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Comparing PET-CT perfusion changes and echocardiographic findings following CTO-PCI
Session:
Sessão de Comunicações Orais 10 – Estratificação de risco guiada por imagem em situações cardíacas complexas
Speaker:
Tomás M. Carlos
Congress:
CPC 2026
Topic:
B. Imaging
Theme:
03. Imaging
Subtheme:
03.4 Nuclear Imaging
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Tomás M. Carlos; Inês Cruz; Luís Leite; António Barbosa; Rodolfo Silva; Andreia Gomes; Lino Gonçalves; Miguel Castelo-Branco; Antero Abrunhosa; Maria João Ferreira
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-family:"Times New Roman",serif">Introduction:</span></strong></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><span style="font-family:"Times New Roman",serif">The role of ischemia and myocardial viability in determining functional recovery after percutaneous coronary intervention (PCI) for chronic total occlusions (CTO) remains uncertain. </span><span style="font-family:"Times New Roman",serif">[<sup>13</sup>N]NH<sub>3</sub> positron emission tomography computed tomography</span><span style="font-family:"Times New Roman",serif"> (PET-CT) provides semiquantitative myocardial perfusion assessment and may clarify the relationship between ischemia burden and left ventricular improvement. This study evaluated the association between changes in PET-derived semiquantitative perfusion with echocardiographic parameters after CTO-PCI and investigated whether greater baseline ischemia or larger ischemia reduction predicted superior global or regional functional recovery.</span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-family:"Times New Roman",serif">Methods:</span></strong></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><span style="font-family:"Times New Roman",serif">We performed a prospective single-centre study including 54 patients with CTO, of whom 37 underwent PCI-CTO with paired PET-CT and transthoracic echocardiography before and 6-month after intervention. PET analysis included global summed difference score (SDS), percentage SDS (SDS%), and regional SDS in the CTO territory. Echocardiographic parameters included left ventricle ejection fraction (LVEF), global longitudinal strain (GLS) and regional wall motion score (RWMS). Statistical analyses used paired comparisons, Spearman correlations, and linear regression models (univariate and multivariate adjusted for age, sex, baseline LVEF and prior myocardial infarction in CTO territory).</span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-family:"Times New Roman",serif">Results:</span></strong></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><span style="font-family:"Times New Roman",serif">CTO-PCI produced significant reductions in global (</span><span style="font-family:"Times New Roman",serif">Δ</span><span style="font-family:"Times New Roman",serif">SDS -6±6, <em>p</em><0.001) and regional (</span><span style="font-family:"Times New Roman",serif">Δ</span><span style="font-family:"Times New Roman",serif">SDS in CTO territory -4±4, <em>p</em><0.001) ischemia. However, echocardiographic recovery was limited (</span><span style="font-family:"Times New Roman",serif">Δ</span><span style="font-family:"Times New Roman",serif">LVEF 0.6%, <em>p</em>=0.561; </span><span style="font-family:"Times New Roman",serif">Δ</span><span style="font-family:"Times New Roman",serif">GLS 0.5%, <em>p</em>=0.322). In univariate analysis, global </span><span style="font-family:"Times New Roman",serif">Δ</span><span style="font-family:"Times New Roman",serif">SDS showed a weak inverse correlation with </span><span style="font-family:"Times New Roman",serif">Δ</span><span style="font-family:"Times New Roman",serif">LVEF in Spearman analysis (</span><span style="font-family:"Times New Roman",serif">ρ</span><span style="font-family:"Times New Roman",serif"> = −0.356, p = 0.031), whereas its associations with RWMS and GLS, as well as those of regional </span><span style="font-family:"Times New Roman",serif">Δ</span><span style="font-family:"Times New Roman",serif">SDS, were not significant. Baseline ischemia burden <strong>-</strong> both global and within the CTO territory <strong>-</strong> was not related to subsequent variation in echocardiographic parameters. In multivariate models adjusted for clinical factors and baseline function, neither changes in SDS nor baseline SDS measures independently predicted </span><span style="font-family:"Times New Roman",serif">Δ</span><span style="font-family:"Times New Roman",serif">LVEF, </span><span style="font-family:"Times New Roman",serif">Δ</span><span style="font-family:"Times New Roman",serif">RWMS, or </span><span style="font-family:"Times New Roman",serif">Δ</span><span style="font-family:"Times New Roman",serif">GLS. The baseline value of each echocardiographic parameter remained the strongest determinant of its follow-up change.</span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-family:"Times New Roman",serif">Conclusion:</span></strong></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><span style="font-family:"Times New Roman",serif">Although CTO-PCI resulted in substantial reductions in global and regional ischemia, echocardiographic markers of left ventricular function showed minimal change and were not independently related to either baseline ischemia or ischemia reduction. These findings suggest a dissociation between reductions in PET-derived perfusion abnormalities and short-term echocardiographic changes in CTO patients, highlighting the complexity of assessing myocardial recovery after revascularization.</span></span></span></p>
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