Korean Circulation Journal

The Korean Society of Cardiology (대한심장학회)
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Ischemic Burden Assessment Using Single Photon Emission Computed Tomography in Single Vessel Chronic Total Occlusion of Coronary Artery

  • Yong-Hoon Yoon (Department of Cardiology, Chungnam National University Sejong Hospital, Chungnam National University School of Medicine) ;
  • Sangwon Han (Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Osung Kwon (Division of Cardiology, Department of Internal Medicine, The Catholic University of Korea, Eunpyeong St. Mary's Hospital) ;
  • Kyusup Lee (Department of Cardiology, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Ju Hyeon Kim (Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Junghoon Lee (Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Tae oh Kim (Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Jae-Hyung Roh (Department of Cardiology, Chungnam National University Sejong Hospital, Chungnam National University School of Medicine) ;
  • Pil Hyung Lee (Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Soo-Jin Kang (Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Jae-Hwan Lee (Department of Cardiology, Chungnam National University Sejong Hospital, Chungnam National University School of Medicine) ;
  • Young-Hak Kim (Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Cheol Whan Lee (Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Dae Hyuk Moon (Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Seung-Whan Lee (Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine)
  • Received : 2021.07.13
  • Accepted : 2021.10.27
  • Published : 2022.02.01
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Abstract

Background and Objectives: Studies evaluating the nature of ischemic burden of chronic total occlusion (CTO) vessels are still lacking. Methods: A total of 165 patients with single vessel CTO >2.5 mm in an epicardial coronary artery who underwent single photon emission computed tomography (SPECT) were enrolled in the study. Ischemic burden was calculated with the use of semi-quantitative SPECT analysis, and was defined as the summed difference score (SDS) divided by the maximal limit of the score (=SDS/68). Results: The mean age of the participants was 59.5 years and the CTO of the left anterior descending coronary artery (LAD), left circumplex coronary artery (LCX), and right coronary artery (RCA) accounted for 93 (56.4%), 18 (10.9%), and 54 (32.7%) patients, respectively. The median ischemic burden of the total population was 8.8%, and it was highest in the LAD CTO (10.3%) compared with the LCX (5.9%) and RCA CTO (5.9%, p<0.001). High-ischemic burden (ischemic burden >10%) was observed in 66 patients (40.0%), and in 47 patients (50.5%) of the LAD CTO. Ischemic burden was different according to the CTO location only in LAD CTO. The statistically significant predictors for high-ischemic burden were hypertension, baseline ejection fraction >45%, LAD CTO, proximal CTO location, and de novo CTO. Japanese-CTO score and Rentrop scale collateral grade were not associated with high-ischemic burden. Conclusions: Only 40% of patients with single vessel CTO had ischemic burden >10%. For CTO vessels, measurement of ischemic burden using SPECT prior to revascularization may be helpful in identifying beneficial subjects.

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References

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