Copyright © 1998 by the European Society of Cardiology.
Coronary collateral circulation behaviour and myocardial viability in chronic total occlusion treated with coronary angioplasty
Department of Cardiology, Angiology and Pneumology, University of Pisa, Pisa, Italy
accepted May 20, 1998
Aims
We explored the role of microcirculation integrity following the chronic occlusion of an infarct-related artery to assess the behaviour of collateral circulation during and after reperfusion by coronary angioplasty
Methods and Results
Eighteen patients with a proximally occluded left anterior descending artery and firm evidence of intercoronary collateral circulation were studied with selective coronary angiography and selective intracoronary myocardial contrast echocardiography, before coronary angioplasty, and at 5 and 15min and 12h later. Myocardial enhancement during myocardial contrast echocardiography was evaluated with a semiquantitative score (0–3), which was correlated to basal and 6 months’ regional left ventricular wall motion results. 16/18 procedures were successfully performed; four patients with an inadequate acoustic window were excluded. Restenosis was evident at the 6 months’ follow-up in two patients. Basal myocardial contrast echocardiography indicated that 81/192 segments from the left anterior descending coronary artery and 90/192 from the right coronary artery were perfused; no perfusion was observed in 21 segments either before or after coronary angioplasty. After coronary angioplasty, the angiographic intercoronary collateral circulation immediately disappeared, and myocardial contrast echocardiography revealed that there was a progressive reduction of segments perfused by the right coronary artery and an increase in segments perfused by the left anterior descending coronary artery. Regional left ventricular wall motion analysis demonstrated that there was abnormal motion in 51/192 segments. There was no improvement in segments with score 0 and abnormal motion after 6 months (100% sensitivity), but 16/17 segments with score 3 did show an improvement (98% specificity). The predictive value of intermediate scores (1–2) in detecting long-term improvement, was only 43%.
Conclusion
These data show that the adaptive mechanism observed in the behaviour of epicardial and microvascular circulation after reperfusion of a chronic occluded infarct-related artery can vary. In addition, this study clearly shows that microvascular integrity detected by myocardial contrast echocardiography can provide myocardial viabilityThe European Society of Cardiology
Key Words: Myocardial contrast echocardiography • collateral circulation • myocardial viability • microcirculation • coronary angioplasty
f1 Correspondence: Anna Sonia Petronio, MD, c/o Ospedale di Cisanello, via Paradisa 2, 56124 Pisa, Italy.
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