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Association between hibernating myocardium and collateral circulation in patients with coronary chronic total
Yaqi Liu1,2, Yongjun Chen3, Feifei Zhang1,2
1Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, China.
Insights
The quantity of hibernating myocardium (HM) is linked to better coronary collateral circulation in chronic total occlusion (CTO) patients. Higher HM index indicates improved collateral development, crucial for managing CTO.
Area of Science:
- Cardiology
- Nuclear Medicine
- Medical Imaging
Background:
- Coronary chronic total occlusion (CTO) presents a significant challenge in cardiovascular disease management.
- Collateral circulation plays a vital role in supplying blood to ischemic areas in CTO patients.
- Assessing myocardial viability, specifically hibernating myocardium (HM), is crucial for treatment planning.
Purpose of the Study:
- To investigate the relationship between the extent of hibernating myocardium (HM) and the development of collateral circulation in patients with coronary CTO.
- To determine if HM quantity is an independent predictor of coronary collateral circulation grading.
Main Methods:
- Retrospective analysis of 88 CTO patients.
- Evaluation of HM using combined 99mTc-MIBI SPECT (myocardial perfusion imaging) and 18F-FDG PET (myocardial metabolism imaging).
- Patients were stratified into poorly-developed (PD) and well-developed (WD) collateral circulation groups based on Rentrop grading (0-1 vs. 2-3).
- Statistical analysis, including adjustment for confounding factors and stratified analysis, was performed to explore the association between HM index and collateral grading.
Main Results:
- Patients with well-developed collateral circulation (WD group) exhibited a significantly higher HM index compared to the poorly-developed group (46.2% ± 15.7% vs. 20.9% ± 16.7%, P < 0.001).
- A positive correlation was observed between the HM index and the likelihood of well-developed collateral circulation.
- Increasing tertiles of HM index showed a progressively higher proportion of patients with WD, with a statistically significant trend (OR: 1.369, P < 0.001), particularly between the highest and lowest tertiles (OR: 4.330, P = 0.008).
Conclusions:
- The hibernating myocardium (HM) index within the CTO region is an independent predictor of coronary collateral circulation grading.
- A higher quantity of hibernating myocardium is associated with a greater likelihood of well-developed collateral circulation in CTO patients.
- These findings highlight the importance of assessing myocardial viability in the context of collateral circulation in CTO management.
Objective:
To explore the association between the quantity of hibernating myocardium (HM) and collateral circulation in patients with coronary chronic total occlusion (CTO).
Materials And Methods:
88 CTO patients were retrospectively analyzed who underwent evaluation for HM using both 99mTc-sestamibi Single photon emission computed tomography (99mTc-MIBI SPECT) myocardial perfusion imaging (MPI) combined with 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET) myocardial metabolism imaging (MMI). They were divided into two groups according Rentrop grading: the poorly/well-developed collateral circulation group (PD/WD group, Rentrop grades 0-1/2-3). After adjusting for the potential confounding factors and conducting a stratified analysis, we explored the association between the HM index within CTO region and the grading of collateral circulation.
Results:
In the WD group, the HM index was notably higher than PD group (46.2 ± 15.7% vs. 20.9 ± 16.7%, P < 0.001). When dividing the HM index into tertiles and after adjusting for potential confounders, we observed that the proportion of patients with WD rose as the HM index increased (OR: 1.322, 95% CI: 0.893-1.750, P < 0.001), the proportion of patients with WD was 17.4%, 63.3%, and 88.6% for Tertile 1 to Tertile 3.This increasing trend was statistically significant (OR: 1.369, 95% CI: 0.873-1.864, P < 0.001), especially between Tertile 3 vs. Tertile 1 (OR: 4.330, 95% CI: 1.459-12.850, P = 0.008). Curve fitting displaying an almost linear positive correlation between the two.
Conclusion:
The HM index within CTO region is an independent correlation factor for the grading of coronary collateral circulation. A greater HM index corresponded to an increased likelihood of WD.
