Netherlands: Chronic total occlusion (CTO) revascularization increases remote myocardial perfusion, a recent study has shown. The biggest gains were observed in patients having significant improvements in various blood flow measures. This indicates that "CTO percutaneous coronary intervention (PCI) may have a favorable physiologic impact beyond the intended treated myocardium," the researchers wrote. The study appears in the journal EuroIntervention.
CTO revascularization is known to impact the coronary physiology of the remote myocardial territory. Ruben W. de Winter, Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands, and colleagues aimed to evaluate the intrinsic effect of CTO PCI on changes in absolute perfusion in remote myocardium.
The study included a total of 164 patients who underwent serial [15O]H2O positron emission tomography (PET) perfusion imaging at baseline and three months after successful single-vessel CTO PCI. They were evaluated for changes in coronary flow reserve (CFR) and hyperaemic myocardial blood flow (hMBF) in remote myocardium supplied by both non-target coronary arteries.
Key findings include:
- 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) and after (resting MBF: r=0.87, hMBF: r=0.87, and CFR: r=0.81) 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).
- Improvements in remote myocardial perfusion were largest in patients with a higher increase in hMBF (β 0.58) and CFR (β 0.54) in the CTO territory, independent of clinical, angiographic, and procedural characteristics.
"CTO revascularization resulted in an increase in remote myocardial perfusion. The quantitative improvement in hMBF and CFR in the CTO territory was found to be independently associated with the absolute perfusion increase in remote myocardial regions," wrote the authors.
As such, CTO PCI may have a favorable physiologic impact beyond the intended treated myocardium, they noted.
Reference:
The study titled, "Impact of percutaneous coronary intervention of chronic total occlusions on absolute perfusion in remote myocardium," was published in the journal EuroIntervention.
DOI: 10.4244/EIJ-D-21-00702
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