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Influence of coronary artery stenosis severity and coronary collateralization on extent of chronic myocardial scar: insights from quantitative coronary angiography and delayed-enhancement MRI.

Bexell D, Setser RM, Schoenhagen P, Lieber ML, Brener SJ, Ivanc TB, Balazs EM, O' Donnell TP, Stillman AE, Arheden H, Wagner GS, White RD - Open Cardiovasc Med J (2008)

Bottom Line: Also, greater stenosis severity (93+/-14%) and mean scar extent (41+/-35%) were found in patients with collaterals than in patients without collaterals (diameter stenosis 48+/-10%, p<0.01) (scar extent 19+/-29%, p=0.01).Using QCA and DE-MRI, we demonstrate a significant relationship between coronary artery stenosis severity and myocardial scar extent, in the absence of a documented history of acute infarction.However, in the absence of collateralization, scar was observed without significant stenosis, especially in females.

View Article: PubMed Central - PubMed

Affiliation: Departments of Diagnostic Radiology and Clinical Physiology, Duke University Medical Center, Durham, NC, USA.

ABSTRACT

Objectives: In patients with chronic ischemic heart disease, the relationship between coronary artery lesion severity and myocardial scarring is unknown.The purpose of this study was to examine the relationship between proximal coronary artery stenosis severity, the amount of coronary collateralization, and myocardial scar extent in the distal distribution of the affected coronary artery based on both quantitative coronary angiography (QCA) and delayed-enhancement magnetic resonance imaging (DE-MRI).

Methods: Thirty-four patients (26 males, 8 females; age range: 35-86 years) with a coronary artery containing a single, proximal stenosis >/=30% by quantitative coronary angiography (QCA) underwent DE-MRI. The relationship between stenosis severity, collateralization, and myocardial scar morphology (area, transmurality and patchiness) was examined using linear mixed-model ANCOVA.

Results: There was a statistically significant correlation between stenosis severity and scar extent (r=0.53, p<0.01). Patients with hemodynamically significant stenoses (>/=70%) exhibited significantly greater collateralization (p<0.05) and scar extent (p<0.01) than patients with <70% stenosis. However, scarring was often found in patients with stenoses <70%. Also, greater stenosis severity (93+/-14%) and mean scar extent (41+/-35%) were found in patients with collaterals than in patients without collaterals (diameter stenosis 48+/-10%, p<0.01) (scar extent 19+/-29%, p=0.01).

Conclusions: Using QCA and DE-MRI, we demonstrate a significant relationship between coronary artery stenosis severity and myocardial scar extent, in the absence of a documented history of acute infarction. The relationship likely reflects increasing ischemia leading to scar formation in the range of angiographically significant stenosis. However, in the absence of collateralization, scar was observed without significant stenosis, especially in females.

No MeSH data available.


Related in: MedlinePlus

Myocardial sectors by coronary artery of interest. Thirty-degree myocardial sectors straddle segments representative of the distribution of a particular coronary artery, with the coronary artery of interest centered over the respective sector. The myocardial sector is centered below the visualized LAD course in the anterior interventricular groove for LAD lesions (left), the mid-lateral free-wall (centered opposite the mid-interventricular septum) for lesions in the LCX (middle), or the visualized PDA course in the posterior interventricular groove for proximal lesions in either the source artery of the PDA or the proximal PDA itself (right).
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Figure 1: Myocardial sectors by coronary artery of interest. Thirty-degree myocardial sectors straddle segments representative of the distribution of a particular coronary artery, with the coronary artery of interest centered over the respective sector. The myocardial sector is centered below the visualized LAD course in the anterior interventricular groove for LAD lesions (left), the mid-lateral free-wall (centered opposite the mid-interventricular septum) for lesions in the LCX (middle), or the visualized PDA course in the posterior interventricular groove for proximal lesions in either the source artery of the PDA or the proximal PDA itself (right).

Mentions: At each of these 2 short-axis levels, quantitative analysis of thresholded images was restricted to a 30º myocardial sector straddling segments representative of the distribution of a particular major coronary artery [15]; the coronary artery of interest was centered over this sector (Fig. (1)). The myocardial sector was centered below the visualized LAD course in the anterior interventricular groove for LAD lesions, the mid-lateral free-wall (centered opposite the mid-interventricular septum) for lesions in the LCX, or the visualized PDA course in the posterior interventricular groove for proximal lesions in either the source artery of the PDA or the proximal PDA itself.


Influence of coronary artery stenosis severity and coronary collateralization on extent of chronic myocardial scar: insights from quantitative coronary angiography and delayed-enhancement MRI.

Bexell D, Setser RM, Schoenhagen P, Lieber ML, Brener SJ, Ivanc TB, Balazs EM, O' Donnell TP, Stillman AE, Arheden H, Wagner GS, White RD - Open Cardiovasc Med J (2008)

Myocardial sectors by coronary artery of interest. Thirty-degree myocardial sectors straddle segments representative of the distribution of a particular coronary artery, with the coronary artery of interest centered over the respective sector. The myocardial sector is centered below the visualized LAD course in the anterior interventricular groove for LAD lesions (left), the mid-lateral free-wall (centered opposite the mid-interventricular septum) for lesions in the LCX (middle), or the visualized PDA course in the posterior interventricular groove for proximal lesions in either the source artery of the PDA or the proximal PDA itself (right).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2627523&req=5

Figure 1: Myocardial sectors by coronary artery of interest. Thirty-degree myocardial sectors straddle segments representative of the distribution of a particular coronary artery, with the coronary artery of interest centered over the respective sector. The myocardial sector is centered below the visualized LAD course in the anterior interventricular groove for LAD lesions (left), the mid-lateral free-wall (centered opposite the mid-interventricular septum) for lesions in the LCX (middle), or the visualized PDA course in the posterior interventricular groove for proximal lesions in either the source artery of the PDA or the proximal PDA itself (right).
Mentions: At each of these 2 short-axis levels, quantitative analysis of thresholded images was restricted to a 30º myocardial sector straddling segments representative of the distribution of a particular major coronary artery [15]; the coronary artery of interest was centered over this sector (Fig. (1)). The myocardial sector was centered below the visualized LAD course in the anterior interventricular groove for LAD lesions, the mid-lateral free-wall (centered opposite the mid-interventricular septum) for lesions in the LCX, or the visualized PDA course in the posterior interventricular groove for proximal lesions in either the source artery of the PDA or the proximal PDA itself.

Bottom Line: Also, greater stenosis severity (93+/-14%) and mean scar extent (41+/-35%) were found in patients with collaterals than in patients without collaterals (diameter stenosis 48+/-10%, p<0.01) (scar extent 19+/-29%, p=0.01).Using QCA and DE-MRI, we demonstrate a significant relationship between coronary artery stenosis severity and myocardial scar extent, in the absence of a documented history of acute infarction.However, in the absence of collateralization, scar was observed without significant stenosis, especially in females.

View Article: PubMed Central - PubMed

Affiliation: Departments of Diagnostic Radiology and Clinical Physiology, Duke University Medical Center, Durham, NC, USA.

ABSTRACT

Objectives: In patients with chronic ischemic heart disease, the relationship between coronary artery lesion severity and myocardial scarring is unknown.The purpose of this study was to examine the relationship between proximal coronary artery stenosis severity, the amount of coronary collateralization, and myocardial scar extent in the distal distribution of the affected coronary artery based on both quantitative coronary angiography (QCA) and delayed-enhancement magnetic resonance imaging (DE-MRI).

Methods: Thirty-four patients (26 males, 8 females; age range: 35-86 years) with a coronary artery containing a single, proximal stenosis >/=30% by quantitative coronary angiography (QCA) underwent DE-MRI. The relationship between stenosis severity, collateralization, and myocardial scar morphology (area, transmurality and patchiness) was examined using linear mixed-model ANCOVA.

Results: There was a statistically significant correlation between stenosis severity and scar extent (r=0.53, p<0.01). Patients with hemodynamically significant stenoses (>/=70%) exhibited significantly greater collateralization (p<0.05) and scar extent (p<0.01) than patients with <70% stenosis. However, scarring was often found in patients with stenoses <70%. Also, greater stenosis severity (93+/-14%) and mean scar extent (41+/-35%) were found in patients with collaterals than in patients without collaterals (diameter stenosis 48+/-10%, p<0.01) (scar extent 19+/-29%, p=0.01).

Conclusions: Using QCA and DE-MRI, we demonstrate a significant relationship between coronary artery stenosis severity and myocardial scar extent, in the absence of a documented history of acute infarction. The relationship likely reflects increasing ischemia leading to scar formation in the range of angiographically significant stenosis. However, in the absence of collateralization, scar was observed without significant stenosis, especially in females.

No MeSH data available.


Related in: MedlinePlus