title: Correlation of Angina Pectoris and Perfusion Decrease by Collateral Circulation in Single-Vessel Coronary Chronic Total Occlusion Using Myocardial Perfusion Single-Photon Emission Computed Tomography.
abstract: OBJECTIVE
  To evaluate the perfusion decrease in donor myocardium by collateral circulation and its correlation with angina pectoris in patients with chronic total occlusion (CTO) using myocardial perfusion single-photon emission computed tomography (MPS).
  
  
  METHODS
  Thirty-six patients with single-vessel CTO without any other stenosis were included. All patients underwent MPS and coronary angiography (CAG) within 2 months. Total 72 donor arteries were evaluated for the grades of collaterals to the CTO artery using the Rentrop grading system on CAG. Perfusion defects and perfusion scores in donor and CTO territories were analyzed on MPS. Myocardial perfusion of donor and CTO territories were evaluated according to the presence of angina pectoris and the grades of collateral circulation.
  
  
  RESULTS
  When the CTO territory was ischemic, symptomatic patients showed higher summed difference scores in the CTO territory compared to asymptomatic patients (3.5 ± 2.4 vs. 1.5 ± 0.8 for symptomatic and asymptomatic groups respectively; p = 0.034). However, when the CTO territory was nonischemic, symptomatic patients showed higher summed stress scores (SSS, 4.3 ± 2.9 vs. 1.6 ± 1.2; p = 0.032) and summed rest scores (SRS, 4.2 ± 2.5 vs. 1.5 ± 1.1; p = 0.003) in the donor territories. On the per-vessel analysis, perfusion defects in donor territories were more frequent (0 % vs. 53 % vs. 86 % for Rentrop 0, Rentrop 1-2 and Rentrop 3, respectively; p < 0.001) and showed higher SSS (0.0 ± 0.0, 1.3 ± 1.6 and 2.1 ± 1.1 for Rentrop 0, Rentrop 1-2 and Rentrop 3, respectively; p = 0.001) and SRS (0.0 ± 0.0, 1.0 ± 1.4 and 1.7 ± 1.2; p = 0.003) at higher Rentrop grades, but their patterns were variable.
  
  
  CONCLUSIONS
  Angina pectoris was related to either ischemia of the myocardium beyond CTO or a perfusion decrease in the donor myocardium. The perfusion decrease in donor myocardium positively correlated with the collateral grades.
authors.affiliation: Department of Nuclear Medicine, Chonnam National University Hospital, Gwang-ju, Korea.
authors.forename: Sang-Geon
authors.initials: SG
authors.lastname: Cho
authors.affiliation: Department of Nuclear Medicine, Chonnam National University Hospital, Gwang-ju, Korea.
authors.forename: Ki Seong
authors.initials: KS
authors.lastname: Park
authors.affiliation: Department of Nuclear Medicine, Chonnam National University Hospital, Gwang-ju, Korea.
authors.forename: Sae-Ryung
authors.initials: SR
authors.lastname: Kang
authors.affiliation: Department of Nuclear Medicine, Chonnam National University Hospital, Gwang-ju, Korea.
authors.forename: Jahae
authors.initials: J
authors.lastname: Kim
authors.affiliation: Department of Nuclear Medicine, Chonnam National University Hospital, Gwang-ju, Korea.
authors.forename: Haeng Man
authors.initials: HM
authors.lastname: Jun
authors.affiliation: Department of Cardiology, Chonnam National University Hospital, Gwang-ju, Korea.
authors.forename: Jae Yeong
authors.initials: JY
authors.lastname: Cho
authors.affiliation: Department of Cardiology, Chonnam National University Hospital, Gwang-ju, Korea.
authors.forename: Hae Chang
authors.initials: HC
authors.lastname: Jeong
authors.affiliation: Department of Cardiology, Chonnam National University Hospital, Gwang-ju, Korea.
authors.forename: Ju Han
authors.initials: JH
authors.lastname: Kim
authors.affiliation: Department of Nuclear Medicine, Chonnam National University Hwasun Hospital, 42 Jebong-ro, Dong-gu, Gwang-ju, Korea 501-757.
authors.forename: Geum-Cheol
authors.initials: GC
authors.lastname: Jeong
authors.affiliation: Department of Nuclear Medicine, Chonnam National University Hwasun Hospital, 42 Jebong-ro, Dong-gu, Gwang-ju, Korea 501-757.
authors.forename: Hee Jeong
authors.initials: HJ
authors.lastname: Park
authors.affiliation: Department of Nuclear Medicine, Chonnam National University Hwasun Hospital, 42 Jebong-ro, Dong-gu, Gwang-ju, Korea 501-757.
authors.forename: Seong Young
authors.initials: SY
authors.lastname: Kwon
authors.affiliation: Department of Nuclear Medicine, Chonnam National University Hwasun Hospital, 42 Jebong-ro, Dong-gu, Gwang-ju, Korea 501-757.
authors.forename: Jung-Joon
authors.initials: JJ
authors.lastname: Min
authors.affiliation: Department of Nuclear Medicine, Chonnam National University Hwasun Hospital, 42 Jebong-ro, Dong-gu, Gwang-ju, Korea 501-757.
authors.forename: Henry Hee-Seung
authors.initials: HH
authors.lastname: Bom
authors.affiliation: Department of Nuclear Medicine, Chonnam National University Hospital, Gwang-ju, Korea.
authors.forename: Ho-Chun
authors.initials: HC
authors.lastname: Song
keywords: Angina pectoris; Collateral circulation; Coronary occlusion; Myocardial perfusion imaging