The Official Journal of EuroPCR and the European Association of Percutaneous Coronary Interventions (EAPCI)

Association between Coronary Collaterals and Myocardial Viability in Patients with a Chronic Total Occlusion

DOI: 10.4244/EIJ-D-19-01006

1. Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands, 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.

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Aims: This study evaluated associations between coronary collaterals and myocardial viability assessed by quantitative cardiac magnetic resonance (CMR) imaging in patients with a chronic coronary total occlusion (CTO).

Methods and results: 218 patients with a CTO who underwent CMR between 2013-2018 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 characterized poorly-developed collaterals. Dysfunctional myocardium (<3mm segmental wall thickening (SWT)) and ≤50% late gadolinium enhancement defined viability. Extensive scar (LGE>50%) was observed in only 5% of CTO segments. In the CTO territory, SWT was higher (3.72±1.51 vs. 3.05±1.60mm, p<0.01) and extent of scar was lower (7.0 [0.1-16.7] vs. 13.1% [2.8-22.2], p=0.048) in patients having well-developed vs. poorly-developed collaterals. Viability was more prevalent in CTO segments among patients with poorly-developed vs. well-developed collaterals (44% vs. 30% of segments, p<0.01), predominantly due to 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.

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