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Optimized assessment for establishing myocardial viability prior to revascularization of a chronic total coronary occlusion using cardiac magnetic resonance imaging
Journal of Cardiovascular Magnetic Resonance volume 11, Article number: P195 (2009)
Predictive value of delayed enhancement CMR is moderate especially in segments with an intermediate transmural extent of infarction (TEI).
We sought to improve the predictive value of cardiac magnetic resonance imaging (CMR) using combined viability assessment in patients before percutaneous coronary intervention (PCI) of a chronic total coronary occlusion (CTO).
We studied patients with a successful (43/71) and without a successful (29/71) PCI of a CTO. Segmental wall thickening (SWT) was quantified before and after PCI. Before PCI, using CMR, 5 viability indexes were evaluated: TEI, contractile reserve during dobutamine, end diastolic wall thickness (EDWT), unenhanced rim thickness and SWT of the unenhanced rim (SWTur). We determined predictive value for improvement in SWT>10% after PCI for each viability index and for combined viability assessment.
Mean SWT improved significantly in patients with successful PCI (16 ± 19% to 39 ± 35 %; p < 0.0001), mean SWT did not improve in patients without successful PCI (19 ± 21% to 21 ± 25%; p = 0.54). Predictive value for each viability index is presented in Table 1. Combined viability assessment using contractile reserve during dobutamine, SWTur and TEI, improved the predictive value with a sensitivity of 92%(95% CI 82–97) and specificity of 83%(95% CI 70–91).
Combined viability assessment was superior to viability assessment using a single parameter. This may be useful for the selection of patients for PCI of a CTO.
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Open Access This article is published under license to BioMed Central Ltd. This is an Open Access article is distributed under the terms of the Creative Commons Attribution 2.0 International License (https://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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Kirschbaum, S.W., Rossi, A., Boersma, E. et al. Optimized assessment for establishing myocardial viability prior to revascularization of a chronic total coronary occlusion using cardiac magnetic resonance imaging. J Cardiovasc Magn Reson 11 (Suppl 1), P195 (2009). https://doi.org/10.1186/1532-429X-11-S1-P195
- Percutaneous Coronary Intervention
- Cardiac Magnetic Resonance
- Single Parameter
- Myocardial Viability