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Coronary collaterals and myocardial viability in patients with chronic total occlusions.

慢性完全闭塞患者的冠状动脉侧支循环和心肌存活性。

  • 影响因子:2.41
  • DOI:10.4244/EIJ-D-19-01006
  • 作者列表:"Schumacher SP","Everaars H","Stuijfzand WJ","Huynh JW","van Diemen PA","Bom MJ","de Winter RW","van Loon RB","van de Ven PM","van Rossum AC","Opolski MP","Nap A","Knaapen P
  • 发表时间:2020-08-07
Abstract

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.

摘要

目的: 本研究旨在通过定量心脏磁共振 (CMR) 成像评估慢性冠状动脉完全闭塞 (CTO) 患者冠状动脉侧支循环与心肌存活力之间的相关性。 方法和结果: 共纳入218例在2013年至2018年间接受CMR的CTO患者。伴随的侧支连接 (CC) 评分2和Rentrop分级3在146 (67%) 例患者中定义了发育良好的侧支,而较低的CC评分或Rentrop分级表征了发育不良的侧支。功能障碍心肌 (<3毫米节段性壁增厚 [SWT]) 和 ≤ 50% 晚期钆增强 (LGE) 定义的活力。仅在50% 的CTO节段中观察到广泛瘢痕 (LGE> 5%)。在CTO领域,SWT较大 (3.72 ± 1.51 vs 3.05 ± 1.60毫米,p<0.01),瘢痕程度较小 (7.0 [0.1-16.7] vs 13.1% [2.8-22.2],p = 0.048)。在侧支循环发育不良的患者中,CTO节段的存活率高于发育良好的患者 (44% vs 30% 的节段,p<0.01),这主要是由于侧支循环发育不良组中功能障碍心肌的患病率较高 (51% vs 34% 的节段,p<0.01)。 结论: 由CTO处理的心肌梗塞区域通常是有限的。发达的侧支与较少的心肌瘢痕和增强的保留功能相关。然而,活动力经常存在于侧支发育不良的患者中。可视化摘要。CMR衍生的具有功能恢复潜力的活力经常存在于CTO患者中发育不良的侧支供应的心肌中。

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影响因子:2.41
发表时间:2020-06-12
DOI:10.4244/EIJ-D-18-01138
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影响因子:1.67
发表时间:2020-01-01
DOI:10.2174/1573403X15666190513105231
作者列表:["Dev M","Sharma M","Rana N"]

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心脏影像技术方向

心脏结构和心脏血流的可视化,用于诊断评估或通过内窥镜、放射性核素成像等技术来指导心脏手术。

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