Improvement of LV functional performance in the chronic total coronary occlusion during the late stage is associated wit
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Improvement of LV functional performance in the chronic total coronary occlusion during the late stage is associated with the extensive collateral development Yuesong Yang1*, Bradley Strauss1, Beiping Qiang1, Azriel Osherov1, John J Graham2, Garry Liu1, Xiuling Qi1, Nigel R Munce1, Michelle Ladouceur-Wodzk1, Normand Robert1, Alexander J Dick3, Graham A Wright1 From 2011 SCMR/Euro CMR Joint Scientific Sessions Nice, France. 3-6 February 2011 Purpose To investigate whether left ventricular (LV) function and regional wall motion improvement are associated with the extent of collateral development in coronary chronic total occlusion (CTO).
micro-CT images was rated qualitatively using a score from 0 to 3, indicating that no, minimal, moderate, or extensive collaterals were observed. A Student’s t-test was used for the statistical significance of differences between measurements at 6 and 12 weeks.
Methods In nine pigs a CTO was created by percutaneously inserting a fibrin plug (AngiosealΤΜ) into the mid-todistal left anterior descending artery (LAD). Animals were studied six (n=3) or twelve weeks (n=6) later prior to sacrifice. An x-ray angiogram confirmed the LAD CTO at those time points. Cardiac MR (CMR) studies were then conducted on a 1.5T (n=6) or on a 3.0T MRI system (n=3), which included SSFP short axis sections for wall motion and post-gadolinium LGE-MRIs for viability. After sacrifice, both right and left coronary systems were injected with Microfil. X-ray or MSCT angiography of the fixed heart was obtained. A longitudinal cardiac section including the CTO lesion, proximal/distal LAD and the borders of infarction was removed and prepared in gel, then imaged in a microCT system at 27 micron resolution. LV functional parameters including wall thickness at end-systole (WTES) and end-diastole (WTED) were measured in border zone, infarct and remote region. Systolic wall thickening (SWT) was calculated using as (WTES-WTED) x100/ WTED. CMR and micro-CT data were processed using commercial software. The extent of collaterals on
Results LGE-MRI determined the presence of LV myocardial infarction (MI). Tables 1 and 2 summarize the results of global and regional LV function measurements at both time points. Ejection fraction (LVEF) at 12 weeks was significantly greater than at 6 weeks (39.45±5.38% vs. 26.27±5.77%, P=0.01) although the extent of infarct was similar between these two groups (P=0.16). In border zone the WTES (11.31±1.72 vs. 8.67±0.57mm, P=0.04) and SWT (68.31±11.55% vs. 35.87±19.14%, P=0.01) increased at 12 versus 6 weeks. On the visual scores of collateral development, between 6 and 12 weeks, there was an increase in collateral number (1.33±0.58 vs. 2.83 ±0.41, p
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