scholarly journals Coronary collaterals provide more than half of normal perfusion in patients with coronary artery disease - quantification by myocardial perfusion SPECT during elective balloon occlusion

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
B Harris ◽  
S Warren ◽  
E Persson ◽  
R Bhindi ◽  
M Ringborn ◽  
...  
Keyword(s):  
Myocardial Perfusion ◽  
Collateral Circulation ◽  
Perfusion Defect ◽  
Coronary Occlusion ◽  
Single Photon ◽  
Photon Emission ◽  
Balloon Occlusion ◽  
Spect Imaging ◽  
Emission Computed Tomography ◽  
Occlusion Time

Abstract Funding Acknowledgements Type of funding sources: None. BACKGROUND The coronary collateral circulation is a preformed network of anastomotic connections acting as a "natural bypass" mechanism. Whilst the prevalence of collaterals varies between species, approximately 25% of patients have angiographically visible robust collaterals at the time of ST elevation myocardial infarction. While the presence of collaterals is associated with improved outcomes, the magnitude of myocardial perfusion which can be provided by the collateral circulation remains uncertain. PURPOSE The aim was to quantify collateral myocardial perfusion during experimental coronary balloon occlusion in patients with CAD. METHODS The study was approved by the local investigational review board, and all patients provided informed consent. Patients without prior infarction, bypass surgery, or angiographically visible collaterals undergoing elective percutaneous transluminal coronary angioplasty (PTCA) to a single epicardial vessel, underwent two scans with 99mTc-sestamibi myocardial perfusion single-photon emission computed tomography (SPECT). All subjects underwent at least three minutes of angiographically verified complete balloon occlusion, at which time an intravenous injection of the radiotracer was administered, followed by SPECT imaging. A second radiotracer injection followed by SPECT imaging was performed 24 hours after PTCA. RESULTS The study included 21 patients (median [interquartile range] age 70 [56-74] years, 52% male). The degree of diameter stenosis of treated vessels ranged from 60-99%, with successful PTCA performed with a mean 5-minute balloon occlusion time, resulting in ≤20% residual stenosis in all cases. The vessels undergoing PTCA were 6 in the LAD, 5 in the LCx, and 10 in the RCA. For the cohort, the size of the perfusion defect was 16 [8-30]% of the LV and the collateral perfusion at rest within the perfusion defect was 64 [58-68]% of normal perfusion within that region. Collateral perfusion was negatively correlated with perfusion defect size (R2 = 0.85, p < 0.001), but did not differ by sex (p = 0.27) or age (p = 0.58). CONCLUSIONS: This is the first study to describe the magnitude of microvascular collateral perfusion in CAD. On average, despite coronary occlusion and an absence of angiographically visible collateral vessels, collaterals provide approximately 60% of the perfusion that reaches the jeopardized myocardium during coronary occlusion. This magnitude of collateral perfusion is much higher than previously speculated. A previous study using microspheres in dogs found that collateral perfusion in the setting of an occluded vessel was 6% of normal. By comparison, the current study found ten times greater collateral perfusion in patients with CAD. Abstract Figure. Collateral perfusion during occlusion.

scholarly journals Coronary collaterals not visible by invasive angiography can provide more than half of normal resting perfusion in patients with coronary artery disease

2021 ◽  
Author(s):  
Brandon Harris ◽  
Stafford Warren ◽  
Eva Persson ◽  
Ravinay Bhindi ◽  
Michael Ringborn ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Myocardial Perfusion ◽  
Perfusion Defect ◽  
Coronary Occlusion ◽  
Balloon Occlusion ◽  
Spect Imaging ◽  
Emission Computed Tomography ◽  
Collateral Flow ◽  
Artery Disease

Background: There is sufficient collateral flow to prevent myocardial ischemia during balloon occlusion in approximately one in five patients. However, the magnitude of myocardial perfusion provided by the coronary collateral circulation during occlusion is unknown. Therefore, the aim of this study was to quantify collateral myocardial perfusion during balloon occlusion in patients with coronary artery disease (CAD). Methods: Patients without angiographically visible collaterals undergoing elective percutaneous transluminal coronary angioplasty (PTCA) to a single epicardial vessel underwent two scans with 99mTc-sestamibi myocardial perfusion single-photon emission computed tomography (SPECT). All subjects underwent at least three minutes of angiographically verified complete balloon occlusion, at which time an intravenous injection of the radiotracer was administered, followed by SPECT imaging. A second radiotracer injection followed by SPECT imaging was performed 24 hours after PTCA. Results: The study included 21 patients (median [interquartile range] age 70 [56-74] years, 48% female). The diameter stenosis ranged from 60-99%, with successful PTCA performed with a mean 5-minute balloon occlusion. The perfusion defect extent was 16 [8-30]% of the LV. The collateral perfusion at rest was 64 [58-68]% of normal perfusion. Collateral perfusion was negatively correlated with perfusion defect size (R2=0.85, p<0.001), and did not differ by sex (p=0.27) or age (p=0.58). Conclusions: This is the first study to describe the magnitude of coronary microvascular collateral perfusion in patients with CAD. On average, despite coronary occlusion and an absence of angiographically visible collateral vessels, collaterals provide approximately 60% of the perfusion that reaches the jeopardized myocardium during coronary occlusion.

scholarly journals NOGA-Guided Analysis of Regional Myocardial Perfusion Abnormalities Treated With Intramyocardial Injections of Plasmid Encoding Vascular Endothelial Growth Factor A-165 in Patients With Chronic Myocardial Ischemia

Circulation ◽  
2005 ◽  
Vol 112 (9_supplement) ◽  
Author(s):  
Mariann Gyöngyösi ◽  
Aliasghar Khorsand ◽  
Sholeh Zamini ◽  
Wolfgang Sperker ◽  
Christoph Strehblow ◽  
...  
Keyword(s):  
Myocardial Perfusion ◽  
Perfusion Defect ◽  
Single Photon ◽  
Photon Emission ◽  
Tracer Uptake ◽  
Emission Computed Tomography ◽  
Single Photon Emission ◽  
Single Photon Emission Computed ◽  
Photon Emission Computed Tomography

Background— The aim of this substudy of the EUROINJECT-ONE double-blind randomized trial was to analyze changes in myocardial perfusion in NOGA-defined regions with intramyocardial injections of plasmid encoding plasmid human (ph)VEGF-A 165 using an elaborated transformation algorithm. Methods and Results— After randomization, 80 no-option patients received either active, phVEGF-A 165 (n=40), or placebo plasmid (n=40) percutaneously via NOGA-Myostar injections. The injected area (region of interest, ROI) was delineated as a best polygon by connecting of the injection points marked on NOGA polar maps. The ROI was projected onto the baseline and follow-up rest and stress polar maps of the 99m-Tc-sestamibi/tetrofosmin single-photon emission computed tomography scintigraphy calculating the extent and severity (expressed as the mean normalized tracer uptake) of the ROI automatically. The extents of the ROI were similar in the VEGF and placebo groups (19.4±4.2% versus 21.5±5.4% of entire myocardium). No differences were found between VEGF and placebo groups at baseline with regard to the perfusion defect severity (rest: 69±11.7% versus 68.7±13.3%; stress: 63±13.3% versus 62.6±13.6%; and reversibility: 6.0±7.7% versus 6.7±9.0%). At follow-up, a trend toward improvement in perfusion defect severity at stress was observed in VEGF group as compared with placebo (68.5±11.9% versus 62.5±13.5%, P =0.072) without reaching normal values. The reversibility of the ROI decreased significantly at follow-up in VEGF group as compared with the placebo group (1.2±9.0% versus 7.1±9.0%, P =0.016). Twenty-one patients in VEGF and 8 patients in placebo group ( P <0.01) exhibited an improvement in tracer uptake during stress, defined as a ≥5% increase in the normalized tracer uptake of the ROI. Conclusions— Projection of the NOGA-guided injection area onto the single-photon emission computed tomography polar maps permits quantitative evaluation of myocardial perfusion in regions treated with angiogenic substances. Injections of phVEGF A 165 plasmid improve, but do not normalize, the stress-induced perfusion abnormalities.

scholarly journals RELATIONSHIP BETWEEN FRONTAL QRS-T ANGLE AND MYOCARDIAL PERFUSION DEFECT (MPD) FROM SINGLE PHOTON EMISSION COMPUTED TOMOGRAPHY (SPECT) IN PATIENTS WITH PRIOR MYOCARDIAL INFARCTION

2021 ◽  
Vol 7 (2) ◽  
pp. 5
Author(s):  
Vitri Alya
Keyword(s):  
Myocardial Infarction ◽  
Myocardial Perfusion ◽  
Perfusion Defect ◽  
Single Photon ◽  
Photon Emission ◽  
Previous History ◽  
Emission Computed Tomography ◽  
Myocardial Perfusion Defect ◽  
Cross Sectional ◽  
History Of

Background: The frontal QRS-T angle is the angle between ventricular depolarization and repolarization. The QRS-T angle abnormalities will mirror the electrical instability, placing the patient in high risk of cardiac arrhythmia and sudden cardiac death. This study was conducted to analyzed as if the QRS-T angle will predict the myocardial perfusion defect in acute ST elevation myocardial infarction (STEMI).   Methods: This is a cross sectional study which conducted in patients with previous history of STEMI in H. Adam Malik General Hospital Medan from June 2018 until March 2020. The patients will then be undergoing electrocardiography (ECG) and myocardial perfusion scintigraphy (SPECT) to acquire the frontal QRS-T angle and myocardial perfusion defect score.   Results: Over 40 patients with prior STEMI we found the frontal QRS-T angle has a positive moderate correlation (r = 0,543; p < 0,001) with myocardial perfusion defect. The best cut-off value for frontal QRS-T angle to predict myocardial perfusion defect is > 70o with sensitivity and specificity of 70.6% and 82.6%, respectively.   Conclusions: The frontal QRS-T angle is an independent predictor for myocardial perfusion defect in patient with previous history of STEMI.   Keywords:  STEMI; frontal QRS-T angle; myocardial perfusion defect.

scholarly journals Increased accuracy of single photon emission computed tomography (SPECT) myocardial perfusion scintigraphy using iterative reconstruction of images

2016 ◽  
Vol 73 (5) ◽  
pp. 469-471
Author(s):  
Milos Stevic ◽  
Marina Vlajkovic
Keyword(s):  
Coronary Artery ◽  
Myocardial Perfusion ◽  
Iterative Reconstruction ◽  
False Positive ◽  
Perfusion Defect ◽  
Single Photon ◽  
Photon Emission ◽  
Emission Computed Tomography ◽  
Positive Finding ◽  
Bivariate Correlation

Background/Aim. Filtered back projection (FBP) is a common way of processing myocardial perfusion imaging (MPI) studies. There are artifacts in FBP which can cause falsepositive results. Iterative reconstruction (IR) is developed to reduce false positive findings in MPI studies. The aim of this study was to evaluate the difference in the number of false positive findings in MPI studies, between FBP and IR processing. Methods. We examined 107 patients with angina pectoris with MPI and coronary angiography (CAG), 77 man and 30 woman, aged 32?82. MPI studies were processed with FBP and with IR. Positive finding at MPI was visualization of the perfusion defect. Positive finding at CAG was stenosis of coronary artery. Perfusion defect at MPI without coronary artery stenosis at CAG was considered like false positive. The results were statistically analyzed with bivariate correlation, and with one sample t-test. Results. There were 20.6% normal, and 79.4% pathologic findings at FBP, 30.8% normal and 69.2% pathologic with IR and 37.4% normal and 62.6% pathologic at CAG. FBP produced 19 false-positive findings, at IR 11 false positive findings. The correlation between FBP and CAG was 0.658 (p < 0.01) and between IR and CAG 0.784 (p < 0.01). The number of false positive findings at MPI with IR was significantly lower than at FBP (p < 0.01). Conclusion. Our study shows that IR processing MPI scintigraphy has less number of false positive findings, therefore it is our choice for processing MPI studies.

SPECT Scan in Somatization Disorder Patients: An Exploratory Study of Eleven Cases

2001 ◽  
Vol 35 (3) ◽  
pp. 359-363 ◽  
Author(s):  
Javier Garcia-Campayo ◽  
Concepcion Sanz-Carrillo ◽  
Teresa Baringo ◽  
Concepción Ceballos
Keyword(s):  
Computed Tomography ◽  
Single Photon ◽  
Photon Emission ◽  
Spect Imaging ◽  
The Other ◽  
University Hospital ◽  
Somatization Disorder ◽  
Emission Computed Tomography ◽  
Axis I ◽  
Pain Symptoms

Objective: There are no previous studies using single photon emission computed tomography (SPECT) scans in somatization disorder (SD) patients. The aim of this paper is to assess SPECT imaging abnormalities in SD patients and study any relation to laterality. Method: Eleven SD patients from the Somatization Disorder Unit of Miguel Servet University Hospital, Zaragoza, Spain, not fulfilling criteria for any other psychiatric disorder and showing normal computed tomography (CT) and magnetic resonance imaging (MRI) images were studied with SPECT. Patients with DSM-IV axis I comorbidity were ruled out because it has been demonstrated that SPECT scans can show abnormalities in patients with depression and anxiety disorders. The technique used for SPECT was 99mTc-D,1,hexamethylpropyleneamide- oxime (99mTc-HMPAO) in four patients and 99mTc-bicisate in the other seven. The SPECT scans were evaluated without knowledge of clinical data and entirely by visual inspection. Results: Seven out of 11 (63.6%) SD patients showed hypoperfusion in SPECT imaging. In four cases there was hypoperfusion in the non-dominant hemisphere and the predominance of pain symptoms took place in the contralateral hemibody. In the other three patients hypoperfusion was bilateral. The anatomical regions affected were cerebellum (four cases), frontal and prefrontal areas (three cases), temporoparietal areas (two cases) and the complete hemisphere (one case). Conclusions: A proportion of SD patients may present hypoperfusion in SPECT images, uni- or bilaterally, in different brain areas. Possible aetiological explanations for this finding are discussed. Controlled studies are necessary to confirm or refute this hypothesis.

Abstract 15252: Segmental Myocardial Perfusion Improves after Repeated Intramyocardial Cell Injection

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Imke Mann ◽  
Sander F Rodrigo ◽  
Jan van Ramshorst ◽  
Saskia L Beeres ◽  
Jaap J Zwaginga ◽  
...  
Keyword(s):  
Myocardial Perfusion ◽  
Single Photon ◽  
Photon Emission ◽  
Emission Computed Tomography ◽  
Bone Marrow Mononuclear Cell ◽  
Repeated Injection ◽  
Refractory Angina ◽  
Rest Perfusion ◽  
Refractory Angina Pectoris ◽  
First Time

Introduction: We previously demonstrated that intramyocardial bone marrow mononuclear cell (MNC) injection improves segmental myocardial perfusion. This study was designed to evaluate in patients with recurrent refractory angina the effect of repeated injection on segmental myocardial perfusion. Methods: Twenty-one patients with recurrent refractory angina pectoris, who received 100x10^6 autologous MNC intramyocardially using the NOGA-system for a second time, were enrolled. Single-photon emission computed tomography was performed at baseline and 3 months after both injection procedures. The myocardium was divided into 17 segments and in both stress and rest images, segmental tracer activity was categorized on a 4-point scale. (1=>75%; 2=50%-74%; 3=25%-49%; 4=<25%) Segments demonstrating increased perfusion of at least 1 point in stress or rest perfusion were categorized as improved. Results: The second injection procedure was 4.6 ± 2.5 years after the first. In total, 139 segments were injected for the first time during either of the procedures, of which 80(58%) segments improved. Repeated injection in the same segment was performed in 45 segments. Of these segments, 18(40%) improved, less than after a first injection (P=0.030). Repeatedly injected segments can be subdivided in 29 previously responding segments (improved after the first injection) and 16 previously non-responding segments (not improved after the first injection). Of the responding segments, 13(45%) segments improved after repeated injection and of the non-responding segments, 5(31%) segments improved. This difference was not significant (P=.476). Conclusions: Segmental myocardial perfusion can improve after repeated intramyocardial MNC injection independently of the effect of the first injection, but the first injection is more effective.

scholarly journals Сравнительный анализ данных перфузионной сцинтиграфии миокарда у пациентов с поражением коронарных артерий различной степени выраженности

2019 ◽  
Author(s):  
E DENISENKO-KANKIYA ◽  
F.N. CHANAKHCHIAN ◽  
E.I. VASILENKO ◽  
M.N. VAKHROMEEVA
Keyword(s):  
Myocardial Perfusion ◽  
Single Photon ◽  
Photon Emission ◽  
Emission Computed Tomography ◽  
Vulnerable Atherosclerotic Plaque ◽  
Gated Perfusion Spect ◽  
Perfusion Spect ◽  
Perfusion Defects ◽  
Reversible Ischemia ◽  
Myocardial Perfusion Defects

Известно, что дестабилизация атеросклеротической бляшки коронарных артерий (КА) играет ключевую роль в развитии осложнений хронической ишемической болезни сердца (ИБС). Ранняя диагностика ишемии миокарда и определение субклинического стеноза КА с помощью неинвазивного метода визуализации сердца может стать важным методом в предотвращении развития сердечно-сосудистых осложнений у данной популяции больных. Цель исследования. Определить выраженность преходящих нарушений перфузии миокарда, выявленных при однофотонной эмиссионной компьютерной томографии (ОЭКТ) миокарда у пациентов со стенозами КА различной степени тяжести. Материал и методы. В исследование включен 231 пациент (средний возраст 6210лет). Проанализированы факторы кардиального риска. Всем пациентам проводили ОЭКТ миокарда по стандартному протоколу. Региональную перфузию миокарда оценивали с использованием стандартизированной 20-сегментной модели, на которой оценивали: SSS общий счет снижения перфузии миокарда при нагрузке SDS общую разницу счета, соответствующую степени выраженности преходящей ишемии левого желудочка (ЛЖ). На основании полученных данных обследуемых пациентов классифицировали на группы: с нормальной перфузией (SSS4), незначительной (SSS4-6), умеренной и выраженной степенью снижения (SSS712 и SSS13 соответственно) перфузии миокарда ЛЖ. Результаты SDS классифицировали как: отсутствие ишемии (SDS2), умеренная преходящая ишемия (SDS2-6) и выраженная преходящая ишемия (SDS7). Количественные показатели перфузии миокарда сравнивали с результатами инвазивной коронароангиографии (КАГ). Результаты. Из 231 пациента у 69 (29,9) по данным КАГ были выявлены стенозы до 20, у 126 (54,5) стенозы 2049, у 36 (15,6) стенозы 50 и более. Сравнительный анализ количественных показателей перфузии миокарда (SSS и SDS) и результатов КАГ показал, что достоверные дефекты перфузии после нагрузки и преходящая ишемия ЛЖ определены в основном у пациентов со стенозами КА50 (47,2 и 63,9 соответственно, р0,01). В группе пациентов с стенозами КА 2049 у 42,1 показатели SSS соответствовали незначительной (25,4) и умеренной (16,7) степени снижения перфузии после нагрузки (р0,01). При сопоставлении данных перфузионной сцинтиграфии миокарда выявлена связь между показателем SSS, наличием факторов риска и наличием сопутствующих заболеваний у пациентов с ИБС (р0,05). Заключение. Перфузионная ОЭКТ миокарда может использоваться в качестве метода выявления преходящей ишемии миокарда у пациентов со стенозами КА различной тяжести. Ключевые слова: ишемическая болезнь сердца, однофотонная эмиссионная компьютерная томография, перфузия миокарда, сцинтиграфия миокарда, необструктивное поражение, обструктивное поражение, коронароангиография.Vulnerable atherosclerotic plaque in coronary arteries (CA) is the primary mechanism responsible for complications of CAD even in the terms of non-obstructive CAD. Early determination of myocardial ischemia and CA stenosis with non-invasive imaging technique could predict the development of major cardiac events in patients with CAD. Aim: evaluation the severity of myocardial perfusion defects with single photon emission computed tomography (SPECT) in patients with obstructive or non-obstructive CAD. Material and methods: Overall 231patients (average age of 6210) were analyzed. All patients underwent 1-day gated perfusion SPECT protocol before coronary angiography (CAG). SPECT images were quantified by SSS and SDS using Cedars-Sinai QPS. Normal myocardial perfusion was considered if SSS4 mildly abnormal: SSS4-7 moderate and significantly abnormal: SSS8-12 and SSS13, respectively. Reversible ischemia was defined as SDS2. Degree of ischemia was assessed to moderate (SDS2-7) and severe (SDS7). Obstructive CAD was defined as 50 stenosis in 1 vessel on CAG. Results: From 231 patients 69 (29,9) have non-significant CA stenosis (20), 126 (54,5) have non-obstructive CAD (20-49) and 36 (15,6) - obstructive CAD (50). There were significant differences between CA stenosis severity via CAG and SSS via SPECT. In obstructive CAD significant myocardial perfusion defect at stress (SSS) and reversible ischemia (SDS) were observed in 47,2 and 63,9 patients, respectively (p0,01). In patients with non-obstructive CAD although the majority has normal myocardial perfusion in stress (SSS4 55,6), 42,1 has both mild (25,4) and moderate (16,7) myocardial perfusion defects in stress (p0,001). In this subgroup 45,2 of patients have moderate and 18,3 - severe reversible ischemia according to SDS (p0,001). Abnormal perfusion in stress was associated with hazards of cardiac risk factors or associated diseases (p0,05). Conclusion: Perfusion SPECT has a prognostic value over invasive CAG. The addition SPECT quantitative analysis to CAG allows improved risk stratification of patients with non-obstructive CAD.

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