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Leite L, Campos G, Silva R, Jorge E, Oliveira-Santos M, Gomes A, Gonçalves L, Castelo-Branco M, Abrunhosa A, Ferreira MJ. The association of collaterals with myocardial ischemia and viability in chronic total occlusions. Int J Cardiovasc Imaging 2022; 39:843-851. [PMID: 36494504 DOI: 10.1007/s10554-022-02772-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 11/30/2022] [Indexed: 12/13/2022]
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.
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Affiliation(s)
- Luís Leite
- Cardiology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
- Institute of Nuclear Sciences Applied to Health - Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
- Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), Coimbra, Portugal.
| | - Gustavo Campos
- Cardiology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Rodolfo Silva
- Institute of Nuclear Sciences Applied to Health - Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), Coimbra, Portugal
| | - Elisabete Jorge
- Cardiology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Coimbra, Portugal
| | - Manuel Oliveira-Santos
- Cardiology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- Institute of Nuclear Sciences Applied to Health - Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), Coimbra, Portugal
| | - Andreia Gomes
- Cardiology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- Institute of Nuclear Sciences Applied to Health - Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Lino Gonçalves
- Cardiology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Coimbra, Portugal
| | - Miguel Castelo-Branco
- Institute of Nuclear Sciences Applied to Health - Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), Coimbra, Portugal
| | - Antero Abrunhosa
- Institute of Nuclear Sciences Applied to Health - Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), Coimbra, Portugal
| | - Maria João Ferreira
- Cardiology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- Institute of Nuclear Sciences Applied to Health - Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), Coimbra, Portugal
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Blanco PJ, Bulant CA, Ares GD, Lemos PA, Feijóo RA. A simple coronary blood flow model to study the collateral flow index. Biomech Model Mechanobiol 2021; 20:1365-1382. [PMID: 33772676 DOI: 10.1007/s10237-021-01449-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 03/06/2021] [Indexed: 11/25/2022]
Abstract
In this work, we present a novel modeling framework to investigate the effects of collateral circulation into the coronary blood flow physiology. A prototypical model of the coronary tree, integrated with the concept of Collateral Flow Index (CFI), is employed to gain insight about the role of model parameters associated with the collateral circuitry, which results in physically-realizable solutions for specific CFI data. Then, we discuss the mathematical feasibility of pressure-derived CFI, anatomical implications and practical considerations involving the estimation of model parameters in collateral connections. A sensitivity analysis is carried out, and the investigation of the impact of the collateral circulation on FFR values is also addressed.
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Affiliation(s)
- Pablo J Blanco
- Laboratório Nacional de Computação Científica, Av. Getúlio Vargas 333, Petrópolis, 25651-075, Brazil.
- National Institute of Science and Technology in Medicine Assisted by Scientific Computing, INCT-MACC, Petrópolis, Brazil.
| | - Carlos A Bulant
- National University of the Center and National Scientific and Technical Research Council, CONICET, Tandil, Argentina
- National Institute of Science and Technology in Medicine Assisted by Scientific Computing, INCT-MACC, Petrópolis, Brazil
| | - Gonzalo D Ares
- National University of Mar del Plata, Mar del Plata, Argentina
| | - Pedro A Lemos
- Hospital Israelita Albert Einstein., São Paulo, Brazil
- National Institute of Science and Technology in Medicine Assisted by Scientific Computing, INCT-MACC, Petrópolis, Brazil
| | - Raúl A Feijóo
- Laboratório Nacional de Computação Científica, Av. Getúlio Vargas 333, Petrópolis, 25651-075, Brazil
- National Institute of Science and Technology in Medicine Assisted by Scientific Computing, INCT-MACC, Petrópolis, Brazil
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