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Evaluation of Collateral Circulation and Ischemia in CTO Using [¹³N]NH3 PET-CT: Insights from Quantitative Perfusion Analysis
Session:
Sessão de Posters 28 - Do diagnóstico à decisão: cuidados orientados por imagem na era moderna
Speaker:
Tomás M. Carlos
Congress:
CPC 2026
Topic:
B. Imaging
Theme:
03. Imaging
Subtheme:
03.4 Nuclear Imaging
Session Type:
Posters Eletrónicos
FP Number:
---
Authors:
Tomás M. Carlos; Luísa Gomes Rocha; Ava Bahadoran; Luís Leite; Gustavo Campos; 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>Introduction:</strong></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif">In chronic total coronary occlusions (CTO), myocardial perfusion distal to the occlusion is maintained through collateral vessels arising from adjacent arteries, which may limit ischemia and partially preserve ventricular function. Angiographic classifications such as Rentrop or Werner are commonly used to grade collateralization, although their relationship with myocardial ischemic burden remains insufficiently defined. This study sought to assess whether angiographic collateral characteristics in CTO correlate with quantitative myocardial ischemic burden using [<sup>13</sup>N]NH<sub>3</sub> positron emission tomography computed tomography (PET-CT).</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>Methods:</strong></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif">We performed a prospective, single-centre observational study of patients with CTO who underwent coronary angiography and quantitative myocardial perfusion with [¹³N]NH3 PET-CT, analyzed with the PCARDP (PMOD Cardiac PET Analysis Tool) software. Patients with insufficient data were excluded. Collateralization was categorized as well developed (WD) when both Rentrop grade 3 and Werner collateral connection score 2 or 3 were present, whereas the remaining were categorized as poorly developed (PD). Baseline characteristics and myocardial perfusion in the CTO territory were compared between the two groups.</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>Results:</strong></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif">Fifteen patients were enrolled, with a mean age of 66.8 ± 4.2 years and a predominance of males (80%). The right coronary artery was the most involved vessel (60%). WD collaterals were identified in 9 patients (60%). Quantitative PET analysis of myocardial ischemic burden revealed no significant differences between patients with WD and PD collaterals in hyperaemic myocardial blood flow (1.24±0.53 vs. 1.25±0.38 mL·min</span><span style="font-family:"Cambria Math",serif">?</span><span style="font-family:Aptos,sans-serif">¹·g</span><span style="font-family:"Cambria Math",serif">?</span></span><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif">¹, <em>p</em>=0.971), resting myocardial blood flow (0.66±0.17 vs. 0.74±0.32 mL·min</span><span style="font-family:"Cambria Math",serif">?</span><span style="font-family:Aptos,sans-serif">¹</span><span style="font-family:Aptos,sans-serif">·g</span><span style="font-family:"Cambria Math",serif">?</span><span style="font-family:"Aptos",sans-serif">¹</span><span style="font-family:Aptos,sans-serif">, </span><em>p</em><span style="font-family:Aptos,sans-serif">=0.513), or myocardial flow reserve (1.91±0.59 vs. 1.91±0.81, </span><em>p</em><span style="font-family:Aptos,sans-serif">=0.893).</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>Conclusion:</strong></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif">Angiographic assessment of collateral circulation in CTO did not correlate with quantitative ischemic burden measured by [¹³N]NH3 PET-CT. These findings suggest that angiographic collateral grading alone may be insufficient to predict the extent of ischemia and should be used cautiously when guiding decisions regarding revascularization. </span></span></p>
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