Correlation of Angina Pectoris and Perfusion Decrease by Collateral Circulation in Single-Vessel Coronary Chronic...

Area of Science:

• Cardiovascular Imaging
• Interventional Cardiology
• Myocardial Perfusion Assessment

Background:

• Chronic total occlusion (CTO) poses challenges in assessing myocardial viability and symptoms.
• Collateral circulation plays a crucial role in supplying blood to ischemic territories in CTO patients.
• Understanding the relationship between collateral flow and symptoms is vital for patient management.

Purpose of the Study:

• To evaluate perfusion decrease in donor myocardium due to collateral circulation in CTO patients.
• To correlate this perfusion decrease with the presence of angina pectoris.
• To utilize myocardial perfusion single-photon emission computed tomography (MPS) for this evaluation.

Main Methods:

• Thirty-six patients with single-vessel CTO underwent MPS and coronary angiography (CAG).
• Collateral grades were assessed using the Rentrop grading system on CAG.
• Perfusion defects and scores in donor and CTO territories were analyzed using MPS.

Main Results:

• Symptomatic patients with ischemic CTO territories had higher perfusion scores in the CTO territory.
• Symptomatic patients with nonischemic CTO territories showed higher summed stress and rest scores in donor territories.
• Perfusion defects in donor territories increased significantly with higher Rentrop grades (p < 0.001).

Conclusions:

• Angina pectoris in CTO patients is associated with either ischemia beyond the CTO or reduced perfusion in the donor myocardium.
• Perfusion decrease in donor myocardium shows a positive correlation with collateral circulation grades.
• MPS and CAG are valuable tools for assessing collateral function and its impact on symptoms in CTO.