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Assessment of Myocardial Viability and Risk Stratification in Coronary Chronic Total Occlusion: A Qualitative and Quantitative Stress Cardiac MRI Study.

  • Jiang, Mengchun1, 2
  • Chen, Yueqin2
  • Su, Yang3
  • Guo, Hu4
  • Zhou, Xiaoyue5
  • Luo, Meichen6
  • Zeng, Mu1
  • Hu, Xinqun7
  • 1 Department of Radiology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China. , (China)
  • 2 Department of Medical Imaging, Affiliated Hospital of Jining Medical University, Jining, Shandong, China. , (China)
  • 3 Department of Cardiology, Affiliated Hospital of Jining Medical University, Jining, Shandong, China. , (China)
  • 4 MR Application, Siemens Healthineers Ltd., Changsha, China. , (China)
  • 5 MR Collaboration, Siemens Healthineers Ltd., Shanghai, China. , (China)
  • 6 Circle Cardiovascular Imaging Inc., Calgary, Alberta, Canada. , (Canada)
  • 7 Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha, China. , (China)
Published Article
Journal of Magnetic Resonance Imaging
Wiley (John Wiley & Sons)
Publication Date
Feb 01, 2024
DOI: 10.1002/jmri.28783
PMID: 37191039


Indicators for assessing myocardial viability and risk stratification in patients with coronary chronic total occlusion (CTO) are still in the research stage. To use stress-MRI to assess myocardial function, blood perfusion, and viability and to explore their relationship with collateral circulation. Prospective. Fifty-one patients with CTO in at least one major artery confirmed by X-ray coronary angiography (male: 46; age 55.2 ± 10.8 years). 3.0T; TurboFlash, balanced steady-state free precession cine, and phase-sensitive inversion recovery sequences. Stress-MRI was used to obtain qualitative and quantitative parameters of segmental myocardium. Myocardial segments supplied by CTO target vessels were grouped according to the degree of collateral circulation assessed by radiographic coronary angiography (no/mild, moderate, or good). Depending on qualitative stress perfusion assessment and late gadolinium enhancement (LGE) extent, segments were also categorized as negative, viable, or trans-infarcted. Independent sample Student's t-test, one-way analysis of variance (ANOVA) test, Mann-Whitney U test, Kruskal-Wallis test, Spearman correlation coefficient (r). P < 0.05 was considered statistically significant. A total of 334 segments were supplied by CTO target vessels. The radial strain (RS), circumferential strain (CS), longitudinal strain (LS) of the negative, viable, and trans-infarcted regions showed a significant and stepwise impairment. Myocardial blood flow at rest was positively correlated with RS, CS, and LS (r = 0.42, 0.43, 0.38, respectively). Among the different collateral circulation, there were no significant differences in RS, CS, LS, and LGE volume (P = 0.788, 0.562, 0.122, 0.170, respectively), and there were also no statistically significant differences in the proportions of negative, viable, and trans-infarcted regions (P = 0.372). Myocardial perfusion obtained by stress-MRI combined with strain and LGE may comprehensively evaluate myocardial function and viability, and has potential to facilitate risk stratification of CTO. 2 TECHNICAL EFFICACY: Stage 1. © 2023 The Authors. Journal of Magnetic Resonance Imaging published by Wiley Periodicals LLC on behalf of International Society for Magnetic Resonance in Medicine.

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