Collateral presence and extent do not predict myocardial viability and ischemia in chronic total occlusions: A stress-CMR study.

Humans Contrast Media Gadolinium Myocardium / pathology Dobutamine Adenosine Ischemia / pathology Predictive Value of Tests Magnetic Resonance Imaging, Cine / methods Myocardial Ischemia / diagnostic imaging

Collateral circulation Dobutamine stress test Late gadolinium enhancement Myocardial ischemia Myocardial viability Stress cardiac magnetic resonance

Journal

International journal of cardiology

ISSN: 1874-1754

Titre abrégé: Int J Cardiol

Pays: Netherlands

ID NLM: 8200291

Informations de publication

Date de publication:
15 Jan 2023

Historique:

received: 09 03 2022

revised: 05 08 2022

accepted: 26 09 2022

pubmed: 2 10 2022

medline: 15 12 2022

entrez: 1 10 2022

Statut: ppublish

Résumé

Well-developed collaterals are assumed as a marker of viability and ischemia in chronic total occlusions (CTO). We aim to correlate viability and ischemia with collateral presence and extent in CTO patients by cardiac magnetic resonance (CMR). Multicentre study of 150 CTO patients undergoing stress-CMR, including adenosine if normal systolic function, high-dose-dobutamine for patients with akinetic/>2 hypokinetic segments and EF ≥35%, otherwise low-dose-dobutamine (LDD); all patients underwent late gadolinium enhancement (LGE) imaging. Viability was defined as mean LGE transmurality ≤50% for adenosine, as functional improvement for dobutamine-stress-test, ischemia as ≥1.5 segments with perfusion defects outside the scar zone. Rentrop 3/CC 2 defined well-developed (WD, n = 74) vs poorly-developed collaterals (PD, n = 76). Viability was equally prevalent in WD vs PD: normo-functional myocardium with ≤50% LGE in 52% vs 58% segments, p = 0.76, functional improvement by LDD in 48% vs 52%, p = 0.12. Segments with none, 1-25%,26-50%,51-75% LGE showed viability by LDD in 90%,84%,81%,61% of cases, whilst in 12% if 76-100% LGE (p < 0.01). There was no difference in WD vs PD for ischemia presence (74% vs 75%, p = 0.99) and extent (2.7 vs 2.8 segments, p = 0.77). In a large cohort of CTO patients, presence and extent of collaterals did not predict viability and ischemia by stress-CMR. Scar extent up to 75% LGE was still associated with viability, whereas ischemia was undetectable in 25% of patients, suggesting that the assessment of CTO patients with CMR would lead to a more comprehensive evaluation of viability and ischemia to guide revascularization.

Sections du résumé

BACKGROUND BACKGROUND

METHODS METHODS

Multicentre study of 150 CTO patients undergoing stress-CMR, including adenosine if normal systolic function, high-dose-dobutamine for patients with akinetic/>2 hypokinetic segments and EF ≥35%, otherwise low-dose-dobutamine (LDD); all patients underwent late gadolinium enhancement (LGE) imaging. Viability was defined as mean LGE transmurality ≤50% for adenosine, as functional improvement for dobutamine-stress-test, ischemia as ≥1.5 segments with perfusion defects outside the scar zone.

RESULTS RESULTS

Rentrop 3/CC 2 defined well-developed (WD, n = 74) vs poorly-developed collaterals (PD, n = 76). Viability was equally prevalent in WD vs PD: normo-functional myocardium with ≤50% LGE in 52% vs 58% segments, p = 0.76, functional improvement by LDD in 48% vs 52%, p = 0.12. Segments with none, 1-25%,26-50%,51-75% LGE showed viability by LDD in 90%,84%,81%,61% of cases, whilst in 12% if 76-100% LGE (p < 0.01). There was no difference in WD vs PD for ischemia presence (74% vs 75%, p = 0.99) and extent (2.7 vs 2.8 segments, p = 0.77).

CONCLUSIONS CONCLUSIONS

In a large cohort of CTO patients, presence and extent of collaterals did not predict viability and ischemia by stress-CMR. Scar extent up to 75% LGE was still associated with viability, whereas ischemia was undetectable in 25% of patients, suggesting that the assessment of CTO patients with CMR would lead to a more comprehensive evaluation of viability and ischemia to guide revascularization.

Identifiants

DOI: 10.1016/j.ijcard.2022.09.071 PMID: 36181950

pubmed: 36181950

pii: S0167-5273(22)01421-8

doi: 10.1016/j.ijcard.2022.09.071

pii:

doi:

Substances chimiques

Contrast Media 0

Gadolinium AU0V1LM3JT

Dobutamine 3S12J47372

Adenosine K72T3FS567

Types de publication

Multicenter Study Journal Article

Langues

eng

Sous-ensembles de citation

Pagination

10-15

Informations de copyright

Déclaration de conflit d'intérêts

Declaration of Competing Interest The authors report no relationships with Industries or other Institutions that could be construed as a conflict of interest related to the present work.