Cho Sang-Geon, Lee Jong Eun, Kim Hyung Yoon, Song Ho-Chun, Kim Yun-Hyeon
Department of Nuclear Medicine, Chonnam National University Hospital, 42, Jebong-ro, Dong-gu, Gwangju, 61469, Republic of Korea.
Department of Radiology, Chonnam National University Hospital, Gwangju, Republic of Korea.
J Nucl Cardiol. 2023 Feb;30(1):388-398. doi: 10.1007/s12350-022-03020-6. Epub 2022 Jul 14.
Myocardial ischemia varies in chronic total occlusion (CTO) despite the occluded artery. We analyzed whether it is associated with the plaque characteristics of the occluded segment.
We retrospectively enrolled 100 patients with CTO who underwent myocardial perfusion single-photon emission computed tomography (SPECT) and coronary computed tomography angiography (CCTA) within 2 months. CTO-related ischemia was classified as moderate to severe (summed difference score [SDS] of the CTO territory ≥ 5) or mild or none (SDS < 5) on SPECT. Using CCTA, the atherosclerotic plaques of the occluded segment were subdivided into low-density (- 100-30 HU), intermediate-density (31-350 HU), and high-density (351-1000 HU) plaques. The plaque composition was compared according to the severity of CTO-related ischemia.
Moderate-to-severe CTO-related ischemia (n = 23) showed significantly higher proportion of intermediate-density plaques (72.4% vs. 64.0%), intermediate/low-density (7.10 vs. 3.65) and intermediate-to-high/low-density (7.78 vs. 3.80) plaque ratios, frequent shorter occlusion (30% vs. 6%), and lower volume (26.5 mm vs. 58.8 mm) and proportion (11.4% vs. 20.8%) of low-density plaques. Multivariable analysis revealed significant associations between higher proportion of intermediate-density plaques and moderate-to-severe CTO-related ischemia, independent of occlusion length.
Higher proportion of intermediate-density plaques in the occluded segment was associated with the moderate-to-severe CTO-related ischemia.
尽管动脉闭塞，但慢性完全闭塞（CTO）中的心肌缺血情况各不相同。我们分析了它是否与闭塞节段的斑块特征相关。
我们回顾性纳入了100例CTO患者，这些患者在2个月内接受了心肌灌注单光子发射计算机断层扫描（SPECT）和冠状动脉计算机断层血管造影（CCTA）。CTO相关缺血在SPECT上被分类为中度至重度（CTO区域的总和差异评分[SDS]≥5）或轻度或无（SDS<5）。使用CCTA，将闭塞节段的动脉粥样硬化斑块细分为低密度（-100-30 HU）、中密度（31-350 HU）和高密度（351-1000 HU）斑块。根据CTO相关缺血的严重程度比较斑块组成。
中度至重度CTO相关缺血（n = 23）显示中密度斑块比例显著更高（72.4%对64.0%）、中/低密度（7.10对3.65）和中至高/低密度（7.78对3.80）斑块比率、更频繁的较短闭塞（30%对6%），以及低密度斑块的体积（26.5 mm对58.8 mm）和比例（11.4%对20.8%）更低。多变量分析显示，中密度斑块比例较高与中度至重度CTO相关缺血之间存在显著关联，与闭塞长度无关。
闭塞节段中密度斑块比例较高与中度至重度CTO相关缺血有关。
