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Updated: Sep 4, 2025

Optical Coherence Tomography Based Biomechanical Fluid-Structure Interaction Analysis of Coronary Atherosclerosis Progression
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Association between myocardial ischemia and plaque characteristics in chronic total occlusion

Sang-Geon Cho1, Jong Eun Lee2, Hyung Yoon Kim3

  • 1Department of Nuclear Medicine, Chonnam National University Hospital, 42, Jebong-ro, Dong-gu, Gwangju, 61469, Republic of Korea.

Journal of Nuclear Cardiology : Official Publication of the American Society of Nuclear Cardiology
|July 14, 2022
PubMed

Insights

Myocardial ischemia severity in chronic total occlusion (CTO) is linked to plaque characteristics. Higher proportions of intermediate-density plaques in the occluded artery correlate with moderate-to-severe ischemia.

Area of Science:

  • Cardiology
  • Radiology
  • Vascular Biology

Background:

  • Myocardial ischemia severity can vary in patients with chronic total occlusion (CTO).
  • The relationship between plaque characteristics and ischemia in CTO is not fully understood.

Purpose of the Study:

  • To investigate the association between atherosclerotic plaque characteristics in the occluded segment and the severity of myocardial ischemia in CTO patients.

Main Methods:

  • Retrospective analysis of 100 CTO patients who underwent myocardial perfusion SPECT and CCTA.
  • Classification of ischemia severity based on SPECT (SDS ≥ 5 for moderate-to-severe).
  • Categorization of plaques by density (low, intermediate, high HU) using CCTA.

Main Results:

  • Moderate-to-severe ischemia was associated with a higher proportion of intermediate-density plaques (72.4% vs. 64.0%).
  • Patients with severe ischemia had higher intermediate/low-density and intermediate-to-high/low-density plaque ratios.
  • Lower volume and proportion of low-density plaques were observed in moderate-to-severe ischemia groups.

Conclusions:

  • A higher proportion of intermediate-density plaques in the occluded segment is significantly associated with moderate-to-severe CTO-related myocardial ischemia.
  • This association is independent of occlusion length.
Abstract

Keywords:
Coronary occlusionatherosclerotic plaquescomputed tomography angiographymyocardial ischemiasingle-photon emission computed tomography

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