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Original Article--Value of Pathological Q Waves and Angiographic Collateral Grade in Patients Undergoing Coronary
Khaled Abdel-Azim Shokry1, El-Sayed Mohamed Farag2, Ahmed Mohamed Salem2
1Department of Cardiology, Military Medical Academy, Cairo, Egypt.
Insights
Successful revascularization of coronary chronic total occlusion (CTO) improves quality of life, especially in patients with Q waves and viable myocardium. Well-developed collateral circulation independently predicts functional recovery post-percutaneous coronary intervention (PCI).
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Imaging
Background:
- Coronary chronic total occlusion (CTO) revascularization is linked to improved left ventricular (LV) function and survival in viable myocardium.
- The impact of CTO revascularization on angina burden and quality of life in patients with electrocardiographic Q waves remains less understood.
Purpose of the Study:
- To investigate the association between CTO revascularization, electrocardiographic Q waves, and health-related quality of life (HRQOL) improvement.
- To identify predictors of HRQOL improvement after successful percutaneous coronary intervention (PCI) for CTO.
Main Methods:
- 100 patients with single-vessel CTO underwent assessment for myocardial viability using cardiac magnetic resonance (CMR) with late gadolinium enhancement (LGE).
- Health-related quality of life was measured using Seattle Angina Questionnaire (SAQ) scores.
- Patients were analyzed based on the presence or absence of Q waves and myocardial viability.
Main Results:
- Patients with Q waves had worse baseline SAQ scores, LV systolic function, and lower prevalence of viability compared to those without Q waves.
- After successful PCI, patients with Q waves and viable CTO territory showed significant improvement in SAQ scores.
- Multivariate analysis identified pathological Q waves, Rentrop's collateral grade, and Canadian Cardiovascular Society (CCS) angina class as independent predictors of improved HRQOL post-PCI.
Conclusions:
- Well-developed collateral circulation is an independent predictor of LV functional recovery after CTO-PCI.
- CTO revascularization significantly improves HRQOL in patients with Q waves and viable CTO territory.
- Pre-PCI factors like Q waves, collateral grade, and angina class predict HRQOL outcomes after successful CTO revascularization.
Background/Aim:
Successful coronary chronic total occlusion (CTO) revascularization was found by many studies to be associated with improved left ventricular (LV) systolic function and survival if evidence of viability is present. Little is known about the association of CTO revascularization in patients with electrocardiographic Q waves and improvement in angina burden as a measurement of health-related quality of life (HRQOL) afterwards.
Methods:
In this study, 100 patients with single vessel CTO were included. Myocardial viability was tested by late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR) and 50 patients showed evidence of viability. Seattle Angina Questionnaire (SAQ) scores were used as a measure of HRQOL.
Results:
Pathological Q waves were present in 48 patients (including 19 patients with viable CTO territory) out of 100 patients. Patients with Q waves tended to have worse Seattle Angina Questionnaire (SAQ) scores compared to those with no Q waves (31.2 ± 11.7 vs 45.3 ± 13.9 respectively, p = 0.002), worse LV systolic function and wall motion score index (WMSI) on CMR. They also had significantly less prevalence of viability (p < 0.001). Patients with Q waves and positive viability had lower SAQ scores (37.2 ± 10.1 vs 52.7 ± 13.2 respectively, p = 0.02), higher LVEF and lower WMSI. They also had well developed collateral grade (2.1 ± 1.03 vs 0.7 ± 0.82 respectively, p < 0.001). After successful percutaneous coronary intervention (PCI), in the viable LV group, presence of Q waves was not associated with better LV functional recovery, while those with higher collateral grades were more likely to have better LV functional recovery post CTO-PCI. Patients with Q waves and viable CTO territory showed significantly better SAQ scores compared to pre-PCI (87.3 ± 12.2 vs 37.2 ± 10.1 respectively, p < 0.001). For angina frequency, post-PCI score was 80.2 ± 7.9 compared to 39.2 ± 7.1 before PCI, p < 0.001). Multivariate regression analysis showed that pathological Q waves, Rentrop's collateral grade and the Canadian Cardiovascular Society (CCS) angina class before PCI were the most significant independent predictors of improved HRQOL as reflected by SAQ (OR for Q waves 7.83, 95% CI 1.62-18.91,p 0.003), (OR for Rentrop's collateral grade 8.31,95% CI 2.21-26.33, p < 0.001), (OR for CCS class 8.39, 95% CI 1.21-20.8, p 0.01).
Conclusion:
Well-developed collateral circulation could independently predict LV functional recovery after CTO-PCI. Patients with Q waves and viable CTO territory tend to have higher CCS class before revascularization and get significant improvement of HRQOL after PCI. Other predictors of improved HRQOL are Rentrop's collateral grade and worse CCS class before PCI.
