Detection Of Viable Myocardium And Curative Effect Of Percutaneous Coronary Intervention For Patients With Chronic Total Coronary Occlusion

Objective To assess the myocardial viability in patients of coronary chronic total occlusion (CTO) by combination of rest 99mTc–methoxy isobutyl isonitrile (99mTc-MIBI) myocardial tomograghy with nitroglycerin (NTG) intravenous pump.To comparatively analyse the results of NTG myocardial tomography,cardial function changes and the incidence of major adverse cardial events(MACE) in CTO patients who received percutaneous coronary intervention (PCI))therapy before and after 6 months. To reserch the feasibility of detecting viable myocardium with NTG myocardial tomograghy,and guiding significanca of PCI strategy.To observe the long-term efficacy of PCI treatment in CTO patients,including clinical symptoms,cardiac function and event-free survival .Methods 32 CTO patients (25male and female 7)who had determinde by coronary angiography(CAG) have single or multi complete coronary arterial occlusion and planned to carry out PCI.Examinating ultrasonic cardiography (UCG), rest and NTG myocardial tomograghy before PCI and 6 months after PCI,we divided A group (myocardial viability≥20%) and B group(<20%) based on the results of how many myocardial viability were detected.Examing UCG and rest 99mTc-MIBI myocardial tomography again in PCI 6 months,to compare these results of viable myocardial segments.Finally we collected and analysed these statistics to make conclusions on clinical symptoms,cardiac function and event-free survival. Results 1.As the standard of rest 99mTc-MIBI myocardial tomograghy after 6 months, NTG 99mTc-MIBI myocardial tomograghy detected the positive predictive value of 72.15%, negtive predictive of 85.23%,and coincidence rate of 84%. 2.After follow-up PCI 6 months ,the results were significant :the left ventricular end systolic volume of A group reduced more than B group,ejection fraction improved,and systolic function improved. LVESV of the two groups was50±9.88ml vs 59.24±7.11 ml (P<0.05),LVEDV was124.46±7.22ml vs 123.91±7.87ml(P<0.05),LVEF was 54.78±8.02% vs 47.31±3.66%(P<0.01),LVEDD was 59.74±4.96ml vs 63.77±3.51 m(P<0.05),LVESD was49.35±7.02ml vs 53.41±4.59mm,(P<0.05),and LVFS was 25.68±4.77% vs 22.57±3.21%(P<0.05)。A group reduced left ventricular volume,and incresed LVEF,compared with PCI before .All parameters were significantly different. The left ventricular volume and LVEF of B group were improved,but its have yet to reach statistically significant difference. Compared the MACE events of the two groups , A group was lower than B group (10% vs 33.34 %,P<0.05).Conclusions 1.NTG 99mTc-MIBI myocardial tomograghy detected the positive predictive value of 72.15%, negtive predictive of 85.23%, sensitivity 72.15%,specificity 91.3%,and coincidence rate of 84.40%. 2.The detection of the myocardial viability had guiding significance to make decision of PCI. 3. PCI can effectively alleviate the clinical symptoms,improve cardiac function,reduce the rate of CABG surgery,improve free-event survival, and wxtend the life of patients for CTO.