Korean Journal of Radiology

The Korean Society of Radiology (대한영상의학회)
권호 표지
DOI QR코드

DOI QR Code

Findings of Single-Photon Emission Computed Tomography and Its Relation with Quantitative Coronary Angiography in Patients with Significant Stenosis of the Left Main Coronary Artery

  • Kim, Hack-Lyoung (Division of Cardiology, Department of Internal Medicine, Boramae Medical Center, Seoul National University College of Medicine) ;
  • Oh, So Won (Department of Nuclear Medicine, Boramae Medical Center, Seoul National University College of Medicine) ;
  • Lee, Hyunjong (Department of Nuclear Medicine, Boramae Medical Center, Seoul National University College of Medicine) ;
  • Kim, Hee Jun (Cardiovascular Center, Boramae Hospital) ;
  • Kim, You Nui (Cardiovascular Center, Boramae Hospital) ;
  • Lim, Woo-Hyun (Division of Cardiology, Department of Internal Medicine, Boramae Medical Center, Seoul National University College of Medicine) ;
  • Seo, Jae-Bin (Division of Cardiology, Department of Internal Medicine, Boramae Medical Center, Seoul National University College of Medicine) ;
  • Kim, Sang-Hyun (Division of Cardiology, Department of Internal Medicine, Boramae Medical Center, Seoul National University College of Medicine) ;
  • Kim, Myung-A (Division of Cardiology, Department of Internal Medicine, Boramae Medical Center, Seoul National University College of Medicine) ;
  • Zo, Joo-Hee (Division of Cardiology, Department of Internal Medicine, Boramae Medical Center, Seoul National University College of Medicine)
  • Received : 2016.12.19
  • Accepted : 2017.07.18
  • Published : 2018.02.01
⟨ Previous Next ⟩

Abstract

Objective: Unrecognized left main coronary artery disease (LMCD) is often fatal; however, accuracy of non-invasive tests for diagnosing LMCD is still unsatisfactory. This study was performed to elucidate single-photon emission computed tomography (SPECT) detection of LMCD using quantitative coronary angiography (QCA) data. Materials and Methods: Fifty-five patients (39 men; mean age, $68.1{\pm}10.9years$) diagnosed with significant left main (LM) stenosis (${\geq}50%$) by invasive coronary angiography (ICA) were retrospectively reviewed. All study patients underwent SPECT with pharmacologic stress within 30 days of ICA. All coronary lesions were quantified via QCA, and SPECT findings were compared with QCA results. Results: Only four patients (7.3%) had isolated LMCD; all others had combined significant stenosis (${\geq}70%$) of one or more other epicardial coronary arteries. Patients with more severe coronary artery disease tended to have higher values for summed difference scores in a greater number of regions, but the specific pattern was not clearly defined. Summed stress score of SPECT did not differ according to LM stenosis severity. Only three patients (5.4%) had a typical LM pattern of reversible perfusion defect on SPECT. A significant negative linear correlation between stenosis severity and stress perfusion percent was found in the left anterior descending artery region (r = -0.455, p < 0.001) but not in the left circumflex artery. Conclusion: Single-photon emission computed tomography findings were heterogeneous, not specific and poorly correlated to QCA data in patients with significant LMCD. This may be due to highly prevalent significant stenosis of other epicardial coronary arteries.

Keywords

References

  1. Chikamori T, Doi YL, Yonezawa Y, Yamada M, Seo H, Ozawa T. Noninvasive identification of significant narrowing of the left main coronary artery by dipyridamole thallium scintigraphy. Am J Cardiol 1991;68:472-477 https://doi.org/10.1016/0002-9149(91)90781-F
  2. Cohen MV, Gorlin R. Main left coronary artery disease. Clinical experience from 1964-1974. Circulation 1975;52:275-285 https://doi.org/10.1161/01.CIR.52.2.275
  3. Giannoglou GD, Antoniadis AP, Chatzizisis YS, Damvopoulou E, Parcharidis GE, Louridas GE. Prevalence of narrowing >or=50% of the left main coronary artery among 17,300 patients having coronary angiography. Am J Cardiol 2006;98:1202- 1205 https://doi.org/10.1016/j.amjcard.2006.05.052
  4. Noto TJ Jr, Johnson LW, Krone R, Weaver WF, Clark DA, Kramer JR Jr, et al. Cardiac catheterization 1990: a report of the Registry of the Society for Cardiac Angiography and Interventions (SCA&I). Cathet Cardiovasc Diagn 1991;24:75-83 https://doi.org/10.1002/ccd.1810240202
  5. Ragosta M. Left main coronary artery disease: importance, diagnosis, assessment, and management. Curr Probl Cardiol 2015;40:93-126 https://doi.org/10.1016/j.cpcardiol.2014.11.003
  6. Hachamovitch R, Hayes SW, Friedman JD, Cohen I, Berman DS. Stress myocardial perfusion single-photon emission computed tomography is clinically effective and cost effective in risk stratification of patients with a high likelihood of coronary artery disease (CAD) but no known CAD. J Am Coll Cardiol 2004;43:200-208 https://doi.org/10.1016/j.jacc.2003.07.043
  7. Hamilos M, Muller O, Cuisset T, Ntalianis A, Chlouverakis G, Sarno G, et al. Long-term clinical outcome after fractional flow reserve-guided treatment in patients with angiographically equivocal left main coronary artery stenosis. Circulation 2009;120:1505-1512 https://doi.org/10.1161/CIRCULATIONAHA.109.850073
  8. Shaw LJ, Hendel RC, Cerquiera M, Mieres JH, Alazraki N, Krawczynska E, et al. Ethnic differences in the prognostic value of stress technetium-99m tetrofosmin gated singlephoton emission computed tomography myocardial perfusion imaging. J Am Coll Cardiol 2005;45:1494-1504 https://doi.org/10.1016/j.jacc.2005.01.036
  9. Uthamalingam S, Zheng H, Leavitt M, Pomerantsev E, Ahmado I, Gurm GS, et al. Exercise-induced ST-segment elevation in ECG lead aVR is a useful indicator of significant left main or ostial LAD coronary artery stenosis. JACC Cardiovasc Imaging 2011;4:176-186 https://doi.org/10.1016/j.jcmg.2010.11.014
  10. Shiba C, Chikamori T, Hida S, Igarashi Y, Tanaka H, Hirose K, et al. Important parameters in the detection of left main trunk disease using stress myocardial perfusion imaging. J Cardiol 2009;53:43-52 https://doi.org/10.1016/j.jjcc.2008.08.010
  11. Berman DS, Kang X, Slomka PJ, Gerlach J, de Yang L, Hayes SW, et al. Underestimation of extent of ischemia by gated SPECT myocardial perfusion imaging in patients with left main coronary artery disease. J Nucl Cardiol 2007;14:521-528 https://doi.org/10.1016/j.nuclcard.2007.05.008
  12. Afonso L, Mahajan N. Single-photon emission computed tomography myocardial perfusion imaging in the diagnosis of left main disease. Clin Cardiol 2009;32:E11-E15
  13. Duvernoy CS, Ficaro EP, Karabajakian MZ, Rose PA, Corbett JR. Improved detection of left main coronary artery disease with attenuation-corrected SPECT. J Nucl Cardiol 2000;7:639-648 https://doi.org/10.1067/mnc.2000.109454
  14. Wakasugi S, Shibata N, Kobayashi T, Fudemoto Y, Hasegawa Y, Nakano S. Specific perfusion pattern in stress 201Tl myocardial scintigraphy of left main coronary artery disease. Eur J Nucl Med 1986;12:369-374
  15. Arnett EN, Isner JM, Redwood DR, Kent KM, Baker WP, Ackerstein H, et al. Coronary artery narrowing in coronary heart disease: comparison of cineangiographic and necropsy findings. Ann Intern Med 1979;91:350-356 https://doi.org/10.7326/0003-4819-91-3-350
  16. Galbraith JE, Murphy ML, de Soyza N. Coronary angiogram interpretation. Interobserver variability. JAMA 1978;240:2053-2056 https://doi.org/10.1001/jama.1978.03290190031023
  17. Goldberg RK, Kleiman NS, Minor ST, Abukhalil J, Raizner AE. Comparison of quantitative coronary angiography to visual estimates of lesion severity pre and post PTCA. Am Heart J 1990;119:178-184 https://doi.org/10.1016/S0002-8703(05)80098-5
  18. Nallamothu BK, Spertus JA, Lansky AJ, Cohen DJ, Jones PG, Kureshi F, et al. Comparison of clinical interpretation with visual assessment and quantitative coronary angiography in patients undergoing percutaneous coronary intervention in contemporary practice: the Assessing Angiography (A2) project. Circulation 2013;127:1793-1800 https://doi.org/10.1161/CIRCULATIONAHA.113.001952
  19. Fihn SD, Gardin JM, Abrams J, Berra K, Blankenship JC, Dallas AP, et al. 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/ STS Guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol 2012;60:e44-e164 https://doi.org/10.1016/j.jacc.2012.07.013
  20. Lee CS, Cha RH, Lim YH, Kim H, Song KH, Gu N, et al. Ethnic coefficients for glomerular filtration rate estimation by the modification of diet in renal disease study equations in the Korean population. J Korean Med Sci 2010;25:1616-1625 https://doi.org/10.3346/jkms.2010.25.11.1616
  21. Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 2015;28:1-39.e14 https://doi.org/10.1016/j.echo.2014.10.003
  22. Henzlova MJ, Duvall WL, Einstein AJ, Travin MI, Verberne HJ. ASNC imaging guidelines for SPECT nuclear cardiology procedures: Stress, protocols, and tracers. J Nucl Cardiol 2016;23:606-639 https://doi.org/10.1007/s12350-015-0387-x
  23. Berman DS, Abidov A, Kang X, Hayes SW, Friedman JD, Sciammarella MG, et al. Prognostic validation of a 17-segment score derived from a 20-segment score for myocardial perfusion SPECT interpretation. J Nucl Cardiol 2004;11:414-423 https://doi.org/10.1016/j.nuclcard.2004.03.033
  24. Cerqueira MD, Weissman NJ, Dilsizian V, Jacobs AK, Kaul S, Laskey WK, et al. Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart. A statement for healthcare professionals from the Cardiac Imaging Committee of the Council on Clinical Cardiology of the American Heart Association. Circulation 2002;105:539-542 https://doi.org/10.1161/hc0402.102975
  25. Medina A, Suárez de Lezo J, Pan M. A new classification of coronary bifurcation lesions. Rev Esp Cardiol 2006;59:183 https://doi.org/10.1157/13084649
  26. Hachamovitch R, Hayes SW, Friedman JD, Cohen I, Berman DS. A prognostic score for prediction of cardiac mortality risk after adenosine stress myocardial perfusion scintigraphy. J Am Coll Cardiol 2005;45:722-729 https://doi.org/10.1016/j.jacc.2004.08.069
  27. Nygaard TW, Gibson RS, Ryan JM, Gascho JA, Watson DD, Beller GA. Prevalence of high-risk thallium-201 scintigraphic findings in left main coronary artery stenosis: comparison with patients with multiple- and single-vessel coronary artery disease. Am J Cardiol 1984;53:462-469 https://doi.org/10.1016/0002-9149(84)90013-4
  28. Rehn T, Griffith LS, Achuff SC, Bailey IK, Bulkley BH, Burow R, et al. Exercise thallium-201 myocardial imaging in left main coronary artery disease: sensitive but not specific. Am J Cardiol 1981;48:217-223 https://doi.org/10.1016/0002-9149(81)90599-3
  29. Lima RS, Watson DD, Goode AR, Siadaty MS, Ragosta M, Beller GA, et al. Incremental value of combined perfusion and function over perfusion alone by gated SPECT myocardial perfusion imaging for detection of severe three-vessel coronary artery disease. J Am Coll Cardiol 2003;42:64-70 https://doi.org/10.1016/S0735-1097(03)00562-X
  30. Lindstaedt M, Spiecker M, Perings C, Lawo T, Yazar A, Holland-Letz T, et al. How good are experienced interventional cardiologists at predicting the functional significance of intermediate or equivocal left main coronary artery stenoses? Int J Cardiol 2007;120:254-261 https://doi.org/10.1016/j.ijcard.2006.11.220
  31. Berman DS. Fourth annual Mario S. Verani, MD Memorial Lecture: noninvasive imaging in coronary artery disease: changing roles, changing players. J Nucl Cardiol 2006;13:457-473 https://doi.org/10.1016/j.nuclcard.2006.05.009
  32. Aarnoudse WH, Botman KJ, Pijls NH. False-negative myocardial scintigraphy in balanced three-vessel disease, revealed by coronary pressure measurement. Int J Cardiovasc Intervent 2003;5:67-71 https://doi.org/10.1080/14628840310003244
  33. Schuijf JD, Achenbach S, de Feyter PJ, Bax JJ. Current applications and limitations of coronary computed tomography angiography in stable coronary artery disease. Heart 2011;97:330-337 https://doi.org/10.1136/hrt.2010.199224
  34. Abizaid AS, Mintz GS, Abizaid A, Mehran R, Lansky AJ, Pichard AD, et al. One-year follow-up after intravascular ultrasound assessment of moderate left main coronary artery disease in patients with ambiguous angiograms. J Am Coll Cardiol 1999;34:707-715 https://doi.org/10.1016/S0735-1097(99)00261-2
  35. Cho SG, Park KS, Kim J, Kang SR, Song HC, Kim JH, et al. Coronary flow reserve and relative flow reserve measured by N-13 ammonia PET for characterization of coronary artery disease. Ann Nucl Med 2017;31:144-152 https://doi.org/10.1007/s12149-016-1138-z
  36. Ragosta M, Dee S, Sarembock IJ, Lipson LC, Gimple LW, Powers ER. Prevalence of unfavorable angiographic characteristics for percutaneous intervention in patients with unprotected left main coronary artery disease. Catheter Cardiovasc Interv 2006;68:357-362 https://doi.org/10.1002/ccd.20709