CORRELATION OF WELL-DEVELOPED COLLATERAL CIRCULATION AS A MARKER OF VIABILITY IN CHRONIC TOTAL OCCLUSION AS EVIDENCED BY CARDIAC MRI
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Keywords
Chronic total occlusion, myocardial viability, cardiac MRI, Rentrop classification, coronary collaterals, late gadolinium enhancement, revascularization
Abstract
Background: The complete blockage (occlusion) of coronary arteries (CTOs) poses a challenge when considering a patient for revascularization, especially for a chronic total occlusion (CTO). Evaluating myocardial viability is crucial in determining which patients will most likely benefit from the procedure. Angiographic collateral circulation can, perhaps, provide a marker of viability without needing a potentially invasive procedure. To evaluate the correlation between collateral vessel development and myocardial viability in patients with coronary CTO, using cardiac magnetic resonance imaging (CMR) as the reference standard.
Methods: This retrospective study reviewed 65 patients with angiographically confirmed CTO of the left anterior descending (LAD) or dominant right coronary artery (RCA), who underwent cardiac MRI within two weeks of angiography. Rentrop grading was used to classify collateral development. Viability was assessed on CMR using late gadolinium enhancement (LGE). The association between collateral grade and myocardial viability was analyzed statistically.
Results: Of the 65 patients, 55.4% had viable myocardium on CMR. Well-developed (Rentrop grade 2) and complete collaterals (grade 3) were significantly more common among patients with viable tissue (p = 0.003). Poor or absent collaterals correlated with non-viable segments.
Conclusion: Well-formed collateral circulation is strongly associated with myocardial viability in patients with chronic coronary occlusion. Rentrop grading may serve as a useful adjunct to guide revascularization decisions when advanced imaging is unavailable.
References
2. de Novoa, J.P.A.F., Chronic Total Oclusion: Collaterals and Myocardial Viability. 2021, Universidade de Coimbra (Portugal).
3. Yang, X., et al., Myocardial viability, functional status, and collaterals of patients with chronically occluded coronary arteries. Frontiers in Cardiovascular Medicine, 2021. 8: p. 754826.
4. Schumacher, S.P., et al., Coronary collaterals and myocardial viability in patients with chronic total occlusions. EuroIntervention, 2020. 16(6): p. e453-e461.
5. Pica, S., et al., Collateral presence and extent do not predict myocardial viability and ischemia in chronic total occlusions: a stress-CMR study. International Journal of Cardiology, 2023. 371: p. 10-15.
6. Leite, L., et al., The association of collaterals with myocardial ischemia and viability in chronic total occlusions. The International Journal of Cardiovascular Imaging, 2023. 39(4): p. 843-851.
7. Nazri, M. and R. Shar, Coronary chronic total occlusions and collateral circulation: physiological impact of percutaneous coronary intervention. 2023, Anglia Ruskin Research Online (ARRO).
8. Maguida, G. and A. Shuaib, Collateral circulation in ischemic stroke: an updated review. Journal of Stroke, 2023. 25(2): p. 179-198.
9. Allahwala, U.K., et al., The indications and utility of adjunctive imaging modalities for chronic total occlusion (CTO) intervention. Journal of Nuclear Cardiology, 2021. 28(6): p. 2597-2608.
10. Melotti, E., et al., The role of multimodality imaging for percutaneous coronary intervention in patients with chronic total occlusions. Frontiers in Cardiovascular Medicine, 2022. 9: p. 823091.
11. Li, Z., et al., Good coronary collateral circulation is not associated with better prognosis in patients with chronic total occlusion, regardless of treatment strategy. Hellenic Journal of Cardiology, 2023. 69: p. 9-15.
12. Kersten, J., et al., Non-invasive Imaging in Patients With Chronic Total Occlusions of the Coronary Arteries—What Does the Interventionalist Need for Success? Frontiers in Cardiovascular Medicine, 2021. 8: p. 713625.
13. Liao, R., et al., Revascularization of chronic total occlusion coronary artery and cardiac regeneration. Frontiers in Cardiovascular Medicine, 2022. 9: p. 940808.
14. Ybarra, L.F. and S. Rinfret, Why and how should we treat chronic total occlusion? Evolution of state-of-the-art methods and future directions. Canadian Journal of Cardiology, 2022. 38(10): p. S42-S53.
15. Assaf, A., et al., Vulnerability for ventricular arrhythmias in patients with chronic coronary total occlusion. Expert Review of Cardiovascular Therapy, 2020. 18(8): p. 487-494.
16. van Veelen, A., et al., Recovery of right ventricular function and strain in patients with ST-segment elevation myocardial infarction and concurrent chronic total occlusion. The International Journal of Cardiovascular Imaging, 2022: p. 1-11.
17. Dewey, M., et al., Clinical quantitative cardiac imaging for the assessment of myocardial ischaemia. Nature Reviews Cardiology, 2020. 17(7): p. 427-450.
18. Kim, S.-H., et al., Prognostic impact of percutaneous coronary intervention of chronic total occlusion in acute and periprocedural myocardial infarction. Journal of Clinical Medicine, 2021. 10(2): p. 258.
19. Frommelt, P., et al., Recommendations for multimodality assessment of congenital coronary anomalies: a guide from the American Society of Echocardiography: developed in collaboration with the Society for Cardiovascular Angiography and Interventions, Japanese Society of Echocardiography, and Society for Cardiovascular Magnetic Resonance. Journal of the American Society of Echocardiography, 2020. 33(3): p. 259-294.
20. Gold, D.A., et al., High Sensitivity Troponin Level and Benefits of Chronic Total Occlusion Revascularization. Journal of the American Heart Association, 2023. 12(21): p. e031431.
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Dr. Rafi Ullah Jan
Assistant Professor, MTI Peshawar Institute of Cardiology, Peshawar, Pakistan
Dr. Muhammad Waleed
Registrar, MTI Peshawar Institute of Cardiology, Peshawar, Pakistan
Dr. Maryam Masood
Senior Registrar, MTI Peshawar Institute of Cardiology, Peshawar, Pakistan