Korean Journal of Radiology

  • 제20권4호
  • /
  • Pages.621-630
  • /
  • 2019
  • /
  • 1229-6929(pISSN)
  • /
  • 2005-8330(eISSN)
대한영상의학회 (The Korean Society of Radiology)
권호 표지
DOI QR코드

DOI QR Code

Prevalence of Decreased Myocardial Blood Flow in Symptomatic Patients with Patent Coronary Stents: Insights from Low-Dose Dynamic CT Myocardial Perfusion Imaging

  • Yuehua Li (Institute of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital) ;
  • Mingyuan Yuan (Department of Radiology, Affiliated Zhoupu Hospital, Shanghai University of Medicine and Health Science) ;
  • Mengmeng Yu (Institute of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital) ;
  • Zhigang Lu (Department of Cardiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital) ;
  • Chengxing Shen (Department of Cardiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital) ;
  • Yining Wang (Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College) ;
  • Bin Lu (Department of Radiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Centre for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College) ;
  • Jiayin Zhang (Institute of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital)
  • 투고 : 2018.06.28
  • 심사 : 2018.11.11
  • 발행 : 2019.04.01
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

Objective: To study the prevalence and clinical characteristics of decreased myocardial blood flow (MBF) quantified by dynamic computed tomography (CT) myocardial perfusion imaging (MPI) in symptomatic patients without in-stent restenosis. Materials and Methods: Thirty-seven (mean age, 71.3 ± 10 years; age range, 48-88 years; 31 males, 6 females) consecutive symptomatic patients with patent coronary stents and without obstructive de novo lesions were prospectively enrolled to undergo dynamic CT-MPI using a third-generation dual-source CT scanner. The shuttle-mode acquisition technique was used to image the complete left ventricle. A bolus of contrast media (50 mL; iopromide, 370 mg iodine/mL) was injected into the antecubital vein at a rate of 6 mL/s, followed by a 40-mL saline flush. The mean MBF value and other quantitative parameters were measured for each segment of both stented-vessel territories and reference territories. The MBFratio was defined as the ratio of the mean MBF value of the whole stent-vessel territory to that of the whole reference territory. An MBFratio of 0.85 was used as the cut-off value to distinguish hypoperfused from non-hypoperfused segments. Results: A total of 629 segments of 37 patients were ultimately included for analysis. The mean effective dose of dynamic CT-MPI was 3.1 ± 1.2 mSv (range, 1.7-6.3 mSv). The mean MBF of stent-vessel territories was decreased in 19 lesions and 81 segments. Compared to stent-vessel territories without hypoperfusion, the mean MBF and myocardial blood volume were markedly lower in hypoperfused stent-vessel territories (77.5 ± 16.6 mL/100 mL/min vs. 140.4 ± 24.1 mL/100 mL/min [p < 0.001] and 6.4 ± 3.7 mL/100 mL vs. 11.5 ± 4 mL/100 mL [p < 0.001, respectively]). Myocardial hypoperfusion in stentvessel territories was present in 48.6% (18/37) of patients. None of clinical parameters differed statistically significantly between hypoperfusion and non-hypoperfusion subgroups. Conclusion: Decreased MBF is commonly present in patients who are symptomatic after percutaneous coronary intervention, despite patent stents and can be detected by dynamic CT-MPI using a low radiation dose.

키워드

과제정보

This study was supported by National Natural Science Foundation of China (Grant No.: 81671678, 81671673), Shanghai Municipal Education Commission-Gaofeng Clinical Medicine Grant Support (Grant No.: 20161428), Shanghai Key Discipline of Medical Imaging (No.: 2017ZZ02005), The National Key Research and Development Program of China (Grant No.: 2016YFC1300400, 2016YFC1300402), 2017 People's Livelihood Project Of PuDong Committee On Science And Technology In Shanghai (Grant No.: PKJ2017-Y39), Key And weak Specialty Construction Program of Pudong Health Bureau of Shanghai (Grant No.: PWZbr2017-11) and Shanghai Health Medical College Innovative collaborative project funding (Grant No.: SPCI-18-17-001).

참고문헌

  1. Sousa JE, Serruys PW, Costa MA. New frontiers in cardiology: drug-eluting stents: part I. Circulation 2003;107:2274-2279
  2. Sousa JE, Serruys PW, Costa MA. New frontiers in cardiology: drug-eluting stents: part II. Circulation 2003;107:2383-2389
  3. Moses JW, Leon MB, Popma JJ, Fitzgerald PJ, Holmes DR, O'Shaughnessy C, et al. Sirolimus-eluting stents versus standard stents in patients with stenosis in a native coronary artery. N Engl J Med 2003;349:1315-1323
  4. Stone GW, Ellis SG, Cox DA, Hermiller J, O'Shaughnessy C, Mann JT, et al. A polymer-based, paclitaxel-eluting stent in patients with coronary artery disease. N Engl J Med 2004;350:221-231
  5. Dangas GD, Claessen BE, Caixeta A, Sanidas EA, Mintz GS, Mehran R. In-stent restenosis in the drug-eluting stent era. J Am Coll Cardiol 2010;56:1897-1907
  6. Hokimoto S, Tabata N, Yamanaga K, Sueta D, Akasaka T, Tsujita K, et al. Prevalence of coronary macro- and microvascular dysfunctions after drug-eluting stent implantation without in-stent restenosis. Int J Cardiol 2016;222:185-194
  7. Ong P, Athanasiadis A, Perne A, Mahrholdt H, Schaufele T, Hill S, et al. Coronary vasomotor abnormalities in patients with stable angina after successful stent implantation but without in-stent restenosis. Clin Res Cardiol 2014;103:11-19
  8. Li Y, Yu M, Li W, Lu Z, Wei M, Zhang J. Third generation dualsource CT enables accurate diagnosis of coronary restenosis in all size stents with low radiation dose and preserved image quality. Eur Radiol 2018;28:2647-2654
  9. Gould KL, Johnson NP, Bateman TM, Beanlands RS, Bengel FM, Bober R, et al. Anatomic versus physiologic assessment of coronary artery disease. Role of coronary flow reserve, fractional flow reserve, and positron emission tomography imaging in revascularization decision-making. J Am Coll Cardiol 2013;62:1639-1653
  10. El Fakhri G, Kardan A, Sitek A, Dorbala S, Abi-Hatem N, Lahoud Y, et al. Reproducibility and accuracy of quantitative myocardial blood flow assessment with (82) Rb PET: comparison with (13)N-ammonia PET. J Nucl Med 2009;50:1062-1071
  11. Alexanderson E, Ochoa JM, Calleja R, Juarez-Rojas JG, Prior JO, Jacome R, et al. Endothelial dysfunction in systemic lupus erythematosus: evaluation with 13N-ammonia PET. J Nucl Med 2010;51:1927-1931
  12. Recio-Mayoral A, Rimoldi OE, Camici PG, Kaski JC. Inflammation and microvascular dysfunction in cardiac syndrome X patients without conventional risk factors for coronary artery disease. JACC Cardiovasc Imaging 2013;6:660-667
  13. Bamberg F, Becker A, Schwarz F, Marcus RP, Greif M, von Ziegler F, et al. Detection of hemodynamically significant coronary artery stenosis: incremental diagnostic value of dynamic CT-based myocardial perfusion imaging. Radiology 2011;260:689-698
  14. Bamberg F, Marcus RP, Becker A, Hildebrandt K, Bauner K, Schwarz F, et al. Dynamic myocardial CT perfusion imaging for evaluation of myocardial ischemia as determined by MR imaging. JACC Cardiovasc Imaging 2014;7:267-277
  15. Coenen A, Rossi A, Lubbers MM, Kurata A, Kono AK, Chelu RG, et al. Integrating CT myocardial perfusion and CT-FFR in the work-up of coronary artery disease. JACC Cardiovasc Imaging 2017;10:760-770
  16. Bamberg F, Klotz E, Flohr T, Becker A, Becker CR, Schmidt B, et al. Dynamic myocardial stress perfusion imaging using fast dual-source CT with alternating table positions: initial experience. Eur Radiol 2010;20:1168-1173
  17. Rossi A, Merkus D, Klotz E, Mollet N, de Feyter PJ, Krestin GP. Stress myocardial perfusion: imaging with multidetector CT. Radiology 2014;270:25-46
  18. Cerqueira MD, Weissman NJ, Dilsizian V, Jacobs AK, Kaul S, Laskey WK, et al.; American Heart Association Writing Group on Myocardial Segmentation and Registration for Cardiac Imaging. 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
  19. Danad I, Szymonifka J, Schulman-Marcus J, Min JK. Static and dynamic assessment of myocardial perfusion by computed tomography. Eur Heart J Cardiovasc Imaging 2016;17:836-844
  20. Kono AK, Coenen A, Lubbers M, Kurata A, Rossi A, Dharampal A, et al. Relative myocardial blood flow by dynamic computed tomographic perfusion imaging predicts hemodynamic significance of coronary stenosis better than absolute blood flow. Invest Radiol 2014;49:801-807
  21. Monnink SH, Tio RA, Veeger NJ, Amoroso G, van Boven AJ, van Gilst WH. Exercise-induced ischemia after successful percutaneous coronary intervention is related to distal coronary endothelial dysfunction. J Investig Med 2003;51:221-226
  22. Balian V, Galli M, Marcassa C, Cecchin G, Child M, Barlocco F, et al. Intracoronary ST-segment shift soon after elective percutaneous coronary intervention accurately predicts periprocedural myocardial injury. Circulation 2006;114:1948-1954
  23. Jaffe R, Dick A, Strauss BH. Prevention and treatment of microvascular obstruction related myocardial injury and coronary no-reflow following percutaneous coronary intervention: a systematic approach. JACC Cardiovasc Interv 2010;3:695-704
  24. Ikenaga H, Kurisu S, Nakao T, Kono S, Sumimoto Y, Watanabe N, et al. Predictive value of plaque morphology assessed by frequency-domain optical coherence tomography for impaired microvascular perfusion after elective stent implantation: the intracoronary electrocardiogram study. Eur Heart J Cardiovasc Imaging 2018;19:310-318
  25. Einstein AJ, Moser KW, Thompson RC, Cerqueira MD, Henzlova MJ. Radiation dose to patients from cardiac diagnostic imaging. Circulation 2007;116:1290-1305
  26. Zhang LJ, Wang Y, Schoepf UJ, Meinel FG, Bayer RR 2nd, Qi L, et al. Image quality, radiation dose, and diagnostic accuracy of prospectively ECG-triggered high-pitch coronary CT angiography at 70 kVp in a clinical setting: comparison with invasive coronary angiography. Eur Radiol 2016;26:797-806
  27. Layritz C, Schmid J, Achenbach S, Ulzheimer S, Wuest W, May M, et al. Accuracy of prospectively ECG-triggered very lowdose coronary dual-source CT angiography using iterative reconstruction for the detection of coronary artery stenosis: comparison with invasive catheterization. Eur Heart J Cardiovasc Imaging 2014;15:1238-1245
  28. Rief M, Zimmermann E, Stenzel F, Martus P, Stangl K, Greupner J, et al. Computed tomography angiography and myocardial computed tomography perfusion in patients with coronary stents: prospective intraindividual comparison with conventional coronary angiography. J Am Coll Cardiol 2013;62:1476-1485