Coronary collaterals and myocardial viability in patients with chronic total occlusions.
- 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
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.
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。
METHODS::We present the case of a 61-year-old woman with a large tumoral infiltration extending from the pelvis throughout the inferior vena cava inferior to the right atrium, protruding into the right ventricle and right ventricular outflow tract. She had been treated 10 years before for low-grade endometrial stromal sarcoma by hysterectomy and adnexectomy followed by hormone- and radio-therapy. Due to cancer recurrence, she underwent peritonectomy, appendectomy, and resection of terminal ileum.
METHODS:AIMS:Significant platelet activation after long stented coronary segments has been associated with periprocedural microvascular impairment and myonecrosis. In long lesions treated either with an everolimus-eluting bioresorbable vascular scaffold (BVS) or an everolimus-eluting stent (EES), we aimed to investigate (a) procedure-related microvascular impairment, and (b) the relationship of platelet activation with microvascular function and related myonecrosis. METHODS AND RESULTS:Patients (n=66) undergoing elective percutaneous coronary intervention (PCI) in long lesions were randomised 1:1 to either BVS or EES. The primary endpoint was the difference between groups in changes of pressure-derived corrected index of microvascular resistance (cIMR) after PCI. Periprocedural myonecrosis was assessed by high-sensitivity cardiac troponin T (hs-cTnT), platelet reactivity by high-sensitivity adenosine diphosphate (hs-ADP)-induced platelet reactivity with the Multiplate Analyzer. Post-dilatation was more frequent in the BVS group, with consequent longer procedure time. A significant difference was observed between the two groups in the primary endpoint of ΔcIMR (p=0.04). hs-ADP was not different between the groups at different time points. hs-cTnT significantly increased after PCI, without difference between the groups. CONCLUSIONS:In long lesions, BVS implantation is associated with significant acute reduction in IMR as compared with EES, with no significant interaction with platelet reactivity or periprocedural myonecrosis.
METHODS:BACKGROUND:Aortopulmonary window is an uncommon congenital heart disease, with untreated cases not surviving beyond childhood. However, very rarely it can present in adult patients with features of pulmonary hypertension. Clinically these patients cannot be differentiated from other more common conditions with left to right shunt. Transthoracic echocardiography if performed meticulously, can depict the defect in aortopulmonary septum. RESULTS:We report a case of large unrepaired aortopulmonary window in a 23 years old patient, diagnosed on transthoracic echocardiography.