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Coronary collaterals grading in Chronic Total Occlusions: is it enough to presume ischemia and viability?
Session:
Prémio Jovem Investigador
Speaker:
Gustavo M. Campos
Congress:
CPC 2021
Topic:
B. Imaging
Theme:
03. Imaging
Subtheme:
03.4 Nuclear Imaging
Session Type:
Prémios
FP Number:
---
Authors:
Gustavo M. Campos; Luís Leite; Rodolfo Silva; Andreia Gomes; Elisabete Jorge; Lino Gonçalves; Maria João Ferreira
Abstract
<p style="text-align:justify"><span style="font-size:7pt"><span style="font-family:Helvetica,sans-serif"><strong><span style="font-size:11.0pt"><span style="font-family:"Calibri","sans-serif"">Introduction:</span></span></strong><span style="font-size:11.0pt"><span style="font-family:"Calibri","sans-serif""> The establishment of well-developed collateral in Chronic Total Occlusions (<span style="background-color:#fcfcfc">CTO)</span> was assumed to prevent ischemia, but some studies stated that in majority <span style="background-color:#fcfcfc">the collateral function during increased blood flow demand in viable myocardium is predominantly insufficient. Current guidelines recommend CTO revascularization in patients with symptoms and/or marked ischemic burden. </span>PET-CT is able to detect both myocardial ischemia and viability with high accuracy.</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Objectives: </strong>To analyze the association between the presence of ischemia and viable myocardium as evaluated by 13N-NH3/<span style="background-color:white">FDG PET-CT and </span>collateral development on coronary angiography.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Methods: </strong>Prospective, observational study including patients with a CTO who underwent 13N-NH3/<span style="background-color:white">FDG PET-CT </span>between 2017 and 2020. Well developed (WD) collaterals were defined as a concomitant Rentrop grade 3 and Werner collateral connection score 2 or 3. <span style="color:black">A 17-segment LV model was used for interpretation of the PET study, and segments were graded for myocardial perfusion using a visual, semi-quantitative scale</span><span style="font-size:8.0pt">.</span> <span style="color:black">The Summed Stress Score (SSS) and the Summed Rest Score (SRS) were obtained by adding the individual segment scores from the CTO vascular territory on the stress and rest perfusion studies; </span>the Ischemia Score (Summed Difference Score <span style="background-color:white"><span style="color:#212121">- SDS</span></span>) was calculated as the difference between SSS and SRS. The Viability Score was analyzed as the difference between SRS and the FDG score. The CTO territory was considered “viable” based on the established threshold of ≥50% FDG uptake compared with remote myocardium.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Results: </strong>We recruited 59 patients (median age 62 <span style="background-color:white"><span style="color:#212121">[57-71])</span></span>, most frequent CTO arteries were the right coronary (44.1%) and the left descending artery (45.8%). Mean J-CTO Score was 1.4 <span style="font-family:Symbol">±</span> 1,0. WD collaterals were present in 31 (52.5%) patients. WD collaterals were more prevalent in right coronary artery CTOs (67.8% vs. 21.4%, p < 0.001). No differences were found in the Ischemia and Viability scores (ischemia score in WD was 5.1 ± 3.3 vs. 5.3 ± 2.9 <span style="background-color:white"><span style="color:#212121">[p = 0.943] and viability score in WD was 2.2 </span></span>± 2.0 vs. 2.2 ± 2.1 <span style="background-color:white"><span style="color:#212121">[p = 0.883]</span></span>). Poor-developed collateral CTO patients had numerically worse perfusion scores, but viability was present in 72.2%.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusions:</strong> Angiographic evaluation of CTO collateral function seems to have a poor association with myocardial perfusion and metabolism, so it should not be used as an assumption of the ischemic burden and viability. Myocardial viability was present in the majority of patients with poorly developed collaterals.</span></span></p>
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