Coronary interventions

Coronary collaterals and myocardial viability in patients with chronic total occlusions

EuroIntervention 2020;16:453-461. DOI: 10.4244/EIJ-D-19-01006

Stefan Schumacher
Stefan P. Schumacher1, MD; Henk Everaars1, MD; Wijnand J. Stuijfzand1, MD; Jennifer W. Huynh1, BSc; Pepijn A. van Diemen1, MD; Michiel J. Bom1, MD; Ruben W. de Winter1, MD; Ramon B. van Loon1, MD, PhD; Peter M. van de Ven2, PhD; Albert C. van Rossum1, MD, PhD; Maksymilian P. Opolski3, MD, PhD; Alexander Nap1, MD, PhD; Paul Knaapen1, MD, PhD
1. Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; 2. Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; 3. Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland

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.

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non-invasive imagingstable anginachronic coronary total occlusion
Coronary interventionsCTO
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