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Published on: February 16, 2016
Impact of percutaneous coronary intervention of chronic total occlusions on absolute perfusion in remote myocardium
Ruben W de Winter1, Stefan P Schumacher1, Pepijn A van Diemen1
1Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
Insights
Percutaneous coronary intervention for chronic total occlusions (CTO PCI) improves blood flow in the heart
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Imaging
Background:
- Revascularization of chronic total coronary occlusion (CTO) significantly impacts coronary physiology in remote myocardial territories.
- Understanding the direct effects of CTO percutaneous coronary intervention (PCI) on remote myocardial perfusion is crucial for comprehensive patient management.
Purpose of the Study:
- To evaluate the intrinsic physiological effect of CTO PCI on absolute perfusion changes in remote myocardial regions.
- To determine if improvements in the CTO territory correlate with enhanced perfusion in non-target areas.
Main Methods:
- 164 patients undergoing successful single-vessel CTO PCI were assessed using serial [15O]H2O positron emission tomography (PET) perfusion imaging.
- Changes in hyperemic myocardial blood flow (hMBF) and coronary flow reserve (CFR) were measured in remote myocardium at baseline and three months post-PCI.
Main Results:
- A significant positive correlation was observed between perfusion indices in CTO and remote myocardium, both before and after PCI.
- CTO revascularization led to absolute increases in hMBF and CFR in the remote myocardium (p<0.01 for both).
- Improvements in remote myocardial perfusion were most pronounced in patients with greater increases in hMBF and CFR within the CTO territory.
Conclusions:
- CTO PCI demonstrably increases remote myocardial perfusion, indicating a beneficial physiological impact extending beyond the treated vessel.
- Quantitative improvements in hMBF and CFR in the CTO territory are independently associated with enhanced perfusion in remote regions.
- CTO PCI offers a favorable physiological benefit to remote myocardial areas, suggesting a broader therapeutic effect than previously understood.
Background:
Revascularisation of a chronic total coronary occlusion (CTO) impacts the coronary physiology of the remote myocardial territory.
Aims:
This study aimed to evaluate the intrinsic effect of CTO percutaneous coronary intervention (PCI) on changes in absolute perfusion in remote myocardium.
Methods:
A total of 164 patients who underwent serial [15O]HO positron emission tomography (PET) perfusion imaging at baseline and three months after successful single-vessel CTO PCI were included to evaluate changes in hyperaemic myocardial blood flow (hMBF) and coronary flow reserve (CFR) in the remote myocardium supplied by both non-target coronary arteries.
Results:
Perfusion indices in CTO and remote myocardium showed a positive correlation before (resting MBF: r=0.84, hMBF: r=0.75, and CFR: r=0.77, p<0.01 for all) and after (resting MBF: r=0.87, hMBF: r=0.87, and CFR: r=0.81, p<0.01 for all) CTO PCI. Absolute increases in hMBF and CFR were observed in remote myocardium following CTO revascularisation (from 2.29±0.67 to 2.48±0.75 mL·min-1·g-1 and from 2.48±0.76 to 2.74±0.85, respectively, p<0.01 for both). Improvements in remote myocardial perfusion were largest in patients with a higher increase in hMBF (β 0.58, 95% CI: 0.48-0.67, p<0.01) and CFR (β 0.54, 95% CI: 0.44-0.64, p<0.01) in the CTO territory, independent of clinical, angiographic and procedural characteristics.
Conclusions:
CTO revascularisation resulted in an increase in remote myocardial perfusion. Furthermore, the quantitative improvement in hMBF and CFR in the CTO territory was independently associated with the absolute perfusion increase in remote myocardial regions. As such, CTO PCI may have a favourable physiologic impact beyond the intended treated myocardium.
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