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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

Scar area (A), transmurality (B), and patchiness (C) as functions of percent diameter stenosis for all patients (n=34); basal and mid-LV results are pooled. Patients are grouped by collateral score: score 0 (filled circles), score 1-3 (open circles). The filled triangle designates the mean value (± SEM) for the 0 collaterals group and the open triangle designates the mean value (± SEM) for the 1-3 collaterals group. Note that each scar parameter is computed within a 30° sector defined in the appropriate coronary artery distribution for each vessel group.
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Figure 2: Scar area (A), transmurality (B), and patchiness (C) as functions of percent diameter stenosis for all patients (n=34); basal and mid-LV results are pooled. Patients are grouped by collateral score: score 0 (filled circles), score 1-3 (open circles). The filled triangle designates the mean value (± SEM) for the 0 collaterals group and the open triangle designates the mean value (± SEM) for the 1-3 collaterals group. Note that each scar parameter is computed within a 30° sector defined in the appropriate coronary artery distribution for each vessel group.

Mentions: Displays of scar area, transmurality, and patchiness as a function of percent diameter stenosis for all 34 patients are shown in Fig. (2) (pooled basal and mid-LV results); identical relationships were observed for percent area stenosis (not shown). Using 70% stenosis as a threshold for hemodynamic significance at rest, there were statistically significant differences in collateralization and scar parameters between patients with stenoses above and below this threshold, but with considerable overlap in the range of values (Table 2). Of note is the high prevalence and quantity of myocardial scarring found beyond less severe (i.e. <70%) stenoses and in the absence of clinical histories of corresponding acute infarction. Conversely, some patients with significant stenoses (70-100%) exhibited little to no scar (Fig. (2)).


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)

Scar area (A), transmurality (B), and patchiness (C) as functions of percent diameter stenosis for all patients (n=34); basal and mid-LV results are pooled. Patients are grouped by collateral score: score 0 (filled circles), score 1-3 (open circles). The filled triangle designates the mean value (± SEM) for the 0 collaterals group and the open triangle designates the mean value (± SEM) for the 1-3 collaterals group. Note that each scar parameter is computed within a 30° sector defined in the appropriate coronary artery distribution for each vessel group.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 2: Scar area (A), transmurality (B), and patchiness (C) as functions of percent diameter stenosis for all patients (n=34); basal and mid-LV results are pooled. Patients are grouped by collateral score: score 0 (filled circles), score 1-3 (open circles). The filled triangle designates the mean value (± SEM) for the 0 collaterals group and the open triangle designates the mean value (± SEM) for the 1-3 collaterals group. Note that each scar parameter is computed within a 30° sector defined in the appropriate coronary artery distribution for each vessel group.
Mentions: Displays of scar area, transmurality, and patchiness as a function of percent diameter stenosis for all 34 patients are shown in Fig. (2) (pooled basal and mid-LV results); identical relationships were observed for percent area stenosis (not shown). Using 70% stenosis as a threshold for hemodynamic significance at rest, there were statistically significant differences in collateralization and scar parameters between patients with stenoses above and below this threshold, but with considerable overlap in the range of values (Table 2). Of note is the high prevalence and quantity of myocardial scarring found beyond less severe (i.e. <70%) stenoses and in the absence of clinical histories of corresponding acute infarction. Conversely, some patients with significant stenoses (70-100%) exhibited little to no scar (Fig. (2)).

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