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Please use this identifier to cite or link to this item: http://hdl.handle.net/1942/23171

Title: Prevalence of ischaemia in patients with a chronic total occlusion and preserved left ventricular ejection fraction
Authors: Stuijfzand, Wynand 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
Issue Date: 2016
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 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 min21 g21, 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.
Notes: [Stuigzandl, Wijnand J.; Driessenl, Roel S.; Rijniersel, Mischa T.; Hollanders, Maurits R.; van Rossum, Albert C.; Naps, Alexander; van Royen, Niels; Knaapen, Paul] Vrije Univ Amsterdam, Med Ctr, Dept Cardiol, De Boelelaan 1117, NL-1081 HV Amsterdam, Netherlands. [Raijmakers, Pieter G.; Lammertsma, Adriaan A.] Vrije Univ Amsterdam, Med Ctr, Dept Radiol & Nucl Med, Amsterdam, Netherlands. [Maeremans, Joren; Dens, Jo] Univ Hasselt, Fac Med & Life Sci, Hasselt, Belgium. [Maeremans, Joren; Dens, Jo] Ziekenhuis Oost Limburg, Dept Cardiol, Genk, Belgium.
URI: http://hdl.handle.net/1942/23171
DOI: 10.1093/ehjci/jew188
ISI #: 000408090700011
ISSN: 2047-2404
Category: A1
Type: Journal Contribution
Validation: ecoom, 2018
Appears in Collections: Research publications

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