Barbara Nardi

Claudia Scardino

Gabriele Gasparini

Gabriella Di Giovine

Lorenzo Monti

Luca Balzarini

Journal of Cardiovascular Magnetic Resonance

PubMed

Crossref

Role of adenosine Stress CMR before Chronic Total Occlusion reopening

Springer - Publisher Connector

POSTER PRESENTATION Open Access
Role of adenosine Stress CMR before Chronic
Total Occlusion reopening
Lorenzo Monti1,2*, Gabriella Di Giovine3, Claudia Scardino4, Barbara Nardi2, Luca Balzarini1, Gabriele Gasparini2
From 19th Annual SCMR Scientific Sessions
Los Angeles, CA, USA. 27-30 January 2016
Background
Conflicting data exists on the usefulness of a perfusion
stress test prior to reopening a chronically occluded coron-
ary artery (CTO). We sought to test whether a stress MR
may improve patient selection for Chronic Total Occlu-
sion (CTO) reopening over a conventional LGE study.
Methods
70 CTO patients without any other relevant coronary
artery stenosis (or already treated if present at baseline
angiography), underwent an adenosine stress CMR before
a reopening attempt. ECG and echocardiographic (echo)
data were available for all. Patients were considered suitable
for the reopening procedure in case of myocardial ischemia
and / or viable myocardium subtended to the CTO.
Presence of a previous myocardial infarction (MI) was
defined at ECG: Q waves > 40 msec; at echo: akinetic
areas with reduced wall thickness; at stress MR: presence
of ischemic Late gadolinium Enhancement.
Presence of myocardial ischemia was defined as a suben-
docardial perfusion defect lasting for at least 4 heart beats
during adenosine infusion in a segment without LGE.
Results
ISCHEMIA: adenosine stress MR showed a perfusion
abnormality in 100% of CTO territory. Inducible ischemia
was observed in 71% of cases, with a perfect concordance
with CTO occlusion.
PREVIOUS MI: using CMR as the gold standard for
the diagnosis, the prevalence was globally high: 69% in
our series. Both ECG and echo significantly underesti-
mate this data (36% and 53% respectively). Presence of
LGE in different sites from the CTO territory was often
observed: in fact, only 58% of patients with LGE had it
exactly in the CTO territory. At echo, 82% of pts with
wall motion abnormality (WMA) had it described in
CTO segments: this can be explained with a portion of
patients with viable, non-ischemic myocardium. The
true prevalence of LGE in CTO segments was 40% for
the whole population, but only 13% (n = 9) of patients
showed a mean LGE transmurality >50%, contraindicat-
ing a reopening attempt. These patients were not identi-
fied by echo that identified 30 patients with akinetic
areas subtended to a CTO.
Conclusions
Perfusion stress MR did not show any additional diag-
nostic value in our population of patients with CTO and
known coronary anatomy, since a perfusion abnormality
was observed in all patients.
LGE analysis showed a 13% prevalence of transmural
MI in CTO territories: this important information can’t
be obtained with a baseline diagnostic approach and
should encourage the use of LGE MR before a CTO
reopening.
1Radiology, Humanitas Research Hospital, Rozzano (MI), Italy
Full list of author information is available at the end of the article
Table 1 Previous MI in CTO patients
ECG (Q waves) ECHO (akinesia + wall < 6 mm) Ischemic LGE pattern
Global prevalence of diagnostic criterion 36% (n = 25) 53% (n = 37) 69% (n = 48)
Correct site of a positive criterion 80% (n = 20) 81% (n = 30) 58% (n = 28)
Previous MI in the CTO territory 29% (n = 20) 43%(n = 30) 40% (n = 28)
Monti et al. Journal of Cardiovascular Magnetic
Resonance 2016, 18(Suppl 1):P80
http://www.jcmr-online.com/content/18/S1/P80
© 2016 Monti et al. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://
creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the
original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/
zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Authors’ details
1Radiology, Humanitas Research Hospital, Rozzano (MI), Italy. 2Cardiology
department, Istituto Clinico Humanitas, Rozzano, Italy. 3Cardiology, Ospedale
di Novara, Novara, Italy. 4Cardiology, IRCCS Ospedale Maggiore Policlinico di
Milano, Milano, Italy.
Published: 27 January 2016
doi:10.1186/1532-429X-18-S1-P80
Cite this article as: Monti et al.: Role of adenosine Stress CMR before
Chronic Total Occlusion reopening. Journal of Cardiovascular Magnetic
Resonance 2016 18(Suppl 1):P80.
Submit your next manuscript to BioMed Central
and take full advantage of: 
• Convenient online submission
• Thorough peer review
• No space constraints or color figure charges
• Immediate publication on acceptance
• Inclusion in PubMed, CAS, Scopus and Google Scholar
• Research which is freely available for redistribution
Submit your manuscript at 
www.biomedcentral.com/submit
Monti et al. Journal of Cardiovascular Magnetic
Resonance 2016, 18(Suppl 1):P80
http://www.jcmr-online.com/content/18/S1/P80
Page 2 of 2


http://dx.doi.org/10.1186/1532-429X-18-S1-P80

Role of adenosine Stress CMR before Chronic Total Occlusion reopening

Abstract

Similar works

Full text

Available Versions

Crossref

Springer - Publisher Connector

Springer - Publisher Connector