AIMS: Previous studies on invasive assessment of collateral function in patients with a chronic total occlusion (CTO) have displayed only a limited increase in collateral flow and high occurrence of coronary steal during pharmacological stress. This could question the necessity for ischaemia testing prior to revascularization of CTOs in the presence of myocardial viability. The purpose of the present study was to determine the prevalence of perfusion impairments in patients with a CTO as assessed by [15O]H2O positron emission tomography (PET). METHODS AND RESULTS: Seventy-six consecutive patients (60 men, 62 ± 10 years) with a documented CTO and preserved left ventricular ejection fraction (LVEF) were included. All patients underwent PET to assess (hyperaemic) myocardial blood flow (MBF) and coronary flow reserve (CFR). Collateral connection score was 0 in 7 (9%), 1 in 13 (17%), and 2 in 56 (74%) of the cases, with predominantly a high Rentrop grade (96% ≥2). MBF of the target area during hyperaemia was significantly lower when compared with the remote area (1.37 ± 0.37 vs. 2.63 ± 0.71 mL min-1 g-1, P < 0.001). Target to remote ratio during hyperaemia was on average 0.54 ± 0.13, and 73 (96%) patients demonstrated a significantly impaired target to remote ratio (≤0.75). Only 7 (9%) patients displayed a preserved CFR of ≥2.50, whereas coronary steal (CFR <1.0) was observed in 10 (13%) patients. CONCLUSIONS: Even in the presence of angiographically well-developed collateral arteries, the vast majority of CTO patients with a preserved LVEF showed significantly impaired perfusion. These results suggest that collateral function during increased blood flow demand in viable myocardium is predominantly insufficient. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: Previous studies on invasive assessment of collateral function in patients with a chronic total occlusion (CTO) have displayed only a limited increase in collateral flow and high occurrence of coronary steal during pharmacological stress. This could question the necessity for ischaemia testing prior to revascularization of CTOs in the presence of myocardial viability. The purpose of the present study was to determine the prevalence of perfusion impairments in patients with a CTO as assessed by [15O]H2O positron emission tomography (PET). METHODS AND RESULTS: Seventy-six consecutive patients (60 men, 62 ± 10 years) with a documented CTO and preserved left ventricular ejection fraction (LVEF) were included. All patients underwent PET to assess (hyperaemic) myocardial blood flow (MBF) and coronary flow reserve (CFR). Collateral connection score was 0 in 7 (9%), 1 in 13 (17%), and 2 in 56 (74%) of the cases, with predominantly a high Rentrop grade (96% ≥2). MBF of the target area during hyperaemia was significantly lower when compared with the remote area (1.37 ± 0.37 vs. 2.63 ± 0.71 mL min-1 g-1, P < 0.001). Target to remote ratio during hyperaemia was on average 0.54 ± 0.13, and 73 (96%) patients demonstrated a significantly impaired target to remote ratio (≤0.75). Only 7 (9%) patients displayed a preserved CFR of ≥2.50, whereas coronary steal (CFR <1.0) was observed in 10 (13%) patients. CONCLUSIONS: Even in the presence of angiographically well-developed collateral arteries, the vast majority of CTO patients with a preserved LVEF showed significantly impaired perfusion. These results suggest that collateral function during increased blood flow demand in viable myocardium is predominantly insufficient. Published on behalf of the European Society of Cardiology. All rights reserved.
Authors: Stefan P Schumacher; Roel S Driessen; Wijnand J Stuijfzand; Pieter G Raijmakers; Ibrahim Danad; Jo Dens; James C Spratt; Colm G Hanratty; Simon J Walsh; Ronald Boellaard; Albert C van Rossum; Maksymilian P Opolski; Alexander Nap; Paul Knaapen Journal: Catheter Cardiovasc Interv Date: 2018-11-15 Impact factor: 2.692
Authors: Teresa Vitadello; Karl P Kunze; Stephan G Nekolla; Nicolas Langwieser; Christian Bradaric; Florian Weis; Salvatore Cassese; Massimiliano Fusaro; Alexander Hapfelmeier; Thorsten Lewalter; Markus Schwaiger; Adnan Kastrati; Karl-Ludwig Laugwitz; Christoph Rischpler; Tareq Ibrahim Journal: Eur J Nucl Med Mol Imaging Date: 2020-05-30 Impact factor: 9.236
Authors: Daniëlle C J Keulards; Grigoris V Karamasis; Osama Alsanjari; Jesse P A Demandt; Marcel Van't Veer; Jo M Zelis; Simon A Dello; Mohamed El Farissi; Klio Konstantinou; Kare H Tang; Paul A Kelly; Thomas R Keeble; Nico H J Pijls; John R Davies; Koen Teeuwen Journal: J Am Heart Assoc Date: 2020-04-22 Impact factor: 5.501