CMR Guidance for Recanalization of Coronary Chronic Total Occlusion

Chiara Bucciarelli-Ducci; Dominique Auger; Carlo Di Mario; Didier Locca; Joanna Petryka; Rory O'Hanlon; Agata Grasso; Christine Wright; Karen Symmonds; Ricardo Wage; Eleni Asimacopoulos; Francesca Del Furia; Jonathan C. Lyne; Peter D. Gatehouse; Kim M. Fox; Dudley J. Pennell

doi:10.1016/j.jcmg.2015.10.025

CMR Guidance for Recanalization of Coronary Chronic Total Occlusion

Chiara Bucciarelli-Ducci, Dominique Auger, Carlo Di Mario, Didier Locca, Joanna Petryka, Rory O'Hanlon, Agata Grasso, Christine Wright, Karen Symmonds, Ricardo Wage, Eleni Asimacopoulos, Francesca Del Furia, Jonathan C. Lyne, Peter D. Gatehouse, Kim M. Fox, Dudley J. Pennell

Research output: Contribution to journal › Article (Academic Journal) › peer-review

63 Citations (Scopus)

Abstract

Objectives

This study explored whether cardiac magnetic resonance (CMR) could help select patients who could benefit from revascularization by identifying inducible myocardial ischemia and viability in the perfusion territory of the artery with chronic total occlusion (CTO).

Background

The benefit of revascularization using percutaneous coronary intervention (PCI) in CTO is controversial. CMR offers incomparable left ventricular (LV) systolic function assessment in addition to potent ischemic burden quantification and reliable myocardial viability analysis. Whether CMR guided CTO revascularization would be helpful to such patients has not yet been explored fully.

Methods

A prospective study of 50 consecutive CTO patients was conducted. Of 50 patients undergoing baseline stress CMR, 32 (64%) were selected for recanalization based on the presence of significant inducible perfusion deficit and myocardial viability within the CTO arterial territory. Patients were rescanned 3 months after successful CTO recanalization.

Results

At baseline, myocardial perfusion reserve (MPR) in the CTO territory was significantly reduced compared with the remote region (1.8 ± 0.72 vs. 2.2 ± 0.7; p = 0.01). MPR in the CTO region improved significantly after PCI (to 2.3 ± 0.9; p = 0.02 vs. baseline) with complete or near-complete resolution of CTO related perfusion defect in 90% of patients. Remote territory MPR was unchanged after PCI (2.5 ± 1.2; p = NS vs. baseline). The LV ejection fraction increased from 63 ± 13% to 67 ± 12% (p < 0.0001) and end-systolic volume decreased from 65 ± 38 to 56 ± 38 ml (p < 0.001) 3 months after CTO PCI. Importantly, despite minimal post-procedural infarction due to distal embolization and side branch occlusion in 8 of 32 patients (25%), the total Seattle Angina Questionnaire score improved from a median of 54 (range 45 to 74) at baseline to 89 (range 77 to 98) after CTO recanalization (p < 0.0001).

Conclusions

In this small group of patients showing CMR evidence of significant myocardial inducible perfusion defect and viability, CTO recanalization reduces ischemic burden, favors reverse remodeling, and ameliorates quality of life.

Original language	English
Pages (from-to)	547-556
Number of pages	10
Journal	JACC: Cardiovascular Imaging
Volume	9
Issue number	5
Early online date	13 Apr 2016
DOIs	https://doi.org/10.1016/j.jcmg.2015.10.025
Publication status	Published - May 2016

Keywords

cardiac magnetic resonance
chronic total occlusion
coronary artery disease

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Bucciarelli-Ducci, C., Auger, D., Di Mario, C., Locca, D., Petryka, J., O'Hanlon, R., Grasso, A., Wright, C., Symmonds, K., Wage, R., Asimacopoulos, E., Del Furia, F., Lyne, J. C., Gatehouse, P. D., Fox, K. M., & Pennell, D. J. (2016). CMR Guidance for Recanalization of Coronary Chronic Total Occlusion. JACC: Cardiovascular Imaging, 9(5), 547-556. https://doi.org/10.1016/j.jcmg.2015.10.025

@article{1345117a663b42098c3200dd9548d605,

title = "CMR Guidance for Recanalization of Coronary Chronic Total Occlusion",

abstract = "ObjectivesThis study explored whether cardiac magnetic resonance (CMR) could help select patients who could benefit from revascularization by identifying inducible myocardial ischemia and viability in the perfusion territory of the artery with chronic total occlusion (CTO).BackgroundThe benefit of revascularization using percutaneous coronary intervention (PCI) in CTO is controversial. CMR offers incomparable left ventricular (LV) systolic function assessment in addition to potent ischemic burden quantification and reliable myocardial viability analysis. Whether CMR guided CTO revascularization would be helpful to such patients has not yet been explored fully.MethodsA prospective study of 50 consecutive CTO patients was conducted. Of 50 patients undergoing baseline stress CMR, 32 (64%) were selected for recanalization based on the presence of significant inducible perfusion deficit and myocardial viability within the CTO arterial territory. Patients were rescanned 3 months after successful CTO recanalization.ResultsAt baseline, myocardial perfusion reserve (MPR) in the CTO territory was significantly reduced compared with the remote region (1.8 ± 0.72 vs. 2.2 ± 0.7; p = 0.01). MPR in the CTO region improved significantly after PCI (to 2.3 ± 0.9; p = 0.02 vs. baseline) with complete or near-complete resolution of CTO related perfusion defect in 90% of patients. Remote territory MPR was unchanged after PCI (2.5 ± 1.2; p = NS vs. baseline). The LV ejection fraction increased from 63 ± 13% to 67 ± 12% (p < 0.0001) and end-systolic volume decreased from 65 ± 38 to 56 ± 38 ml (p < 0.001) 3 months after CTO PCI. Importantly, despite minimal post-procedural infarction due to distal embolization and side branch occlusion in 8 of 32 patients (25%), the total Seattle Angina Questionnaire score improved from a median of 54 (range 45 to 74) at baseline to 89 (range 77 to 98) after CTO recanalization (p < 0.0001).ConclusionsIn this small group of patients showing CMR evidence of significant myocardial inducible perfusion defect and viability, CTO recanalization reduces ischemic burden, favors reverse remodeling, and ameliorates quality of life.",

keywords = "cardiac magnetic resonance, chronic total occlusion, coronary artery disease",

author = "Chiara Bucciarelli-Ducci and Dominique Auger and {Di Mario}, Carlo and Didier Locca and Joanna Petryka and Rory O'Hanlon and Agata Grasso and Christine Wright and Karen Symmonds and Ricardo Wage and Eleni Asimacopoulos and {Del Furia}, Francesca and Lyne, {Jonathan C.} and Gatehouse, {Peter D.} and Fox, {Kim M.} and Pennell, {Dudley J.}",

year = "2016",

month = may,

doi = "10.1016/j.jcmg.2015.10.025",

language = "English",

volume = "9",

pages = "547--556",

journal = "JACC: Cardiovascular Imaging",

issn = "1936-878X",

publisher = "Elsevier Inc.",

number = "5",

}

Bucciarelli-Ducci, C, Auger, D, Di Mario, C, Locca, D, Petryka, J, O'Hanlon, R, Grasso, A, Wright, C, Symmonds, K, Wage, R, Asimacopoulos, E, Del Furia, F, Lyne, JC, Gatehouse, PD, Fox, KM & Pennell, DJ 2016, 'CMR Guidance for Recanalization of Coronary Chronic Total Occlusion', JACC: Cardiovascular Imaging, vol. 9, no. 5, pp. 547-556. https://doi.org/10.1016/j.jcmg.2015.10.025

TY - JOUR

T1 - CMR Guidance for Recanalization of Coronary Chronic Total Occlusion

AU - Bucciarelli-Ducci, Chiara

AU - Auger, Dominique

AU - Di Mario, Carlo

AU - Locca, Didier

AU - Petryka, Joanna

AU - O'Hanlon, Rory

AU - Grasso, Agata

AU - Wright, Christine

AU - Symmonds, Karen

AU - Wage, Ricardo

AU - Asimacopoulos, Eleni

AU - Del Furia, Francesca

AU - Lyne, Jonathan C.

AU - Gatehouse, Peter D.

AU - Fox, Kim M.

AU - Pennell, Dudley J.

PY - 2016/5

Y1 - 2016/5

N2 - ObjectivesThis study explored whether cardiac magnetic resonance (CMR) could help select patients who could benefit from revascularization by identifying inducible myocardial ischemia and viability in the perfusion territory of the artery with chronic total occlusion (CTO).BackgroundThe benefit of revascularization using percutaneous coronary intervention (PCI) in CTO is controversial. CMR offers incomparable left ventricular (LV) systolic function assessment in addition to potent ischemic burden quantification and reliable myocardial viability analysis. Whether CMR guided CTO revascularization would be helpful to such patients has not yet been explored fully.MethodsA prospective study of 50 consecutive CTO patients was conducted. Of 50 patients undergoing baseline stress CMR, 32 (64%) were selected for recanalization based on the presence of significant inducible perfusion deficit and myocardial viability within the CTO arterial territory. Patients were rescanned 3 months after successful CTO recanalization.ResultsAt baseline, myocardial perfusion reserve (MPR) in the CTO territory was significantly reduced compared with the remote region (1.8 ± 0.72 vs. 2.2 ± 0.7; p = 0.01). MPR in the CTO region improved significantly after PCI (to 2.3 ± 0.9; p = 0.02 vs. baseline) with complete or near-complete resolution of CTO related perfusion defect in 90% of patients. Remote territory MPR was unchanged after PCI (2.5 ± 1.2; p = NS vs. baseline). The LV ejection fraction increased from 63 ± 13% to 67 ± 12% (p < 0.0001) and end-systolic volume decreased from 65 ± 38 to 56 ± 38 ml (p < 0.001) 3 months after CTO PCI. Importantly, despite minimal post-procedural infarction due to distal embolization and side branch occlusion in 8 of 32 patients (25%), the total Seattle Angina Questionnaire score improved from a median of 54 (range 45 to 74) at baseline to 89 (range 77 to 98) after CTO recanalization (p < 0.0001).ConclusionsIn this small group of patients showing CMR evidence of significant myocardial inducible perfusion defect and viability, CTO recanalization reduces ischemic burden, favors reverse remodeling, and ameliorates quality of life.

AB - ObjectivesThis study explored whether cardiac magnetic resonance (CMR) could help select patients who could benefit from revascularization by identifying inducible myocardial ischemia and viability in the perfusion territory of the artery with chronic total occlusion (CTO).BackgroundThe benefit of revascularization using percutaneous coronary intervention (PCI) in CTO is controversial. CMR offers incomparable left ventricular (LV) systolic function assessment in addition to potent ischemic burden quantification and reliable myocardial viability analysis. Whether CMR guided CTO revascularization would be helpful to such patients has not yet been explored fully.MethodsA prospective study of 50 consecutive CTO patients was conducted. Of 50 patients undergoing baseline stress CMR, 32 (64%) were selected for recanalization based on the presence of significant inducible perfusion deficit and myocardial viability within the CTO arterial territory. Patients were rescanned 3 months after successful CTO recanalization.ResultsAt baseline, myocardial perfusion reserve (MPR) in the CTO territory was significantly reduced compared with the remote region (1.8 ± 0.72 vs. 2.2 ± 0.7; p = 0.01). MPR in the CTO region improved significantly after PCI (to 2.3 ± 0.9; p = 0.02 vs. baseline) with complete or near-complete resolution of CTO related perfusion defect in 90% of patients. Remote territory MPR was unchanged after PCI (2.5 ± 1.2; p = NS vs. baseline). The LV ejection fraction increased from 63 ± 13% to 67 ± 12% (p < 0.0001) and end-systolic volume decreased from 65 ± 38 to 56 ± 38 ml (p < 0.001) 3 months after CTO PCI. Importantly, despite minimal post-procedural infarction due to distal embolization and side branch occlusion in 8 of 32 patients (25%), the total Seattle Angina Questionnaire score improved from a median of 54 (range 45 to 74) at baseline to 89 (range 77 to 98) after CTO recanalization (p < 0.0001).ConclusionsIn this small group of patients showing CMR evidence of significant myocardial inducible perfusion defect and viability, CTO recanalization reduces ischemic burden, favors reverse remodeling, and ameliorates quality of life.

KW - cardiac magnetic resonance

KW - chronic total occlusion

KW - coronary artery disease

U2 - 10.1016/j.jcmg.2015.10.025

DO - 10.1016/j.jcmg.2015.10.025

M3 - Article (Academic Journal)

C2 - 27085432

SN - 1936-878X

VL - 9

SP - 547

EP - 556

JO - JACC: Cardiovascular Imaging

JF - JACC: Cardiovascular Imaging

IS - 5

ER -