The relationship between the contralateral collateral supply and myocardial viability on cardiovascular magnetic resonance: can the angiogram predict functional recovery?

2.50
Hdl Handle:
http://hdl.handle.net/11287/593882
Title:
The relationship between the contralateral collateral supply and myocardial viability on cardiovascular magnetic resonance: can the angiogram predict functional recovery?
Authors:
Ripley, David P.; Gosling, Oliver E.; Bhatia, L.; Peebles, C. R.; Shore, Angela ( 0000-0003-3039-308x ) ; Curzen, N.; Bellenger, Nick G.
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.
Citation:
Int J Cardiol. 2014 Dec 15;177(2):362-7.
Publisher:
Elsevier
Journal:
International journal of cardiology
Issue Date:
15-Dec-2014
URI:
http://hdl.handle.net/11287/593882
DOI:
10.1016/j.ijcard.2014.06.048
PubMed ID:
25440470
Additional Links:
http://www.sciencedirect.com/science/article/pii/S0167527314011152
Type:
Journal Article; Research Support, Non-U.S. Gov't
Language:
eng
ISSN:
1874-1754
Appears in Collections:
2014 RD&E publications; Cardiology; Honorary contracts publications

Full metadata record

DC FieldValue Language
dc.contributor.authorRipley, David P.en
dc.contributor.authorGosling, Oliver E.en
dc.contributor.authorBhatia, L.en
dc.contributor.authorPeebles, C. R.en
dc.contributor.authorShore, Angelaen
dc.contributor.authorCurzen, N.en
dc.contributor.authorBellenger, Nick G.en
dc.date.accessioned2016-01-19T12:36:15Zen
dc.date.available2016-01-19T12:36:15Zen
dc.date.issued2014-12-15en
dc.identifier.citationInt J Cardiol. 2014 Dec 15;177(2):362-7.en
dc.identifier.issn1874-1754en
dc.identifier.pmid25440470en
dc.identifier.doi10.1016/j.ijcard.2014.06.048en
dc.identifier.urihttp://hdl.handle.net/11287/593882en
dc.description.abstractBACKGROUND: 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.en
dc.language.isoengen
dc.publisherElsevieren
dc.relation.urlhttp://www.sciencedirect.com/science/article/pii/S0167527314011152en
dc.titleThe relationship between the contralateral collateral supply and myocardial viability on cardiovascular magnetic resonance: can the angiogram predict functional recovery?en
dc.typeJournal Articleen
dc.typeResearch Support, Non-U.S. Gov'ten
dc.identifier.journalInternational journal of cardiologyen

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