Ischemic Burden Assessment Using Single Photon Emission Computed Tomography in Single Vessel Chronic Total Occlusion
Yong-Hoon Yoon1, Sangwon Han2, Osung Kwon3
1Department of Cardiology, Chungnam National University Sejong Hospital, Chungnam National University School of Medicine, Sejong, Korea.
Insights
Assessing ischemic burden in chronic total occlusion (CTO) vessels using single photon emission computed tomography (SPECT) is crucial. This study found that only 40% of patients with CTO had significant ischemic burden, suggesting SPECT can guide revascularization decisions.
Area of Science:
- Cardiology
- Nuclear Cardiology
- Interventional Cardiology
Background:
- Studies evaluating the ischemic burden of chronic total occlusion (CTO) vessels are limited.
- Understanding the extent of myocardial ischemia in CTO is essential for guiding revascularization strategies.
Purpose of the Study:
- To evaluate the ischemic burden in patients with single-vessel CTO using single photon emission computed tomography (SPECT).
- To identify predictors of high ischemic burden in CTO patients.
Main Methods:
- 165 patients with single-vessel CTO (>2.5 mm) underwent SPECT.
- Ischemic burden was quantified using semi-quantitative SPECT analysis (Summed Difference Score/68).
Main Results:
- The median ischemic burden was 8.8%, highest in Left Anterior Descending Artery (LAD) CTO (10.3%).
- High ischemic burden (>10%) was observed in 40% of patients, particularly in LAD CTO (50.5%).
- Hypertension, baseline ejection fraction >45%, LAD CTO, proximal CTO, and de novo CTO were predictors of high ischemic burden.
Conclusions:
- Only 40% of patients with single-vessel CTO exhibited an ischemic burden >10%.
- SPECT assessment of ischemic burden prior to revascularization may help identify suitable candidates for intervention in CTO vessels.
Background And Objectives:
Studies evaluating the nature of ischemic burden of chronic total occlusion (CTO) vessels are still lacking.
Methods:
A total of 165 patients with single vessel CTO >2.5 mm in an epicardial coronary artery who underwent single photon emission computed tomography (SPECT) were enrolled in the study. Ischemic burden was calculated with the use of semi-quantitative SPECT analysis, and was defined as the summed difference score (SDS) divided by the maximal limit of the score (=SDS/68).
Results:
The mean age of the participants was 59.5 years and the CTO of the left anterior descending coronary artery (LAD), left circumplex coronary artery (LCX), and right coronary artery (RCA) accounted for 93 (56.4%), 18 (10.9%), and 54 (32.7%) patients, respectively. The median ischemic burden of the total population was 8.8%, and it was highest in the LAD CTO (10.3%) compared with the LCX (5.9%) and RCA CTO (5.9%, p<0.001). High-ischemic burden (ischemic burden >10%) was observed in 66 patients (40.0%), and in 47 patients (50.5%) of the LAD CTO. Ischemic burden was different according to the CTO location only in LAD CTO. The statistically significant predictors for high-ischemic burden were hypertension, baseline ejection fraction >45%, LAD CTO, proximal CTO location, and de novo CTO. Japanese-CTO score and Rentrop scale collateral grade were not associated with high-ischemic burden.
Conclusions:
Only 40% of patients with single vessel CTO had ischemic burden >10%. For CTO vessels, measurement of ischemic burden using SPECT prior to revascularization may be helpful in identifying beneficial subjects.
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