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Updated: Jan 19, 2026
In Vivo Quantitative Assessment of Myocardial Structure, Function, Perfusion and Viability Using Cardiac Micro-computed Tomography
Published on: February 16, 2016
Ischaemic burden and changes in absolute myocardial perfusion after chronic total occlusion percutaneous coronary
Stefan P Schumacher1, Marly Kockx, Wijnand J Stuijfzand
1Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
Insights
Chronic total occlusion percutaneous coronary intervention (CTO PCI) significantly reduces ischaemic burden. Myocardial blood flow and coronary flow reserve improve regardless of initial defect size after successful CTO PCI.
Area of Science:
- Cardiovascular Imaging
- Interventional Cardiology
- Myocardial Perfusion Imaging
Background:
- Chronic total occlusion (CTO) poses challenges in coronary artery disease management.
- Assessing the impact of CTO percutaneous coronary intervention (PCI) on myocardial perfusion is crucial for treatment efficacy.
- Understanding the relationship between ischaemic burden and perfusion changes post-CTO PCI is vital.
Purpose of the Study:
- To investigate the correlation between ischaemic burden and myocardial perfusion changes after successful CTO PCI.
- To quantify the impact of CTO PCI on perfusion defect size, myocardial blood flow (MBF), and coronary flow reserve (CFR).
Main Methods:
- 193 patients with CTO underwent [15O]H2O Positron Emission Tomography (PET) before and 3 months after CTO PCI.
- Perfusion defect size, hyperaemic MBF, and CFR were assessed and compared based on baseline defect size (limited, moderate, large).
- Patients were stratified into tertiles based on baseline hyperaemic MBF and CFR to analyze changes post-intervention.
Main Results:
- Significant reductions in perfusion defect size were observed, with greater reduction in patients with larger baseline defects (p<0.01).
- Hyperaemic MBF and CFR improved significantly across all baseline defect sizes (p=0.45 and p=0.55, respectively).
- Post-CTO PCI changes in hyperaemic MBF and CFR were comparable across baseline tertiles (p=0.75 and p=0.79, respectively).
Conclusions:
- CTO PCI effectively reduces ischaemic burden, particularly in patients with larger initial perfusion defects.
- Significant improvements in myocardial blood flow and coronary flow reserve are achieved irrespective of baseline perfusion defect size or absolute flow values.
- These findings highlight the benefit of CTO PCI in restoring myocardial perfusion across a spectrum of ischaemic severity.
Aims:
The aim of this study was to explore the relationships between ischaemic burden and changes in absolute myocardial perfusion following chronic coronary total occlusion (CTO) percutaneous coronary intervention (PCI).
Methods And Results:
A total of 193 consecutive patients underwent [15O]H2O positron emission tomography prior to and three months after successful CTO PCI. Change in perfusion defect size, quantitative hyperaemic myocardial blood flow (MBF) and coronary flow reserve (CFR) within the CTO area were compared among patients with limited (0-1 segment, N=15), moderate (2-3 segments, N=61) and large (≥4 segments, N=117) perfusion defects. Median reductions in defect size were 1 [0-1], 2 [1-3], and 4 [2-5] segments in patients with a limited, moderate and large defect (all comparisons p<0.01). Hyperaemic MBF and CFR improved significantly regardless of baseline defect size (overall between groups p=0.45 and p=0.55). After stratification of patients to a low, intermediate or high tertile according to baseline hyperaemic MBF or CFR levels, changes in hyperaemic MBF and CFR after CTO PCI were comparable between tertiles (overall p=0.75 and p=0.79).
Conclusions:
Major reductions in ischaemic burden can be achieved following CTO PCI, with more defect size reduction in patients with a larger perfusion defect, whereas hyperaemic MBF and CFR improve significantly irrespective of their baseline values or perfusion defect size.
