| (Part 1):Predictive value of 99mTc-MIBI SPECT myocardial perfusion imaging in patients with unrevascularized coronary chronic total occlusionObjective:Data involved the association between myocardial ischaemia and the outcome for unrevascularized coronary chronic total occlusion(CTO)patients was limited.The purpose of this study was to evaluate the predictive value of ischaemia detected by single photon emission computed tomography(SPECT)myocardial perfusion imaging(MPI)for the adverse events in unrevascularized CTO patients.We further explored whether ischaemia generated from CTO vessel can independently predict the outcome.Methods:Patients with at least one unrevascularized CTO on coronary angiography were enrolled in this study.Exercise stress/rest SPECT MPI were performed in all patients.All patients were then followed by telephone interview and reviewing of medical records.Results:Patients with ischaemia experienced significantly higher rate of adverse events than non-ischaemia patients(40.7%vs 7.1%,P=0.002).Ischaemia demonstrated on MPI[odds ratio(OR)=7.656;95%confidence interval(CI)1.598-36.677;P=0.011]was an independent predictor for adverse events.Moreover,CTO-ischaemia(OR=5.466;95%CI 1.015-29.420;P=0.048),non-CTO ischaemia(OR=29.174;95%CI 3.245-262.322;P=0.003),mixed-ischaemia(OR=7.130,95%CI 1.257-40.445;P=0.027)were all independent predictors for outcome.Conclusion:Ischaemia demonstrated on MPI,especially CTO-ischaemia were independent predictors for the adverse events.SPECT MPI can aid to identify patients at risk of adverse events,who may benefit from subsequent CTO percutaneous coronary intervention.(Part 2):The predictive value of 99mTc-MIBI SPECT/18F-FDG PET myocardial perfusion/metabolic imaging in patients with unrevascularized coronary chronic total occlusion and left ventricular dysfunctionObjective:The predictive value of viable myocardial for the adverse events in unrevascularized CTO patients with left ventricular dysfunction was unclear.The purpose of this study was to explore the predictive value of viable myocardial detected by SPECT/PET myocardial perfusion/metabolism imaging for the adverse events in unrevascularized CTO patients with left ventricular dysfunction.We further explored whether viable myocardial in the area of CTO vessel can independently predict the outcome.Method:Patients with at least one unrevascularized CTO on coronary angiography were enrolled in this study.Resting 99mTc MIBI SPECT myocardial perfusion and 18F-FDG PET myocardial metabolism imaging were performed in all patients.All patients were then followed by telephone interview and reviewing of medical records.Results:The extent of total viable myocardial[odds ratio(OR)=1.053;95%confidence interval(CI),1.007 to 1.101;P=0.025)and the extent of viable myocardial in the area of CTO vessel(OR=1.061;95%CI,1.004 to 1.121;P=0.036)were both independent predictors for cardiac death.The extent of viable myocardial in the area of non-CTO vessel(OR=1.017;95%CI,0.970 to 1.066;P=0.486),the extent of total myocardial infarction(OR=0.984;95%CI,0.951 to 1.017;P=0.332),the extent of myocardial infarction in the area of CTO vessel(OR=0.991;95%CI,0.950 to 1.035;P=0.686)and non-CTO vessel(OR=0.976;95%CI,0.928 to 1.026;P=0.342)were all not associated with the outcome.Conclusion:99mTc-MIBI/18F-FDG SPECT/PET myocardial perfusion/metabolism imaging has an important predictive value for adverse events in unrevascularized CTO patients with left ventricular dysfunction.The extent of total viable myocardial,especially the extent of viable myocardial in the area of CTO vessel were independent predictors for cardiac death,indicating that when viable myocardial was present,unrevascularized CTO patients with left ventricular dysfunction were at high risk of cardiac death,these patients may benefit from subsequent elective CABG surgery after left ventricular function was stable. |
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