David P Ripley1, Oliver E Gosling1, Loke Bhatia2, Charles R Peebles2, Angela C Shore3, Nick Curzen2, Nick G Bellenger4. 1. Cardiovascular Magnetic Resonance Unit, Royal Devon & Exeter NHS Foundation Trust, Barrack Road, Exeter EX2 5DW, United Kingdom; University of Exeter, Barrack Road, Exeter EX2 5DW, United Kingdom. 2. University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, United Kingdom; Faculty of Medicine, University of Southampton, United Kingdom. 3. University of Exeter, Barrack Road, Exeter EX2 5DW, United Kingdom. 4. Cardiovascular Magnetic Resonance Unit, Royal Devon & Exeter NHS Foundation Trust, Barrack Road, Exeter EX2 5DW, United Kingdom; University of Exeter, Barrack Road, Exeter EX2 5DW, United Kingdom. Electronic address: nick.bellenger@nhs.net.
Abstract
BACKGROUND: A collateral circulation which supplies a myocardial territory, subtended by a chronic total occlusion (CTO), may be observed at invasive coronary angiography. The prognostic and protective role of such collateralisation is well demonstrated suggesting that a good collateral circulation may be a predictor of myocardial viability, but current evidence is discrepant. The aim of this study is to assess the relationship between collateralisation from the contralateral epicardial vessels and myocardial viability by cardiovascular magnetic resonance (CMR). METHOD: Consecutive patients with CTO having had both CMR and invasive coronary angiography were retrospectively identified. The collateral circulation was graded with the Cohen and Rentrop classification. CMR images were graded per segment for wall motion (1: normal/hyperkinetic, 2: hypokinetic, 3: akinetic, or 4: dyskinetic) and wall motion score index (WMSI) was calculated. The segmental transmurality of late gadolinium enhancement was scored as 1 (0%), 2 (1-25%), 3 (26-50%), 4 (51-75%) and 5 (76-100%). RESULTS: A good collateral circulation was more likely to supply viable myocardium (p=0.01). There was no relationship between collateral circulation supply and wall motion score index (WMSI), however, increasing transmurality of LGE was significantly associated with higher mean WMSI representing increasing dysfunctional myocardium (p<0.001). CONCLUSION: The presence of collateral coronary circulation at angiography predicts the presence of viability on cardiovascular MRI, with a gradation of greater viability associated with improving Rentrop grade. A collateral circulation at angiography should, therefore, prompt more formal assessment of viability and consideration of revascularisation in order for the patient to obtain the associated functional and prognostic improvement.
BACKGROUND: A collateral circulation which supplies a myocardial territory, subtended by a chronic total occlusion (CTO), may be observed at invasive coronary angiography. The prognostic and protective role of such collateralisation is well demonstrated suggesting that a good collateral circulation may be a predictor of myocardial viability, but current evidence is discrepant. The aim of this study is to assess the relationship between collateralisation from the contralateral epicardial vessels and myocardial viability by cardiovascular magnetic resonance (CMR). METHOD: Consecutive patients with CTO having had both CMR and invasive coronary angiography were retrospectively identified. The collateral circulation was graded with the Cohen and Rentrop classification. CMR images were graded per segment for wall motion (1: normal/hyperkinetic, 2: hypokinetic, 3: akinetic, or 4: dyskinetic) and wall motion score index (WMSI) was calculated. The segmental transmurality of late gadolinium enhancement was scored as 1 (0%), 2 (1-25%), 3 (26-50%), 4 (51-75%) and 5 (76-100%). RESULTS: A good collateral circulation was more likely to supply viable myocardium (p=0.01). There was no relationship between collateral circulation supply and wall motion score index (WMSI), however, increasing transmurality of LGE was significantly associated with higher mean WMSI representing increasing dysfunctional myocardium (p<0.001). CONCLUSION: The presence of collateral coronary circulation at angiography predicts the presence of viability on cardiovascular MRI, with a gradation of greater viability associated with improving Rentrop grade. A collateral circulation at angiography should, therefore, prompt more formal assessment of viability and consideration of revascularisation in order for the patient to obtain the associated functional and prognostic improvement.
Authors: Maja Pirnat; Arthur E Stillman; Rainer Rienmueller; Marko Noc; Mario Gorenjak; Tomaž Šeruga Journal: Int J Cardiovasc Imaging Date: 2020-09-21 Impact factor: 2.357
Authors: Wijnand J Stuijfzand; Pieter G Raijmakers; Roel S Driessen; Niels van Royen; Alexander Nap; Albert C van Rossum; Paul Knaapen Journal: Curr Cardiovasc Imaging Rep Date: 2015
Authors: Maurits R Hollander; Matthijs F Jansen; Luuk H G A Hopman; Edward Dolk; Peter M van de Ven; Paul Knaapen; Anton J Horrevoets; Esther Lutgens; Niels van Royen Journal: J Am Heart Assoc Date: 2019-10-09 Impact factor: 5.501
Authors: Se Yeon Choi; Byoung Geol Choi; Seung-Woon Rha; Man Jong Baek; Yang Gi Ryu; Yoonjee Park; Jae Kyeong Byun; Minsuk Shim; Hu Li; Ahmed Mashaly; Won Young Jang; Woohyeun Kim; Jah Yeon Choi; Eun Jin Park; Jin Oh Na; Cheol Ung Choi; Hong Euy Lim; Eung Ju Kim; Chang Gyu Park; Hong Seog Seo; Dong Joo Oh Journal: J Am Heart Assoc Date: 2017-09-13 Impact factor: 5.501