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 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 &lt; 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.

Myocardial perfusion scintigraphy: image interpretation

2017 ◽  
Author(s):  
Nikant Sabharwal ◽  
Parthiban Arumugam ◽  
Andrew Kelion
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Myocardial Perfusion ◽  
Myocardial Perfusion Scintigraphy ◽  
Photon Emission ◽  
Image Interpretation ◽  
Left Ventricular ◽  
Emission Computed Tomography ◽  
Perfusion Scintigraphy ◽  
Artery Disease

This chapter focuses on image interpretation in myocardial perfusion scintigraphy. It covers planar acquisitions, the general approach to reporting single photon emission computed tomography (SPECT) images, and both qualitative and quantitative evaluation of tomographic slices. Detail is also provided on gated SPECT and attenuation correction, as well as a range of artefacts including image, instrumentation-related, and patient-related artefacts. Information is provided on abnormal appearances in coronary artery disease, perfusion defects, and indirect markers of severe coronary artery disease. The chapter also covers interpretation in left ventricular dysfunction and appearances in non-coronary cardiac disease, and includes a section on writing a useful report.

scholarly journals Automatic Diagnosis of Coronary Artery Disease in SPECT Myocardial Perfusion Imaging Employing Deep Learning

2021 ◽  
Vol 11 (14) ◽  
pp. 6362
Author(s):  
Nikolaos Papandrianos ◽  
Elpiniki Papageorgiou
Keyword(s):  
Coronary Artery Disease ◽  
Deep Learning ◽  
Coronary Artery ◽  
Myocardial Perfusion Imaging ◽  
Myocardial Perfusion ◽  
Perfusion Imaging ◽  
Emission Computed Tomography ◽  
Automatic Diagnosis ◽  
Spect Mpi ◽  
Artery Disease

Focusing on coronary artery disease (CAD) patients, this research paper addresses the problem of automatic diagnosis of ischemia or infarction using single-photon emission computed tomography (SPECT) (Siemens Symbia S Series) myocardial perfusion imaging (MPI) scans and investigates the capabilities of deep learning and convolutional neural networks. Considering the wide applicability of deep learning in medical image classification, a robust CNN model whose architecture was previously determined in nuclear image analysis is introduced to recognize myocardial perfusion images by extracting the insightful features of an image and use them to classify it correctly. In addition, a deep learning classification approach using transfer learning is implemented to classify cardiovascular images as normal or abnormal (ischemia or infarction) from SPECT MPI scans. The present work is differentiated from other studies in nuclear cardiology as it utilizes SPECT MPI images. To address the two-class classification problem of CAD diagnosis, achieving adequate accuracy, simple, fast and efficient CNN architectures were built based on a CNN exploration process. They were then employed to identify the category of CAD diagnosis, presenting its generalization capabilities. The results revealed that the applied methods are sufficiently accurate and able to differentiate the infarction or ischemia from healthy patients (overall classification accuracy = 93.47% ± 2.81%, AUC score = 0.936). To strengthen the findings of this study, the proposed deep learning approaches were compared with other popular state-of-the-art CNN architectures for the specific dataset. The prediction results show the efficacy of new deep learning architecture applied for CAD diagnosis using SPECT MPI scans over the existing ones in nuclear medicine.

scholarly journals The role of myocardial scintigraphy in the assessment of coronary artery disease

2016 ◽  
Vol 68 (4) ◽  
Author(s):  
Pasquale Perrone Filardi ◽  
Alberto Cuocolo ◽  
Andrea Petretta ◽  
Gianluca Caiazzo ◽  
Pierluigi Costanzo ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Myocardial Perfusion ◽  
Single Photon ◽  
Systolic Function ◽  
Photon Emission ◽  
Left Ventricular ◽  
Emission Computed Tomography ◽  
Myocardial Spect ◽  
Artery Disease

Single photon emission computed tomography (SPECT) for the assessment of myocardial perfusion was introduced in the early 1970s, following pioneer studies of Gould et al. It has rapidly become one of the most used noninvasive technique for the assessment of myocardial ischemia. Thanks to the current technetium based tracers that allow electrocardiogram gated synchronization, it is possible to assess the regional ventricular systolic function and the evaluation of myocardial perfusion as well. In the last twenty years, beyond its diagnostic role, myocardial SPECT has become also a prognostic technique. Indeed, it has acquired a role for the short-term prediction of major coronary events in a large cohort with known or suspected coronary artery disease (CAD). The aim of this review is to give an update of the correct use and interpretation of myocardial SPECT in patients with known or suspected CAD and without left ventricular dysfunction.

scholarly journals Comparability of scintigraphy data with coronary angiography after surgical myocardial revascularization

2019 ◽  
Vol 18 (3) ◽  
pp. 23-28
Author(s):  
A. A. Shilov ◽  
N. A. Kochergin ◽  
V. I. Ganyukov ◽  
A. N. Kokov ◽  
K. A. Kozyrin ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Sensitivity And Specificity ◽  
Perfusion Defect ◽  
Myocardial Revascularization ◽  
Emission Computed Tomography ◽  
Hybrid Revascularization ◽  
Artery Disease

Introduction. Radionuclide imaging is included in diagnostic methods after PCI and CABG in patients with symptoms, but the recommendations caution against routine testing in all asymptomatic patients after revascularization. The paper shows the results of single-photon emission computed tomography after hybrid coronary myocardial revascularization; an analysis of the sensitivity and specificity of three methods of surgical myocardial revascularization was carried out in 12 months.Aim of the study was to determine the sensitivity and specificity of SPECT in determining coronary artery stenosis ≥ 50 % after performing three methods of surgical myocardial revascularization: CABG, PCI, and hybrid myocardial revascularization in patients with coronary artery disease and multi-vascular coronary lesion.Material and methods. A retrospective analysis of 82 patients with stable forms of coronary artery disease who underwent myocardial revascularization for the presence of the multivascular coronary lesion was carried out. The patients were divided into three groups: the first group consisted of 40 patients who underwent CABG, the second – 29 patients after PCI, and the third – 23 patients who underwent hybrid myocardial revascularization.Results. All patients after myocardial revascularization, on average, after 21.8±8.6 months, were hospitalized, where singlephoton emission computed tomography of the myocardium with 99mTc-technetril (SPECT) and control coronarography/ shuntography were performed. The frequency of the presence of significant stenosis during coronary angiography with a perfusion defect of ≥5 % on SPECT during exercise was 50, 50 and 33 % in the CABG, PCI, and hybrid revascularization, respectively (p=0.894). The least sensitivity of SPECT was after hybrid myocardial revascularization (20 %), while in the CABG group, the sensitivity was 71.4 % (p = 0.190). The SPECT specificity indices were much higher: in the GABG, PCI, and hybrid revascularization groups, respectively, 75.8, 79 and 88.9 % (p=0.530).Conclusion. There is no significant relationship between the size of the defect on SPECT and coronary angiography data, regardless of the type of surgical myocardial revascularization in patients after myocardial revascularization. Detection of a perfusion defect with a load of more than 10% in SPECT after surgical myocardial revascularization is the basis for coronary angiography in order to exclude stent restenosis or shunt dysfunction, as well as progression of coronary atherosclerosis.

Sign in / Sign up

Export Citation Format

Share Document