Original Article

Value of Myocardial Regional Perfusion on Long-Term Function in Collateral-Dependent Myocardium

Authors: Jun Jin, MD, Lan Huang, MD, Hong Wang, MD, Yao-Ming Song, MD, Ai-Ming Li, MD, Jun Qin, MD, Xue-Jun Yu, MD, Zhao-Hua Geng, MD, Xiao-Bo Zhou, MD, Gang Zhao, MD, Yun-Hua Gao, MD, Zhen Liu, MD, Li Yang, MD, Hong-Mei Xia, MD

Abstract

Background: Collateral circulation is considered key for left ventricular (LV) function recovery in patients with chronic total occlusion (CTO). However, there are conflicting reports about the influence of collaterals on LV recovery after revascularization.


Methods: Echocardiographic assessment of regional myocardial perfusion, wall motion score (WMS), and left ventricular ejection fraction (LVEF) were performed in patients with angiographically visible collateral circulation of grades 2 and 3.


Results: The WMS and LVEF of group B (with presence of myocardial regional perfusion) were significantly improved at one month and six months compared to those of group A (with absence of myocardial regional perfusion). The correlation between myocardial regional blood flow and changes in WMS and LVEF was significant at 6 months in patients with angiographically visible collateral circulation of grade 2 and 3. Similar correlations were observed on myocardial contrast echocardiography (MCE) score index.


Conclusion: Myocardial function recovery in patients with CTO is determined by myocardial regional perfusion. MCE has important value for prognosis and risk stratification in patients with CTO undergoing cardiac catheterization.


Key Points


* Collateral circulation is considered key for left ventricular (LV) function recovery in patients with chronic total occlusion (CTO).


* There are conflicting reports about the influence of collaterals on LV recovery after revascularization.


* Our study shows that myocardial function recovery in patients with CTO is not only closely linked to coronary collateral circulation, but is determined by myocardial regional perfusion.


* Myocardial contrast echocardiography has an important additional value for prognosis and risk stratification in patients with CTO undergoing cardiac catheterization.

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References

1. Werner GS, Surber R, Kuethe F, et al. Collaterals and the recovery of left ventricular function after recanalization of a chronic total coronary occlusion. Am Heart J 2005;149:129–137.
 
2. Suero JA, Marso SP, Jones PG, et al. Procedural outcomes and longterm survival among patients undergoing percutaneous coronary intervention of a chronic total occlusion in native coronary arteries: a 20-year experience. J Am Coll Cardiol 2001;38:409–414.
 
3. Olivari Z, Rubartelli P, Piscione F, et al. Immediate results and one-year clinical outcome after percutaneous coronary interventions in chronic total occlusions: data from a multicenter, prospective, observational study (TOAST-GISE). J Am Coll Cardiol 2003;41:1672–1678.
 
4. Sirnes PA, Myreng Y, Molstad P, et al. Improvement of left ventricular ejection fraction and wall motion after successful recanalization of chronic coronary occlusions. Eur Heart J 1998;19:273–281.
 
5. Dzavik V, Carere RG, Mancini GB, et al. Predictors of improvement in left ventricular function after percutaneous revascularization of occluded coronary arteries: a report from the Total Occlusion Study of Canada (TOSCA). Am Heart J 2001;142:301–308.
 
6. Anjaneyulu A, Raghavaraju P, Krishnaswamy R, et al. Demonstration of recanalized left coronary artery after thrombolysis by transthoracic echocardiography. J Am Soc Echocardiogr 2005;18:686–692.
 
7. Lamm G, Auer J, Berent R, et al. Chronic total occlusion–a definite state? Int J Cardiol 2005;102:155–156.
 
8. Seiler C. The human coronary collateral circulation. Heart 2003;89:1352–1357.
 
9. Gorlin R. Coronary collaterals. Major Probl Intern Med 1976;11:59–70.
 
10. Saito Y, Yasuno M, Ishida M, et al. Importance of coronary collaterals for restoration of left ventricular function after intracoronary thrombolysis. Am J Cardiol 1985;55:1259–1263.
 
11. Cohen M, Rentrop KP. Limitation of myocardial ischemia by collateral circulation during sudden controlled coronary artery occlusion in human subjects: a prospective study. Circulation 1986;74:469–476.
 
12. Sabia PJ, Powers ER, Jayaweera AR, et al. Functional significance of collateral blood flow in patients with recent acute myocardial infarction. A study using myocardial contrast echocardiography. Circulation 1992;85:2080–2089.
 
13. Onishi T, Uematsu M, Nanto S, et al. Positive isovolumic relaxation velocity detected by a spectral tissue Doppler mapping technique as an indicator of coronary artery disease: a prospective study. J Am Soc Echocardiogr 2007;20:158–164.
 
14. Hirai T, Fujita M, Nakajima H, et al. Importance of collateral circulation for prevention of left ventricular aneurysm formation in acute myocardial infarction. Circulation 1989;79:791–796.
 
15. Fukai M, Ii M, Nakakoji T, et al. Angiographically demonstrated coronary collaterals predict residual viable myocardium in patients with chronic myocardial infarction: a regional metabolic study. J Cardiol 2000;35:103–111.
 
16. Banerjee AK, Madan Mohan SK, Ching GW, et al. Functional significance of coronary vessels in patients with previous ‘Q' wave infarction: relation to aneurysm, left ventricular end diastolic pressure and ejection fraction. Int J Cardiol 1993;38:263–271.
 
17. Mutlak DM, Habib S, Markiewicz W, et al. Determinants of regional myocardial function in patients with chronic significant coronary stenosis or occlusion. Am Heart J 1998;136:169–175.
 
18. Ragosta M, Camarano G, Kaul S, et al. Microvascular integrity indicates myocellular viability in patients with recent myocardial infarction. New insights using myocardial contrast echocardiography. Circulation 1994;89:2562–2569.
 
19. Swinburn JM, Lahiri A, Senior R. Intravenous myocardial contrast echocardiography predicts recovery of dysynergic myocardium early after acute myocardial infarction. J Am Coll Cardiol 2001;38:19–25.
 
20. Janardhanan R, Swinburn JM, Greaves K, et al. Usefulness of myocardial contrast echocardiography using low-power continuous imaging early after acute myocardial infarction to predict late functional left ventricular recovery. Am J Cardiol 2003;92:493–497.
 
21. Rentrop KP, Cohen M, Blanke H, et al. Changes in collateral filling after controlled coronary artery occlusion by an angioplasty balloon in human subjects. J Am Coll Cardiol 1985;5:587–592.
 
22. Levin DC. Pathways and functional significance of the coronary collateral circulation. Circulation 1974;50:831–837.
 
23. Rockstroh J, Brown BG. Coronary collateral size, flow capacity, and growth: estimates from the angiogram in patients with obstructive coronary artery disease. Circulation 2002;105:168–173.
 
24. Bolognese L, Antoniucci D, Rovai D, et al. Myocardial contrast echocardiography versus dobutamine echocardiography for predicting functional recovery after acute myocardial infarction treated with primary coronary angioplasty. J Am Coll Cardiol 1996;28:1677–1683.
 
25. Schiller NB, Shah PM, Crawford M, et al. Recommendations for quantitation of the left ventricle by two-dimensional echocardiography.American Society of Echocardiography Committee on Standards, Subcommittee on Quantitation of Two-Dimensional Echocardiograms. J Am Soc Echocardiogr 1989;2:358–367.
 
26. Cianciulli TF, Lax JA, Beck MA, et al. Usefulness of myocardial contrast echocardiography early after acute myocardial infarction. Echocardiography 2006;23:208–217.
 
27. Iwanaga S, Ewing SG, Husseini WK, et al. Changes in contractility and afterload have only slight effects on subendocardial systolic flow impediment. Am J Physiol 1995;269:H1202–H1212.
 
28. Wei K, Jayaweera AR, Firoozan S, et al. Quantification of myocardial blood flow with ultrasound-induced destruction of microbubbles administered as a constant venous infusion. Circulation 1998;97:473–483.
 
29. Vernon SM, Camarano G, Kaul S, et al. Myocardial contrast echocardiography demonstrates that collateral flow can preserve myocardial function beyond a chronically occluded coronary artery. Am J Cardiol 1996;78:958–960.
 
30. Werner GS, Richartz BM, Gastmann O, et al. Immediate changes of collateral function after successful recanalization of chronic total coronary occlusions. Circulation 2000;102:2959–2965.
 
31. Werner GS, Ferrari M, Betge S, et al. Collateral function in chronic total coronary occlusions is related to regional myocardial function and duration of occlusion. Circulation 2001;104:2784–2790.
 
32. Van Liebergen RA, Piek JJ, Koch KT, et al. Quantification of collateral flow in humans: a comparison of angiographic, electrocardiographic and hemodynamic variables. J Am Coll Cardiol 1999;33:670–677.
 
33. Hickman M, Janardhanan R, Dwivedi G, et al. Clinical significance of perfusion techniques utilising different physiological mechanisms to detect myocardial viability: a comparative study with myocardial contrast echocardiography and single photon emission computed tomography. Int J Cardiol 2007;114:139–140.