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

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    URI
    http://hdl.handle.net/11287/593882
    Author
    Ripley, David P.
    Gosling, Oliver E.
    Bhatia, L.
    Peebles, C. R.
    Shore, Angela
    Curzen, N.
    Bellenger, Nick G.
    Date
    2014-12-15
    Journal
    International journal of cardiology
    Type
    Journal Article
    Research Support, Non-U.S. Gov't
    Publisher
    Elsevier
    DOI
    10.1016/j.ijcard.2014.06.048
    Metadata
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    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 URL
    http://www.sciencedirect.com/science/article/pii/S0167527314011152
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    • 2014 RD&E publications
    • Cardiology
    • Honorary contracts publications

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