Zhai G Y, Wang J L, Liu Y Y, Zhou Y J
The 12th Ward, Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China.
Zhonghua Yi Xue Za Zhi. 2018 May 8;98(17):1342-1346. doi: 10.3760/cma.j.issn.0376-2491.2018.17.012.
To evaluate the location, extent of viable myocardial of chronic total coronary occlusions(CTO)lesions by (18)F-FDG PET myocardial metabolism imaging and then compare with coronary collateral circulation(CCC) to evaluate the prognostic evaluation in patients with CTO lesions. A total of Sixty consecutive patients with CTO lesions referred for viability assessment from April 2016 to April 2017 in Department of Cardiology, Beijing Anzhen Hospital were included in the study. These patients underwent (99m)Tc-sestamibi ECG-gated SPECT rest myocardial perfusion imaging and ECG-gated (18)F-FDG PET/CT myocardial metabolic imaging, as well as coronary arteriography were recruited in this study. LV functional parameters(EDV, ESV, and LVEF) were analyzed by QGS software. The extent of CCC to the area of CTO related artery was graded as poorly, or well developed collaterals, assessed by Rentrop classification. All patients were followed up for a median of 17 months(range 12-20 months) and evaluated the changes of NYHA. Then the prognostic value of (18)F-FDG PET myocardial metabolism imaging and CCC in patients with CTO lesions were analyzed and evaluated. As the standard evaluation of NYHA in patients with CTO lesions after 12-20 months, fifty-three patients were assigned in this study. According to the changes of NYHA, the patients were divided into no progress group and progress group. There were no statistically difference in age, gender, high risk of CTO lesion and drugs in two groups, but there were significant statistical differences in myocardial parameters. LVEF was significantly increased in patients with CTO lesion in no progress group(42.3%±17.2% vs 22.2%±10.4%, <0.01). The EDV and ESV in no progress group were significantly smaller than patients in progress group.The sensitivity(95.2% vs 75.7%) and specificity(62.8% vs 38.1%) of (18)F-FDG PET myocardial metabolism imaging was much better than CCC in the evaluation of prognosis in patients with CTO lesion. (18)F-FDG PET myocardial metabolism imaging has important role in the prognosis of patient with CTO lesions when compared with CCC.
通过（18）F-FDG PET心肌代谢成像评估慢性完全性冠状动脉闭塞（CTO）病变存活心肌的位置和范围，然后与冠状动脉侧支循环（CCC）进行比较，以评估CTO病变患者的预后。本研究纳入了2016年4月至2017年4月在北京安贞医院心内科因存活能力评估而转诊的60例连续CTO病变患者。这些患者接受了（99m）Tc- sestamibi心电图门控SPECT静息心肌灌注成像、心电图门控（18）F-FDG PET/CT心肌代谢成像以及冠状动脉造影。通过QGS软件分析左心室功能参数（EDV、ESV和LVEF）。根据Rentrop分类法，将CTO相关动脉区域的CCC程度分为侧支循环差或良好。所有患者中位随访17个月（范围12 - 20个月），并评估纽约心脏协会（NYHA）分级的变化。然后分析和评估（18）F-FDG PET心肌代谢成像和CCC对CTO病变患者的预后价值。作为12 - 20个月后CTO病变患者NYHA的标准评估，本研究纳入了53例患者。根据NYHA分级的变化，将患者分为无进展组和进展组。两组在年龄、性别、CTO病变高危因素和用药方面无统计学差异，但在心肌参数方面存在显著统计学差异。无进展组CTO病变患者的LVEF显著升高（42.3%±17.2%对22.2%±10.4%，<0.01）。无进展组的EDV和ESV显著小于进展组患者。在评估CTO病变患者的预后方面，（18）F-FDG PET心肌代谢成像的敏感性（95.2%对75.7%）和特异性（62.8%对38.1%）远优于CCC。与CCC相比，（18）F-FDG PET心肌代谢成像在CTO病变患者的预后中具有重要作用。
