Analysis Of Prognostic And Coronary Angiography In Coronary Artery Disease Patients With Negative Myocardial Perfusion Imaging

PartⅠBackground:Coronary angiography (CAG) is the golden standard for the diagnosis of coronary artery disease (CAD). Stress myocardial perfusion imaging (MPI) is a well-established non-invasive method for detection of CAD. In clinical, radionuclide MPI might be negative while the CAG showed significant stenosis in coronary artery. The aims of this study was to analysis the clinical materials of patients with negative MPI and significant stenosis in CAG, so as to further improve the understanding of this phenomenon.Method : Two hundred and eighty-one Suspected CAD patients who had CAG and subsequent MPI studies were retrospectively reviewed from August 2010 to September 2014. All patients underwent CAG and showed at least one artery stenosis≥50%, single photon emission computed tomography (SPECT) stress MPI were normal analyzed by both qualitative and semi-quantitative analysis. Clinial materials, the exact location, extention, stress test of all patients were analyzed, and the follow-up,prognosis were also analyzed.Results:Among all two hundred and eighty-one patients, there were 190 male (68%),91 female (32%), mean age of (58 ± 10) years. Two hundred and fifty-six (91%) patients underwent exercise stress MPI, while other twenty-five patients (9%) took adenosine stress MPI. The total summed stress score (SSS) was (0.36 ± 0.875). Seventy-eight (30%) patients performed adequate treadmill exercise testing and achieved more than 85% of their predicted maximal heart rates; while one hundred and seventy-eight (70%) fail to achieve the predicted heart rates. The CAG of all two hundred and eighty-one patients were having significant stenosis. One hundred and thirty-three (47%) patients had single coronary stenosis,83 (30%) patients two-vessel and 63 (22%) three-vessel diseases and left main coronary artery (LM) 14 (5%). There totally 502 coronary artery stenosis in 281 patients. 254 (51%) in left anterior descending coronary artery (LAD),111 (22%) left circumflex coronary artery (LCX),123 (24%) right coronary artery (RCA) and 14 (3%) LM disease. According to the extent of coronary artery stenosis, two hundred and sixty-eight (54%) vessels had>50~70% stenosis, two hundred and seventeen vessels (43%) had>70~90% stenosis, seventeen (3%) vessels had more than stenosis. Of all the 288 patients,251(89%) patients completed the follow-up. After median follow-up time of 42.78±14.75 months,15 (6%) patients had cardiac event, and two (1%) of them were cardiac death, coronary artery revascularization happened to 13(5%)patients. Annualized cardiac event rate was 1.6%.Conclusion:Negative myocardial perfusion imaging with significant coronary artery stenosis may probably happen to patients fail to achieve the maximum expected heart rates. The major distribution of coronary stenosis are patients with single vessel disease, patients with stenosis in LAD and patients with mild coronary artery stenosis. The prognostic demonstrated that patients with stenosis in CAG while negative in MPI may have moderate prognosis, with annualized cardiac event rate of 1.6%.PartⅡNuclear Myocardial Perfusion Imaging of Hypertrophic Cardiomyopathy complicated with Myocardial InfarctionBackground:Hypertrophic Cardiomyopathy (HCM) is a common inherited cardiomyopathy, which is characterized by asymmetry thickening of myocardium. HCM patients complicatd with Myocardial Infarction (MI) were discovered in clinical practice. This study aims to investigate the Nuclear Myocardial Perfusion Imaging (MPI) characteristics of HCM Complicated with old MI, to compare the differences of MPI between HCM patients with or without Coronary Artery Disease(CAD).Method:Thirty-four patients with HCM complicated with OMI(26 men and 11 women;mean age,57±11y) underwent rest MPI, and the imaging characteristics were analyzed. According to the results of coronary arteriography(CAG) or spiral CT, patients were divided into to groups,Groupl was HCM patients with CAD(20,58.8%), Group2 without CAD(14,41.2%). Semi-quantitative perfusion evaluation were performed in 17 LV segments, and the scores were compared between two groups.Results:There were 24(70.6%) patients represent segmental increased uptake in MPI from 34 HCM patients,28(82.4%) patients showed decreased uptake or defect in MPI. When compared by 17 segmental semiquantification assessment,14 segments exhibited no significant differences, Only 3 segments including apical anterior, mid anterior and apical lateral exhibited significant differences, the patients without CAD(group2) score was 1.57±1.453、0.86±1.292 and 1.21±1.477 respectively higher than patients with CAD(groupl) 1.60±1.273、0.20±0.523 and 0.30±0.979, and the P value was 0.047、0.048 and 0.037 respectively.Conclusion:Even if there is no coronary artery disease in patients with HCM,when occurred myocardial infarction.myocardial perfusion imaging showed range and extent are serious.