Comparison of Perfusion Defect Assess by Single Photon Emission Computed Tomography Myocardial Perfusion Imaging in Multivessel Coronary Artery Diseases With and Without Coronary Collateral Circulation
Author : M.K. Hazrina, Z. Muchtar, Edison, H. Hasan
Upload Date : 19-04-2018
Background: Coronary collateral circulation (CCC) has been known to have associated with better clinical outcome in patient with coronary artery disease due to less infarct size, especially in acute onset of myocardial infarction (MI). The influence of coronary collateral vessels on infarct size in stable multivessel coronary artery disease (CAD) is still unknown. The aim of this study is to investigate the influence of CCC in myocardial perfusion defect in patient with stable multivessel CAD.
Methods: We observed patients with multivessel CAD who underwent stress and rest cardiac SPECT with documented coronary angiography. The coronary angiography was evaluated to determine the presence of coronary collateral. MPI studies were conducted at rest and post stress using 99mTc-sestamibi intravenously. All images were analysed by a nuclear medicine physicist using standard 17-segment model and scored on 5-point scale. Infarct and ischemia at rest (SRS) and stress (SSS), and also ischemia induced exercise (SDS) were evaluated. SDS 0-4 was considered as normal-mild ischemia and > 5 was considered as moderate-severe ischemia. MPI and coronary angiography were performed within 30 days interval.
Results: Total 49 patients with multivessel CAD (26 males, median age 57 ± 7.8 years) with coronary collateral was found in 33 (67%) patients. SRS, SSS and SDS were found insignificant between the two groups (SRS p value 0.617; SSS p value 0.668; SDS p value 0.079). Even though, the SRS in patients without CCC was higher and more severe (50% vs 42%) compared with CCC group, and the SDS was higher and more severe (52% vs 25%) in patients with CCC group.
Conclusion: This study showed that CCC had no influence in infarct and ischemia size at rest and stress myocardium. The ischemia size was higher in patient with CCC which represented more viable myocardium.
KEYWORDS : coronary collateral, SSS, SRS, SDS.