TY - JOUR
T1 - Coronary collaterals and myocardial viability in patients with chronic total occlusions
AU - Schumacher, Stefan P.
AU - Everaars, Henk
AU - Stuijfzand, Wijnand J.
AU - Huynh, Jennifer W.
AU - van Diemen, Pepijn A.
AU - Bom, Michiel J.
AU - de Winter, Ruben W.
AU - van Loon, Ramon B.
AU - van de Ven, Peter M.
AU - van Rossum, Albert C.
AU - Opolski, Maksymilian P.
AU - Nap, Alexander
AU - Knaapen, Paul
N1 - Publisher Copyright: © Europa Digital & Publishing 2020. All rights reserved. Copyright: Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2021
Y1 - 2021
N2 - AIMS: This study aimed to evaluate associations between coronary collaterals and myocardial viability as assessed by quantitative cardiac magnetic resonance (CMR) imaging in patients with a chronic coronary total occlusion (CTO). METHODS AND RESULTS: A total of 218 patients with a CTO who underwent CMR between 2013 and 2018 were included. A concomitant collateral connection (CC) score 2 and Rentrop grade 3 defined well-developed collaterals in 146 (67%) patients, whereas lower CC scores or Rentrop grades characterised poorly developed collaterals. Dysfunctional myocardium (<3 mm segmental wall thickening [SWT]) and ≤50% late gadolinium enhancement (LGE) defined viability. Extensive scar (LGE >50%) was observed in only 5% of CTO segments. In the CTO territory, SWT was greater (3.72±1.51 vs 3.05±1.60 mm, p<0.01) and the extent of scar was less (7.0 [0.1-16.7] vs 13.1% [2.8-22.2], p=0.048) in patients having well-developed versus poorly developed collaterals. Viability was more prevalent in CTO segments among patients with poorly developed versus well-developed collaterals (44% vs 30% of segments, p<0.01), predominantly due to a higher prevalence of dysfunctional myocardium (51% vs 34% of segments, p<0.01) in the poorly developed collateral group. CONCLUSIONS: The infarcted area in myocardium subtended by a CTO is generally limited. Well-developed collaterals are associated with less myocardial scar and enhanced preserved function. However, viability was regularly present in patients with poorly developed collaterals. Visual summary. CMR-derived viability with potential for functional recovery is regularly present in myocardium supplied by poorly developed collaterals in patients with a CTO.
AB - AIMS: This study aimed to evaluate associations between coronary collaterals and myocardial viability as assessed by quantitative cardiac magnetic resonance (CMR) imaging in patients with a chronic coronary total occlusion (CTO). METHODS AND RESULTS: A total of 218 patients with a CTO who underwent CMR between 2013 and 2018 were included. A concomitant collateral connection (CC) score 2 and Rentrop grade 3 defined well-developed collaterals in 146 (67%) patients, whereas lower CC scores or Rentrop grades characterised poorly developed collaterals. Dysfunctional myocardium (<3 mm segmental wall thickening [SWT]) and ≤50% late gadolinium enhancement (LGE) defined viability. Extensive scar (LGE >50%) was observed in only 5% of CTO segments. In the CTO territory, SWT was greater (3.72±1.51 vs 3.05±1.60 mm, p<0.01) and the extent of scar was less (7.0 [0.1-16.7] vs 13.1% [2.8-22.2], p=0.048) in patients having well-developed versus poorly developed collaterals. Viability was more prevalent in CTO segments among patients with poorly developed versus well-developed collaterals (44% vs 30% of segments, p<0.01), predominantly due to a higher prevalence of dysfunctional myocardium (51% vs 34% of segments, p<0.01) in the poorly developed collateral group. CONCLUSIONS: The infarcted area in myocardium subtended by a CTO is generally limited. Well-developed collaterals are associated with less myocardial scar and enhanced preserved function. However, viability was regularly present in patients with poorly developed collaterals. Visual summary. CMR-derived viability with potential for functional recovery is regularly present in myocardium supplied by poorly developed collaterals in patients with a CTO.
KW - Chronic coronary total occlusion
KW - Non-invasive imaging
KW - Stable angina
UR - http://www.scopus.com/inward/record.url?scp=85089300729&partnerID=8YFLogxK
U2 - https://doi.org/10.4244/EIJ-D-19-01006
DO - https://doi.org/10.4244/EIJ-D-19-01006
M3 - Article
C2 - 32122823
SN - 1774-024X
VL - 16
SP - e453-e461
JO - Eurointervention
JF - Eurointervention
IS - 6
ER -