Can the degree of coronary collateralization be used in clinical routine as a valid angiographic parameter of viability?

Pirnat, Maja; Stillman, Arthur E.; Rienmueller, Rainer; Noč, Marko; Gorenjak, Mario; Seruga, Tomaz

doi:10.1007/s10554-020-01984-5

Cited by 3 publications

(3 citation statements)

References 39 publications

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“…Indeed, the presence of well-developed collateral circulation in segments affected by CTO is correlated with preserved myocardial function and reduced scar burden on cardiac magnetic resonance (CMR). 12,13 A meta-analysis of 34 observational studies found that successful revascularization of CTO is associated with an improvement in LVEF and a reduction in end-systolic volume. This is likely due to left ventricle reverse remodeling following coronary flow restoration.…”

Section: Coronary Anatomy Assessmentmentioning

confidence: 99%

“…In the case of chronically occluded or suboccluded coronary arteries, the subsequent step is to assess the presence and status of collateral circulation, which may originate from either the contralateral or ipsilateral coronary artery. Indeed, the presence of well‐developed collateral circulation in segments affected by CTO is correlated with preserved myocardial function and reduced scar burden on cardiac magnetic resonance (CMR) 12,13 . A meta‐analysis of 34 observational studies found that successful revascularization of CTO is associated with an improvement in LVEF and a reduction in end‐systolic volume.…”

Section: Introductionmentioning

confidence: 99%

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Clinical impact of multimodality assessment of myocardial viability

Canton,

Suma,

Amicone

et al. 2024

Echocardiography

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Coronary artery disease (CAD) is a prevalent cause of left ventricular dysfunction. Nevertheless, effective elective revascularization, particularly surgical revascularization, can enhance long‐term outcomes and, in selected cases, global left ventricular contractility. The assessment of myocardial viability and scars is still relevant in guiding treatment decisions and selecting patients who are likely to benefit most from blood flow restoration. Although the most recent randomized studies challenge the notion of “hibernating myocardium” and the clinical usefulness of assessing myocardial viability, the advancement of imaging techniques still renders this assessment valuable in specific situations. According to the guidelines of the European Society of Cardiology, non‐invasive stress imaging may be employed to define myocardial ischemia and viability in patients with CAD and heart failure before revascularization. Currently, several non‐invasive imaging techniques are available to evaluate the presence and extent of viable myocardium. The selection of the most suitable technique should be based on the patient, clinical context, and resource availability. This narrative review evaluates the characteristics of available imaging modalities for assessing myocardial viability to determine the most appropriate therapeutic strategy.

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Section: Coronary Anatomy Assessmentmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Clinical impact of multimodality assessment of myocardial viability

Canton,

Suma,

Amicone

et al. 2024

Echocardiography

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“…using 2-[ 18 F]FDG PET-CT also concluded that collateral circulation cannot accurately predict myocardial viability, but studies[15,32,33] using late gadolinium enhancement CMR stated that WD collaterals are associated with less myocardial scar. A study by Beitzke D. et al [34] used hybrid [ 13 N]NH3/2-[ 18 F]FDG PET-MRI to study viability assessment in ischemic heart disease (not only CTO patients)…”

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confidence: 99%

The association of collaterals with myocardial ischemia and viability in chronic total occlusions

Leite

Campos

Silva

et al. 2022

Int J Cardiovasc Imaging

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Collateral development in chronic total occlusions (CTO) is crucial to perfuse the distal myocardium and its angiographic evaluation is frequently used to assess the need for revascularization. We aimed to analyse the association between the presence of ischemia and hibernating myocardium, evaluated by cardiac [ 13 N]NH3/2-[ 18 F]FDG PET-CT, and the angiographic characterization of the collateral circulation.Prospective study including patients with a CTO who underwent a [ 13 N]NH3 and, when deemed necessary, 2-[ 18 F]FDG PET-CT. Well developed (WD) collaterals were de ned as a concomitant angiographic Rentrop grade 3 and Werner collateral connection score 2 or 3, whereas the remaining as poorly developed (PD). Two percentage thresholds used to identify prognostic bene t of revascularization were applied: ischemia >10% and hibernating myocardium >7%. Fifty-nine patients (age 62.9±9.1 years, 58 male) were recruited, WD collaterals were present in 28 (47.5%). No signi cant differences were found in ischemia (WD 6.4±4.3 vs. PD 7.0±4.1, p=0.64) and hibernation (WD 1.8±1.9 vs. PD 3.1±3.3, p=0.18) scores. Most CTO territories demonstrated ischemia, but only 19 (46.3%) were associated with an area >10% (WD 47.6% vs. PD 45.0%, p=0.58). Scared non-viable myocardium was limited to 9 (15.3%) patients and was not associated with PD collaterals. Hibernating myocardium was frequent (54.2%), but just 6 (10.2%) CTO patients had an area of >7% (WD 3.6% vs. PD 16.1%, p=0.20).Collateral assessment by angiography has a poor association with the ischemic burden and hibernation state of CTO territories. Myocardial viability was present even in most CTO with angiographic PD collaterals.

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The association of collaterals with myocardial ischemia and viability in chronic total occlusions

Leite

Campos

Silva

et al. 2022

Preprint

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Collateral development in chronic total occlusions (CTO) is crucial to perfuse the distal myocardium and its angiographic evaluation is frequently used to assess the need for revascularization. We aimed to analyse the association between the presence of ischemia and hibernating myocardium, evaluated by cardiac [13N]NH3/2-[18F]FDG PET-CT, and the angiographic characterization of the collateral circulation. Prospective study including patients with a CTO who underwent a [13N]NH3 and, when deemed necessary, 2-[18F]FDG PET-CT. Well developed (WD) collaterals were defined as a concomitant angiographic Rentrop grade 3 and Werner collateral connection score 2 or 3, whereas the remaining as poorly developed (PD). Two percentage thresholds used to identify prognostic benefit of revascularization were applied: ischemia >10% and hibernating myocardium >7%. Fifty-nine patients (age 62.9±9.1 years, 58 male) were recruited, WD collaterals were present in 28 (47.5%). No significant differences were found in ischemia (WD 6.4±4.3 vs. PD 7.0±4.1, p=0.64) and hibernation (WD 1.8±1.9 vs. PD 3.1±3.3, p=0.18) scores. Most CTO territories demonstrated ischemia, but only 19 (46.3%) were associated with an area >10% (WD 47.6% vs. PD 45.0%, p=0.58). Scared non-viable myocardium was limited to 9 (15.3%) patients and was not associated with PD collaterals. Hibernating myocardium was frequent (54.2%), but just 6 (10.2%) CTO patients had an area of >7% (WD 3.6% vs. PD 16.1%, p=0.20). Collateral assessment by angiography has a poor association with the ischemic burden and hibernation state of CTO territories. Myocardial viability was present even in most CTO with angiographic PD collaterals.

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Can the degree of coronary collateralization be used in clinical routine as a valid angiographic parameter of viability?

Cited by 3 publications

References 39 publications

Clinical impact of multimodality assessment of myocardial viability

Clinical impact of multimodality assessment of myocardial viability

The association of collaterals with myocardial ischemia and viability in chronic total occlusions

The association of collaterals with myocardial ischemia and viability in chronic total occlusions

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