limited data exists on the association between myocardial ischemia and outcomes in unrevascularized coronary chronic total occlusion (CTO) patients.
- Accurate risk stratification is crucial for managing these complex cases.
Purpose of the Study:
- To evaluate the predictive value of ischemia detected by single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) for adverse events in unrevascularized CTO patients.
- To determine if ischemia originating from the CTO vessel independently predicts patient outcomes.
Main Methods:
- Patients with at least one unrevascularized CTO underwent exercise stress/rest SPECT MPI.
- Follow-up was conducted via telephone interviews and medical record review.
Main Results:
- Patients with ischemia had a significantly higher rate of adverse events (40.7%) compared to those without ischemia (7.1%, P=0.002).
- Ischemia on MPI was an independent predictor of adverse events (OR=7.656, P=0.011).
- CTO-related ischemia, non-CTO ischemia, and mixed ischemia were all independent predictors of adverse events (P<0.05 for all).
Conclusions:
- Myocardial ischemia detected by SPECT MPI, especially CTO-related ischemia, independently predicts adverse events in unrevascularized CTO patients.
- SPECT MPI can identify high-risk patients who may benefit from percutaneous coronary intervention.
- This imaging modality aids in clinical decision-making for CTO management.
Objective:
Data involved the association between myocardial ischaemia and the outcome for unrevascularized coronary chronic total occlusion (CTO) patients were limited. The purpose of this study was to evaluate the predictive value of ischaemia detected by single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) for the adverse events in unrevascularized CTO patients. We further explored whether ischaemia generated from CTO vessel can independently predict the outcome.
Methods:
Patients with at least one unrevascularized CTO on coronary angiography were enrolled in this study. Exercise stress/rest SPECT MPI was performed in all patients. All patients were then followed by telephone interview and reviewing of medical records.
Results:
Patients with ischaemia experienced significantly higher rate of adverse events than non-ischaemia patients (40.7% vs 7.1%, P = 0.002). Ischaemia demonstrated on MPI [odds ratio (OR) = 7.656; 95% confidence interval (CI) 1.598-36.677; P = 0.011] was an independent predictor for adverse events. Moreover, CTO-ischaemia (OR = 5.466; 95% CI 1.015-29.420; P = 0.048), non-CTO ischaemia (OR = 29.174; 95% CI 3.245-262.322; P = 0.003), mixed-ischaemia (OR = 7.130, 95% CI 1.257-40.445; P = 0.027) were all independent predictors for outcome.
Conclusion:
Ischaemia demonstrated on MPI, especially CTO-ischaemia were independent predictors for the adverse events. SPECT MPI can aid to identify patients at risk of adverse events, who may benefit from subsequent CTO percutaneous coronary intervention.
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