Prompt and consistent improvement of coronary flow velocity reserve following successful recanalization of the coronary chronic total occlusion in patients with viable myocardium

Milan Dobric, Branko Beleslin, Milorad Tesic, Ana Djordjevic Dikic, Sinisa Stojkovic, Vojislav Giga, Miloje Tomasevic, Ivana Jovanovic, Olga Petrovic, Jelena Rakocevic, Nikola Boskovic, Dragana Sobic Saranovic, Goran Stankovic, Vladan Vukcevic, Dejan Orlic, Dragan Simic, Milan A Nedeljkovic, Srdjan Aleksandric, Stefan Juricic, Miodrag Ostojic, Milan Dobric, Branko Beleslin, Milorad Tesic, Ana Djordjevic Dikic, Sinisa Stojkovic, Vojislav Giga, Miloje Tomasevic, Ivana Jovanovic, Olga Petrovic, Jelena Rakocevic, Nikola Boskovic, Dragana Sobic Saranovic, Goran Stankovic, Vladan Vukcevic, Dejan Orlic, Dragan Simic, Milan A Nedeljkovic, Srdjan Aleksandric, Stefan Juricic, Miodrag Ostojic

Abstract

Background: Coronary chronic total occlusion (CTO) is characterized by the presence of collateral blood vessels which can provide additional blood supply to CTO-artery dependent myocardium. Successful CTO recanalization is followed by significant decrease in collateral donor artery blood flow and collateral derecruitment, but data on coronary hemodynamic changes in relation to myocardial function are limited. We assessed changes in coronary flow velocity reserve (CFVR) by echocardiography in collateral donor and recanalized artery following successful opening of coronary CTO.

Methods: Our study enrolled 31 patients (60 ± 9 years; 22 male) with CTO and viable myocardium by SPECT scheduled for percutaneous coronary intervention (PCI). Non-invasive CFVR was measured in collateral donor artery before PCI, 24 h and 6 months post-PCI, and 24 h and 6 months in recanalized artery following successful PCI of CTO.

Results: Collateral donor artery showed significant increase in CFVR 24 h after CTO recanalization compared to pre-PCI values (2.30 ± 0.49 vs. 2.71 ± 0.45, p = 0.005), which remained unchanged after 6-months (2.68 ± 0.24). Baseline blood flow velocity of the collateral donor artery significantly decreased 24 h post-PCI compared to pre-PCI (0.28 ± 0.06 vs. 0.24 ± 0.04 m/s), and remained similar after 6 months, with no significant difference in maximum hyperemic blood flow velocity pre-PCI, 24 h and 6 months post-PCI. CFVR of the recanalized coronary artery 24 h post-PCI was 2.55 ± 0.35, and remained similar 6 months later (2.62 ± 0.26, p = NS).

Conclusions: In patients with viable myocardium, prompt and significant CFVR increase in both recanalized and collateral donor artery, was observed within 24 h after successful recanalization of CTO artery, which maintained constant during the 6 months.

Trial registration: ClinicalTrials.gov (Number NCT04060615 ).

Keywords: CFVR; CTO; Coronary chronic total occlusion; Coronary flow velocity reserve; Recanalization.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Temporal change in CFVR (a), maximum baseline blood flow velocity (b), and maximum hyperemic blood flow velocity of the donor artery (c) before PCI, 24 h after, and 6 months after PCI, *values represent mean ± standard deviation
Fig. 2
Fig. 2
Inverse correlation between LVEF measured by gated SPECT MPI (x-axis) and change (delta) in CFVR of the collateral donor artery 24 h post-PCI compared to pre-PCI values (y-axis)
Fig. 3
Fig. 3
a Before CTO RCA recanalization: CTO of RCA with collaterals from LAD (A1); peak baseline (A2) and hyperemic (A3) diastolic flow velocities in collateral donor LAD artery - CFVR LAD (0.76/0.36) - 2.11. b After CTO RCA recanalization: Recanalized RCA (B1); peak baseline (B2) and hyperemic (B3) diastolic flow velocities in LAD artery - CFVR LAD (0.74/0.29) - 2.55

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