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Effects of late REopening of Coronary total Occlusion on micRovascular perfusion and myocarDial function: the RECORD
Leonarda Galiuto1, Sabrina Barchetta, Elisa Fedele
1Institute of Cardiology, Catholic University of the Sacred Heart, Policlinico A. Gemelli, Largo A. Gemelli, 8 00168 Rome, Italy. lgaliuto@rm.unicatt.it
Insights
Reopening a coronary total occlusion improves microvascular perfusion and heart function in patients with coronary syndromes. This study demonstrates significant recovery of myocardial perfusion and contractile function after revascularization.
Area of Science:
- Cardiology
- Cardiovascular Imaging
- Interventional Cardiology
Background:
- Coronary total occlusions (CoTO) impact microvascular perfusion in coronary syndromes.
- The effects of reopening CoTO on microvascular function are not well understood.
Purpose of the Study:
- To evaluate microvascular perfusion and left ventricular (LV) function before and after reopening CoTO.
- To assess changes using myocardial contrast echocardiography (MCE).
Main Methods:
- 24 patients with subacute/chronic coronary syndromes and CoTO (>7 days) underwent MCE.
- Microvascular perfusion assessed by contrast score index (CSI) and contrast defect length (CDL%).
- LV function evaluated by wall motion score index (WMSI) and ejection fraction.
Main Results:
- Baseline showed mild impairment in LV function and coronary microvascular perfusion.
- Follow-up revealed significant reduction in CDL% (P=0.005) and improved CSI (P=0.001).
- Significant improvements in WMSI (P=0.0004) and ejection fraction (P=0.0001) were observed.
Conclusions:
- Reopening CoTO improves coronary microvascular perfusion.
- Revascularization is associated with recovery of contractile function in these patients.
Aims:
The effects of the reopening of a coronary total occlusion (CoTO) on microvascular perfusion in subacute or chronic coronary syndromes are actually unclear. We aimed at evaluating the microvascular perfusion pattern by myocardial contrast echocardiography (MCE), in addition to contractile function, before and after CoTO reopening.
Methods:
Twenty four patients with subacute and chronic coronary syndromes and CoTO datable >7 days underwent evaluation of microvascular perfusion and left ventricular (LV) function by MCE (Acuson Sequoia, with Sonovue, Bracco) before the reopening of the CoTO and at 9 ± 3 months of follow-up. Microvascular perfusion was semi-quantitatively assessed by the contrast score index (CSI), whereas the endocardial length of the perfusion defect [contrast defect length (CDL)], measured in three apical views and averaged, was expressed as a percentage of the total LV endocardial border. The wall motion score index (WMSI), LV volumes, and ejection fraction were also calculated.
Results:
At baseline, a mild impairment of LV contractile function was observed, which corresponded to a similar impairment of the coronary microvascular perfusion in the overall study population. At follow-up, a significant reduction of CDL% [8.23 (0-19.63) vs. 0 (0-3.68), P = 0.005], improvement of the CSI (1.41 ± 0.29 vs. 1.12 ± 0.17, P = 0.001) and the WMSI (1.73 ± 0.41 vs. 1.33 ± 0.34, P = 0.0004), and increase in the ejection fraction (47.48% ± 8.66 vs. 55.60% ± 8.29, P = 0.0001) were found.
Conclusion:
Reopening of a CoTO in patients with clinical indications to myocardial revascularization is associated with the improvement of coronary microvascular perfusion and the recovery of contractile function.
