| Objective:To investigate the correlation between regional myocardial perfusion,wall motion and wall thickening rate and collateral circulation classification in patients with chronic total coronary occlusion(CTO)in gated myocardial perfusion imaging.The effectiveness of resting-gated myocardial perfusion imaging in judging the formation of collateral circulation in CTO patients.Methods:A retrospective analysis of 114 patients with CTO diagnosed by coronary angiography from December 2014 to September 2019 in the Department of Cardiology of the First Affiliated Hospital of Dalian Medical University.All patients received a resting gate within 1 month after coronary angiography.Controlled myocardial perfusion imaging.First,according to the coronary angiography collateral circulation Rentrop classification,the patients were divided into collateral circulation poor group(Rentrop 0-1 grade)and collateral circulation good group(Rentrop 2-3grade),and the general information such as gender,age,previous medical history,and family history were recorded.The independent sample T test was used to compare the differences between the two groups.Secondly,the resting myocardial perfusion imaging was used to obtain the regional myocardial blood flow perfusion score,regional wall motion score,and regional wall thickening rate score.Logistic two A meta-regression model was used to evaluate the correlation between collateral circulation classification and regional myocardial blood flow perfusion score,regional wall motion score,and regional wall thickening rate score in CTO patients.Finally,we followed up 114 patients with an average follow-up time of(17.7±0.8 months).We divided them into two groups based on whether the regional myocardial blood flow perfusion score was abnormal;Then,the collateral circulation group and the collateral circulation group were divided into two subgroups according to whether the regional myocardial blood flow perfusion score was abnormal.The occurrence of MACE event was used as the endpoint event,and Kaplan-Meier was used to analyze the survival curve.Results:A total of 114 CTO patients were eligible for evaluation,66(57.8%)of whom were in the collateral circulation group;48(42.2%)of whom were in the collateral circulation group.36 cases(31.5%)had chronic complete occlusion of the left anterior descending branch,22 cases(19.2%)had chronic complete occlusion of the left circumflex branch,35 cases(30.7%)had chronic complete occlusion of the right coronary artery,and 21(18.4%)had multiple chronic complete occlusion.The results of logistic binary regression analysis showed that for patients with chronic total occlusion,the regional myocardial perfusion score,regional wall motion score,and regional wall thickening rate score in resting-gated myocardial perfusion imaging was negatively correlated with the collateral circulation grade,and there was a significant statistical difference(P<0.05);For patients with chronic total occlusion of the left anterior descending branch(single branch),the regional wall thickening rate score in resting-gated myocardial perfusion imaging was negatively correlated with the collateral circulation grade(P<0.05);For patients with chronic complete occlusion of the right coronary artery(single branch),negative correlation were found with the regional perfusion defect score,regional wall motion score,regional wall thickening rate score,and collateral circulation grade(P<0.05).Kaplan-Meier survival curve results:1.Compared with patients with good regional perfusion group(RRS?3 points),the incidence of MACE events was higher in patients with poor regional perfusion group(RRS>3 points).With the increase of observation time,the incidence rate MACE in patients with RRS>3 showed a significant upward trend,and there was a statistically significant difference in the incidence of MACE events between the two groups.(Log-Rank x~2=4.6,P<0.05).2.Among the patients with good collateral circulation group,compared with patients with good regional perfusion group(RRS?3 points),the incidence of MACE events was higher in patients with poor regional perfusion group(RRS>3points),and with the increase of observation time,the incidence of MACE in the RRS>3 group showed a significant upward trend,but there was no significant statistical difference in the incidence of MACE between the two groups.(Log-Rank x~2=2.29,P>0.05)3.In the patients with poor collateral circulation group,compared with patients with good regional perfusion group(RRS?3 points),the incidence of MACE events was higher in patients with poor regional perfusion group(RRS>3 points),and with the increase of observation time,the incidence of MACE in the RRS>3 group showed a significant upward trend,but there was no significant statistical difference in the incidence of MACE between the two groups.(Log-Rank x~2=1.39,P>0.05)Conclusion:In resting-gated myocardial perfusion imaging,regional resting myocardial ischemia score,regional wall motion score,and regional wall thickening rate score are inversely related to the collateral circulation grade of CTO lesions.With the increase of myocardial perfusion defect score in the corresponding area of occlusion,the occurrence of MACE event starts to increase.Resting-gated myocardium perfusion imaging combined with coronary angiography can fully evaluate the collateral circulation of CTO lesions from both aspects of morphology and function.This method has great clinical value for evaluating the effectiveness of collateral circulation in CTO patients. |
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