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Title: The association of collaterals with myocardial ischemia and viability in chronic total occlusions
Authors: Leite, Luís 
Campos, Gustavo
Silva, Rodolfo
Jorge, Elisabete 
Oliveira-Santos, Manuel 
Gomes, Andreia 
Gonçalves, Lino 
Castelo-Branco, Miguel 
Abrunhosa, Antero 
Ferreira, Maria João 
Keywords: Chronic total occlusion; Collateral; PET-CT; Ischemia; Viability
Issue Date: Apr-2023
Publisher: Springer Nature
Serial title, monograph or event: International Journal of Cardiovascular Imaging
Volume: 39
Issue: 4
Abstract: Collateral development in chronic total occlusions (CTO) is crucial to perfuse the distal myocardium and its angiographic evaluation is frequently used to assess the need for revascularization. We aimed to analyse the association between the presence of ischemia and hibernating myocardium, evaluated by cardiac [13 N]NH3/2-[18 F]FDG PET-CT, and the angiographic characterization of the collateral circulation. Prospective study including patients with a CTO who underwent a [13 N]NH3 and, when deemed necessary, 2-[18 F]FDG PET-CT. Well developed (WD) collaterals were defined as a concomitant angiographic Rentrop grade 3 and Werner collateral connection score 2 or 3, whereas the remaining as poorly developed (PD). 2% thresholds used to identify prognostic benefit of revascularization were applied: ischemia > 10% and hibernating myocardium > 7%. Fifty-nine patients (age 62.9±9.1 years, 58 male) were recruited, WD collaterals were present in 28 (47.5%). No significant differences were found in ischemia (WD 6.4±4.3 vs. PD 7.0±4.1, p = 0.64) and hibernation (WD 1.8±1.9 vs. PD 3.1±3.3, p = 0.18) scores. Most CTO territories demonstrated ischemia, but only 19 (46.3%) were associated with an area > 10% (WD 47.6% vs. PD 45.0%, p = 0.58). Scared non-viable myocardium was limited to 9 (15.3%) patients and was not associated with PD collaterals. Hibernating myocardium was frequent (54.2%), but just 6 (10.2%) CTO patients had an area of > 7% (WD 3.6% vs. PD 16.1%, p = 0.20). Collateral assessment by angiography has a poor association with the ischemic burden and hibernation state of CTO territories. Myocardial viability was present even in most CTO with angiographic PD collaterals.
ISSN: 1875-8312
DOI: 10.1007/s10554-022-02772-z
Rights: openAccess
Appears in Collections:I&D ICBR - Artigos em Revistas Internacionais
I&D CIBIT - Artigos em Revistas Internacionais
FMUC Medicina - Artigos em Revistas Internacionais
I&D ICNAS - Artigos em Revistas Internacionais

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