Collaterals and the recovery of left ventricular function after recanalization of a chronic total coronary occlusion
Gerald S Werner1, Ralf Surber, Friedhelm Kuethe
1Clinic for Internal Medicine I, Friedrich-Schiller-University Jena, Jena, Germany. gerald.werner@med.uni-jena.de
Insights
Myocardial recovery after chronic total occlusion (CTO) revascularization is not directly linked to collateral function. Preserved microvascular integrity, however, may be crucial for left ventricular (LV) function recovery.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Myocardial Viability
Background:
- Collateral function in myocardial dysfunction may predict left ventricular (LV) recovery post-revascularization of chronic total coronary occlusion (CTO).
- Assessing collateral function is key to understanding potential for LV recovery.
Purpose of the Study:
- To investigate the relationship between collateral function and myocardial recovery after CTO revascularization.
- To determine factors influencing left ventricular (LV) function recovery post-intervention.
Main Methods:
- Recanalization of chronic total coronary occlusion (CTO) in 126 patients.
- Assessment of collateral function using intracoronary Doppler and pressure wires.
- Evaluation of left ventricular ejection fraction (LVEF) and wall motion severity index (WMSI) pre- and post-procedure.
Main Results:
- 42% of patients had normal LV function, 16% had mild dysfunction (LVEF ≥ 0.60), and 42% had severe dysfunction (LVEF < 0.60).
- Patients with normal LV function exhibited better collateral function than those with dysfunction.
- Significant myocardial recovery was observed in 39% of patients with LV dysfunction; collateral function was similar, but preserved microvascular integrity was noted in those with recovery.
Conclusions:
- Collateral function quality is not directly predictive of impaired LV function recovery after CTO revascularization.
- Collateral development does not necessitate the presence of viable myocardium.
- Preserved microvascular integrity appears to be a relevant factor for myocardial recovery post-CTO revascularization.
Background:
A good collateral function in patients with regional myocardial dysfunction may indicate viability with the potential for left ventricular (LV) recovery after revascularization of a chronic total coronary occlusion (CTO).
Methods:
A CTO (duration > 2 weeks) was successfully recanalized in 126 patients. During this procedure, the collateral function was assessed before the first balloon inflation by intracoronary Doppler and pressure wires. Collateral function indexes were calculated. Left ventricular function was assessed by the LV ejection fraction (LVEF) and the wall motion severity index (WMSI [SD/chords]). A repeat angiography was available in 119 patients after 4.9 +/- 1.4 m. An improvement of WMSI > or =1 SD/chord was considered significant.
Results:
Left ventricular function was normal in 42%, regional dysfunction with LVEF > or = 0.60 was observed in 16%, and regional dysfunction with LVEF < 0.60 in 42%. The former had a better collateral function than patients with LV dysfunction. In 39% of patients with LV dysfunction, a significant myocardial recovery was observed at follow-up. The collateral function was similar in patients with and without recovery. However, patients with recovery had a lower peripheral resistance as an indicator of a better preserved microvascular integrity.
Conclusions:
Recovery of impaired LV function after revascularization of a CTO is not directly related to the quality of collateral function, as collateral development does not appear to require the presence of viable myocardium. However, a preserved microvascular integrity may be of relevance for myocardial recovery.
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