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Clinical significance of a single multi-slice CT assessment in patients with coronary chronic total occlusion lesions prior to revascularization.

Qu X, Fang W, Gong K, Ye J, Guan S, Li R, Xu Y, Shen Y, Zhang M, Liu H, Xie W - PLoS ONE (2014)

Bottom Line: Myocardial perfusion imaging showed that the location of the early defect region identified by MSCT was corresponded to the nuclide filling defect on the stressed 201thallium-SPECT imaging.The late hyperenhancement on MSCT was presented as incomplete nuclide filling on the 99mTc-MIBI imaging.The results suggested that a single MSCT examination in previous myocardial infarction without revascularization facilitates to provide some valuable information on the nature of the occluded lesion, myocardial perfusion and globe cardiac function, which would be helpful to design appropriate revascularization strategy in these subjects.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China.

ABSTRACT
Accurate assessment of coronary chronic total occlusion (CTO) lesion is essential to design an appropriate procedural strategy before revascularization. The present study aims to evaluate the significance of a single multislice computed tomography (MSCT) examination in patients with CTO lesion. We retrospectively analyzed the clinical data of 23 CTO lesions in twenty patients underwent computed tomography coronary angiography (CTCA) and SPECT. The CTCA was more powerful and sensitive to determine the CTO lesion length (100% v.s 47.8%) and to identify the length and location of calcification in occluded vessels compared with the coronary angiography (CAG). The LVEF measured by MSCT was comparable to that from the gated SPECT. Myocardial perfusion imaging showed that the location of the early defect region identified by MSCT was corresponded to the nuclide filling defect on the stressed 201thallium-SPECT imaging. The late hyperenhancement on MSCT was presented as incomplete nuclide filling on the 99mTc-MIBI imaging. The results suggested that a single MSCT examination in previous myocardial infarction without revascularization facilitates to provide some valuable information on the nature of the occluded lesion, myocardial perfusion and globe cardiac function, which would be helpful to design appropriate revascularization strategy in these subjects.

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Representative Reconstructed Images of CTO Lesions at the Left Anterior Descending Coronary Artery (LAD) and Right Coronary Artery (RCA).1A, 1D: Coronary angiography (CAG) image; 1B, 1E: Multiplanar reconstruction images; 1C, 1F: Three-dimensional volume rendering (Tree) image.
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pone-0098242-g001: Representative Reconstructed Images of CTO Lesions at the Left Anterior Descending Coronary Artery (LAD) and Right Coronary Artery (RCA).1A, 1D: Coronary angiography (CAG) image; 1B, 1E: Multiplanar reconstruction images; 1C, 1F: Three-dimensional volume rendering (Tree) image.

Mentions: A total of twenty-three CTO lesions were assessed by CTCA and CAG in 20 patients, including eight CTOs in the left anterior descending coronary artery, seven in the left circumflex coronary artery and eight in the right coronary artery. The length of the occluded segment was determined by CTCA examination in all 23 CTOs. In contrast, only 11 CTOs was measured by CAG because of missing collateral angiography. In eleven patients with data acquired both by MSCT and CAG, the length of the CTOs showed no significant difference between two methods (23±12 mm vs. 22±11 mm, P>0.05). However, CTCA had higher sensitivity in the rate of detection of calcification lesion compared with CAG (69.6% vs. 43.4%, P<0.05). Also, the length of calcification lesion could be successfully measured by CTCA (10.1±5.5 mm), but not by CAG. It is noted that CTCA could detect the detailed location (proximal, middle and distal segment) of calcification in occlusive vessels, and facilitated to visualize the tract of the occluded segment by using 3D reconstruction (Fig. 1).


Clinical significance of a single multi-slice CT assessment in patients with coronary chronic total occlusion lesions prior to revascularization.

Qu X, Fang W, Gong K, Ye J, Guan S, Li R, Xu Y, Shen Y, Zhang M, Liu H, Xie W - PLoS ONE (2014)

Representative Reconstructed Images of CTO Lesions at the Left Anterior Descending Coronary Artery (LAD) and Right Coronary Artery (RCA).1A, 1D: Coronary angiography (CAG) image; 1B, 1E: Multiplanar reconstruction images; 1C, 1F: Three-dimensional volume rendering (Tree) image.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4048204&req=5

pone-0098242-g001: Representative Reconstructed Images of CTO Lesions at the Left Anterior Descending Coronary Artery (LAD) and Right Coronary Artery (RCA).1A, 1D: Coronary angiography (CAG) image; 1B, 1E: Multiplanar reconstruction images; 1C, 1F: Three-dimensional volume rendering (Tree) image.
Mentions: A total of twenty-three CTO lesions were assessed by CTCA and CAG in 20 patients, including eight CTOs in the left anterior descending coronary artery, seven in the left circumflex coronary artery and eight in the right coronary artery. The length of the occluded segment was determined by CTCA examination in all 23 CTOs. In contrast, only 11 CTOs was measured by CAG because of missing collateral angiography. In eleven patients with data acquired both by MSCT and CAG, the length of the CTOs showed no significant difference between two methods (23±12 mm vs. 22±11 mm, P>0.05). However, CTCA had higher sensitivity in the rate of detection of calcification lesion compared with CAG (69.6% vs. 43.4%, P<0.05). Also, the length of calcification lesion could be successfully measured by CTCA (10.1±5.5 mm), but not by CAG. It is noted that CTCA could detect the detailed location (proximal, middle and distal segment) of calcification in occlusive vessels, and facilitated to visualize the tract of the occluded segment by using 3D reconstruction (Fig. 1).

Bottom Line: Myocardial perfusion imaging showed that the location of the early defect region identified by MSCT was corresponded to the nuclide filling defect on the stressed 201thallium-SPECT imaging.The late hyperenhancement on MSCT was presented as incomplete nuclide filling on the 99mTc-MIBI imaging.The results suggested that a single MSCT examination in previous myocardial infarction without revascularization facilitates to provide some valuable information on the nature of the occluded lesion, myocardial perfusion and globe cardiac function, which would be helpful to design appropriate revascularization strategy in these subjects.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China.

ABSTRACT
Accurate assessment of coronary chronic total occlusion (CTO) lesion is essential to design an appropriate procedural strategy before revascularization. The present study aims to evaluate the significance of a single multislice computed tomography (MSCT) examination in patients with CTO lesion. We retrospectively analyzed the clinical data of 23 CTO lesions in twenty patients underwent computed tomography coronary angiography (CTCA) and SPECT. The CTCA was more powerful and sensitive to determine the CTO lesion length (100% v.s 47.8%) and to identify the length and location of calcification in occluded vessels compared with the coronary angiography (CAG). The LVEF measured by MSCT was comparable to that from the gated SPECT. Myocardial perfusion imaging showed that the location of the early defect region identified by MSCT was corresponded to the nuclide filling defect on the stressed 201thallium-SPECT imaging. The late hyperenhancement on MSCT was presented as incomplete nuclide filling on the 99mTc-MIBI imaging. The results suggested that a single MSCT examination in previous myocardial infarction without revascularization facilitates to provide some valuable information on the nature of the occluded lesion, myocardial perfusion and globe cardiac function, which would be helpful to design appropriate revascularization strategy in these subjects.

Show MeSH
Related in: MedlinePlus