Evaluation Of The Relationship Between Viable Myocardium And Collateral Circulation Grade And Cardiac Function In Patients With Chronic Total Occlusion Of Coronary Artery By Dual Nuclear Imaging

Objective: Objective to evaluate the relationship between the number of viable myocardium,cardiac function parameters and different levels of collateral circulation in patients with chronic total coronary occlusion,and to study the correlation between the number of viable myocardium before PCI and the changes of cardiac function after PCI.Methods: fifty seven patients with chronic coronary artery occlusion diagnosed by coronary angiography were selected.Before PCI,99 m Tc MIBI myocardial perfusion imaging and 18F-FDG were performed,According to the results of 18F-FDG myocardial metabolism imaging,the myocardial survival of patients with chronic coronary artery occlusion was evaluated,and the cardiac function parameters were followed up for 3-6 months.According to Rentrop classification,57 patients were divided into poor collateral circulation group(grade 0 and grade 1),good collateral circulation group(grade 2 and grade 3)and group B.the relationship between left ventricular ejection fraction(LVEF),viable myocardium and different grades of collateral circulation was analyzed.Group C1,C2 and C3 were defined according to the percentage of perfusion metabolic mismatch(< 10%,10-20% and > 20%).The number of viable myocardium,the changes of left ventricular ejection fraction(levf)and left ventricular end diastolic volume before and after operation were compared The relationship between left ventricular end systolic volume(LVESV)and left ventricular end systolic volume(LVESV)was analyzed.ROC curve was used to analyze the diagnostic effect and critical value of perfusion metabolic mismatch percentage on left ventricular ejection fraction increase,left ventricular end systolic volume decrease and left ventricular end diastolic volume decrease.Results: 1.There was no significant difference in the number and range of viable myocardium,cardiac function index and collateral circulation grade(P > 0.05).2.When the percentage of mismatch of perfusion metabolism was less than 10%,LVEF did not change or even decreased significantly(P > 0.05).When the perfusion metabolic mismatch percentage was more than or equal to 10%,the higher the perfusion metabolic mismatch percentage was,the better the LVEF was(P < 0.05).The percentage of perfusion metabolic mismatch was positively correlated with the change of left ventricular ejection fraction(r = 0.854,P < 0.05),negatively correlated with the change of left ventricular end diastolic volume(r =-0.913),and negatively correlated with the change of left ventricular end systolic volume(-0.966,P < 0.05).3.The ROC curve showed that the percentage of perfusion metabolic mismatch predicted the increase of left ventricular ejection fraction,the decrease of left ventricular end diastolic volume and the decrease of left ventricular end systolic volume.The ROC AUC of the three were 0.979,0.988 and 0.984(P < 0.05),and the cut-off values of perfusion metabolic mismatch were 11.5 %,10 % and 10 %,respectively.Conclusion: The grade of collateral circulation in patients with chronic coronary occlusion cannot predict the number of viable myocardium in patients.When the degree of perfusion metabolism mismatch is ≥ 10%,the left ventricular ejection fraction improves after surgery.Perfusion metabolic mismatch percentage is positively correlated with LVEF changes,and negatively correlated with LVEDV and LVESV changes.Dual nuclear myocardial imaging has important guiding significance for the selection of clinical strategies for patients with chronic coronary artery occlusion.