Department of Interventional Cardiology and Angiology, National Institute of Cardiology, Warsaw, Poland.
Department of Interventional Cardiology and Angiology, National Institute of Cardiology, Warsaw, Poland.
J Cardiovasc Comput Tomogr. 2022 May-Jun;16(3):281-283. doi: 10.1016/j.jcct.2021.11.001. Epub 2021 Nov 14.
We aimed to establish the feasibility and safety of dynamic computed tomography perfusion (CTP) in patients with chronic total occlusion (CTO) undergoing percutaneous coronary intervention (PCI). Ten consecutive CTO patients with preserved left ventricular ejection fraction (≥50%) underwent regadenoson dynamic CTP prior to and at least 3 months after successful CTO recanalization. Quantitative absolute and indexed values of stress myocardial blood flow (MBF) were measured for each myocardial segment, and perfusion defect size was defined by the number of segments with indexed MBF ≤0.78. The control group comprised 10 subjects without ischemia on CTP. Out of 20 CTP studies with 320 segments, 311 segments (97.2%) were interpretable. The dose-length product for CTP was 589.5 ± 144.3 mGy cm, and no severe adverse reactions to either regadenoson or contrast were observed. Successful PCI resulted in a significant increase in stress MBF in CTO (101.8 [82.9-127.1] vs. 158.4 [132.6-172] ml/100ml/min, p = 0.004). Overall, there were significant reductions in both CTO and total defect size post-PCI (5 [5-6] vs. 1 [0.3-2] and 6 [5-8.5] vs. 1.5 [1-3.8] segments, both p = 0.002). In segment analysis, the indexed MBF was lowest in the pre-PCI CTO group (0.90 [0.53-1.0]), followed by post-PCI CTO group (0.96 [0.88-1.0]) and the control group (0.98 [0.94-1.0]). Dynamic CTP is feasible and safe, and shows large perfusion defects in patients with CTO. While ischemic burden can be significantly improved after successful CTO PCI, it is still larger as compared with normal myocardium. NCT04465526: The Influence of Coronary Chronic Total Occlusion on Myocardial Perfusion on Computed Tomography (COPACABANA).
我们旨在确定动态计算机断层灌注（CTP）在接受经皮冠状动脉介入治疗（PCI）的慢性完全闭塞（CTO）患者中的可行性和安全性。连续 10 例左心室射血分数（≥50%）保存的 CTO 患者在 CTO 再通前后进行雷加登诺动态 CTP。为每个心肌节段测量应激性心肌血流（MBF）的定量绝对值和指数值，并通过索引 MBF≤0.78 的节段数量定义灌注缺损大小。对照组包括 10 例 CTP 无缺血的受试者。20 次 CTP 研究中有 320 个节段，311 个节段（97.2%）可解读。CTP 的剂量长度乘积为 589.5±144.3 mGy cm，且未观察到雷加登诺或造影剂的严重不良反应。成功的 PCI 导致 CTO 应激 MBF 显著增加（101.8[82.9-127.1] vs. 158.4[132.6-172]ml/100ml/min，p=0.004）。总体而言，PCI 后 CTO 和总缺陷大小均显著减小（5[5-6] vs. 1[0.3-2]和 6[5-8.5] vs. 1.5[1-3.8]节段，均 p=0.002）。在节段分析中，PCI 前 CTO 组的指数 MBF 最低（0.90[0.53-1.0]），其次是 PCI 后 CTO 组（0.96[0.88-1.0]）和对照组（0.98[0.94-1.0]）。动态 CTP 是可行和安全的，可显示 CTO 患者的大灌注缺陷。虽然 CTO PCI 后缺血负荷可显著改善，但仍大于正常心肌。NCT04465526：慢性完全闭塞冠状动脉对 CT 心肌灌注的影响（COPACABANA）。
