We found a match
Your institution may have access to this item. Find your institution then sign in to continue.
- Title
Prevalence of ischaemia in patients with a chronic total occlusion and preserved left ventricular ejection fraction.
- Authors
Stuijfzand, Wijnand J.; Driessen, Roel S.; Raijmakers, Pieter G.; Rijnierse, Mischa T.; Maeremans, Joren; Hollander, Maurits R.; Lammertsma, Adriaan A.; van Rossum, Albert C.; Dens, Jo; Nap, Alexander; van Royen, Niels; Knaapen, Paul
- Abstract
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 CTOand 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.
- Subjects
BLOOD circulation; COLLATERAL circulation; CORONARY circulation; CORONARY disease; POSITRON emission tomography; VENTRICULAR ejection fraction
- Publication
European Heart Journal - Cardiovascular Imaging, 2017, Vol 18, Issue 9, p1025
- ISSN
2047-2404
- Publication type
Article
- DOI
10.1093/ehjci/jew188