Objective: To explore the clinical value of quantitatively assessment of left ventricular strain in patients with coronary chronic total occlusion (CTO) by cardiac magnetic resonance imaging (CMR)-feature tracking (CMR-FT) technique. Methods: In this retrospective and observation study, patients with single CTO, who underwent CMR examination in Beijing Anzhen Hospital from November 2014 to January 2019, were selected as case group (CTO group), and those without cardiovascular diseases defined by echocardiography, electrocardiogram (ECG) and clinical history and with normal CMR results were selected as healthy control group (control group). General clinical data including age, gender, discharge diagnosis, and the examination results of echocardiography and ECG were obtained from the electronic medical record system. Two-dimensional CMR-FT was applied to measure left ventricle (LV) global peak radial, circumferential, and longitudinal strains (GPRS, GPCS and GPLS, respectively), and the regional myocardial strain in the target vessel area of CTO was analyzed. Grayscale thresholds of 5 standard deviations (SDs) were used to quantify late gadolinium enhancement (LGE). Patients with CTOs were divided into infract size>10% group and infarct size≤10% group, and left ventricular ejection fraction (LVEF)≥50% group and LVEF<50% group, respectively. The differences between various groups were compared. Results: There were 52 patients in CTO group (34 males, age (54.1±11.7) years, body mass index (BMI) (26.2±2.5)kg/m²) and 30 patients in control group (14 males, age(51.6±12.3)years, BMI (25.6±3.3)kg/m²). There was no significant difference in age, gender, and BMI between the two groups (all P>0.05). LVEF, GPRS, GPCS and GPLS were significantly lower in CTO group than in control group (all P<0.05), left ventricular volume (LVEDV) was similar between the two groups (P>0.05). Among the patients with CTO, there were 26 patients with infarct size>10% and 26 patients with infarct size≤10%. GPRS, GPCS and GPLS were significantly lower (all P<0.05), while LVEF and LVEDV were similar in CTO patients with infarct size≤10% as compared to control group (both P>0.05). LVEF, GPRS, GPCS and GPLS were significantly lower (all P<0.05), while LVEDV was similar in CTO patients with infarct size>10% (P>0.05) as compared to control group. GPRS and GPCS were significantly lower (both P<0.05), while LVEF, LVEDV and GPLS were similar in CTO patients with infarct size>10% as compared to infarct size≤10% group. There were 40 subjects in LVEF≥50% group and 12 subjects in LVEF<50% group. Compared with the control group, GPCS and GPLS of CTO patients were significantly lower in LVEF≥50% group and LVEF<50% group (all P<0.01), LVEF and LVEDV was similar in CTO patients with LVEF≥50% (both P>0.05), but LVEF was lower and LVEDV was larger in LVEF<50% group (both P<0.05). The GPRS, GPCS, GPLS and LVEF of CTO patients in LVEF ≥ 50% group were higher than those in LVEF<50% group (all P<0.0l), and the myocardial infarction size was smaller than that in LVEF reduced group (P<0.0l), but there was no significant difference in LVEDV between the two groups (P=0.07). In the CTO group, there were 21 patients with left anterior descending artery (LAD) occlusion and 126 segments supplied by the target vessels. The peak radial strain (PRS), circumferential strain (PCS) and longitudinal strain (PLS) in the blood supply area were lower than those in the control group (all P<0 01). In 7 patients with left circumflex artery (LCX) occlusion, the number of myocardial segments supplied by the target vessels was 35, and the PRS, PCS and PLS in the target vessel supply area were lower than those in the control group (all P<0 05). In 24 patients with right coronary artery (RCA) occlusion, the number of myocardial segments supplied by the target vessels was 120, and the PRS, PCS and PLS in the target vessel supply area were lower than those in the control group (all P<0.01). Among the 126 segments in 21 patients with LAD CTO, 91 (72.2%) segments had infarct size≤25%, 17 (13.5%) segments had infarct size between 26%-50%, 11 segments (8.7%) had infarct size between 51%-75%, and 7 (5.6%) segments had infarct size between 76%-100%. Among the 35 segments in 7 patients with LCX CTO, 31 (88.6%) segments had infarct size≤25%, and 4 (11.4%) segments had infarct size between 26%-75%. Among the 120 segments in 24 patients with RCA CTO, 96 (80.0%) segments had infarct size≤25%, 11 (9.2%) segments had infarct size between 26%-50%, 8 (6.7%) segments had infarct size between 51%-75%, and 5 segments (4.2%) had infarct size between 76%-100%. Conclusions: In this study with single CTO, although the LVEF is preserved in the majority of the patients, the left ventricular global and regional strain values are significantly decreased. The larger the infarct size, the greater the impact on radial and circumferential motion, reflecting the early impairment of left ventricular function in these patients.
Adult ; Aged ; Contrast Media ; Coronary Occlusion/diagnostic imaging* ; Gadolinium ; Heart Ventricles/diagnostic imaging* ; Humans ; Magnetic Resonance Spectroscopy ; Male ; Middle Aged ; Percutaneous Coronary Intervention ; Retrospective Studies ; Stroke Volume ; Ventricular Function, Left

de Winter syndrome is a special equivalent of anterior ST-segment elevation myocardial infarction (STEMI) characterized by the absence of overt ST-elevation with upsloping ST-segment depression followed by tall symmetrical T-waves in the precordial leads, often associated with total occlusion of the proximal left anterior descending coronary artery. Herein we present a case of de Winter syndrome in a 63-year-old man, whose initial ECG showed no ST-segment elevation, but subsequent coronary angiography confirmed total occlusion of the proximal LAD coronary artery. The patient was successfully treated via mechanical reperfusion therapy and stenting through percutaneous coronary intervention (PCI). de Winter syndrome is associated with a high mortality often due to insufficient awareness of this condition by clinicians. Immediate reperfusion therapy by PCI is the life-saving treatment for the patients diagnosed with this syndrome, and prompt recognition of the ECG pattern is critical to ensure the timely administration of the therapy.
Coronary Angiography ; Coronary Occlusion ; diagnostic imaging ; therapy ; Electrocardiography ; Humans ; Male ; Middle Aged ; Myocardial Reperfusion ; Percutaneous Coronary Intervention ; ST Elevation Myocardial Infarction ; Stents ; Treatment Outcome

BACKGROUNDThe retrograde approach through collaterals has been applied in the treatment of chronic total occlusion (CTO) lesions during percutaneous recanalization of coronary arteries. This study was to investigate the success rate of recanalization and collateral related complications in patients when using the retrograde approach.

METHODSEighty-four cases subjected to retrograde approach identified from July 2005 to July 2012 were included in this study. Patient characteristics, procedural outcomes and in-hospital clinical events were evaluated.

RESULTSMean age of the patient was (59.6 ± 11.2) years old and 91.7% were men. The target CTO lesions were distributed among the left anterior descending artery in 45 cases (53.5%), left circumflex artery in one case (1.2%), right coronary artery in 34 cases (40.5%), and left main in four cases (4.8%). The overall success rate of recanalization was 79.8%. The septal collateral was three times more frequently used for retrograde access than the epicardial collateral, 68/84 (81%) vs. 16/84 (19%). Successful wire passage through the collateral channel was achieved in 58 (72.6%) patients. The success rate of recanalization was 93.1% (54/58) in patients with and 50% (13/26) in patients without successful retrograde wire passage of the collateral channel (P < 0.01). Successful retrograde wire passage through the collaterals was achieved in 49 of 68 septal collaterals (72.1%) and in 9 of 16 epicardial collaterals (56.3%) (P = NS). There was no significant difference between the septal collateral group and the epicardial group in the success rate of recanalization after retrograde wire crossing the collaterals (91.8% vs. 100%, P > 0.05). CART or reverse CART technique was used in 15 patients, and 14 patients (93.3%) were recanalized successfully. Collateral related perforation occurred in three (18.8%) cases with the epicardial collateral as the first choice (compared with the septal collateral group (0), P < 0.01). There were 17 (20.2%) patients failure of recanalize the CTO lesions, among which 13 (15.5%) were due to the failure of retrograde wire crossing the collaterals.

CONCLUSIONSThe retrograde approach is an effective technique to recanalize CTO lesions, the septal collateral was preferable. When the epicardial collateral is selected, careful manipulation of devices and wires is essential due to the potential risk of perforation of collateral channels.

Adult ; Angioplasty, Balloon, Coronary ; Collateral Circulation ; physiology ; Coronary Angiography ; Coronary Occlusion ; diagnostic imaging ; physiopathology ; therapy ; Female ; Humans ; Male ; Middle Aged

OBJECTIVETo analyze the imaging characteristics of coronary arteries with total occlusion (TO) lesions shown by dual-source computed tomography CT (DSCT) coronary angiography.

METHODThe clinical data of patients who were diagnosed as coronary heart disease together with total occlusion lesions between March 2008 and March 2010 were retrospectively analyzed.

RESULTSIn a cohort of 140 patients with 152 TO lesions, TO vessels in right coronary artery, left anterior descending artery, left circumflex coronary artery, or left main coronary artery were 68, 48, 20, and 1, respectively. Side branch TO were found in 15 vessels, in which 13 cases were found to be with TO in two coronary arteries. The length of TO was 5-58 mm, mean (16.8 ± 3.9) mm. TO lesions with a length ≥ 1 cm accounted for 91.4%. The appearance of stump in TO were abrupt occlusion (n=68) , blunt occlusion (n=64) , and mouse-tail occlusion (n=20) . Among all the TO lesions, 73% were soft plaque or mainly soft plaque together with minimal calcification. Mixed plaque and calcified plaque were less seen. Ten TO segments presented with dilated lumens were thrombogenesis. There were 25 TO segments angulated or tortuosity, which were most frequently shown in right coronary artery. DSCT only presented 3 TO with clear collateral vessels and no TO with bridge collateral vessels was shown.

CONCLUSIONSDSCT can provide most necessary information of coronary TO lesions. Therefore, it can be used to guide surgeries on TO lesions and improve the success rates of surgeries.

Adult ; Aged ; Coronary Angiography ; methods ; Coronary Occlusion ; diagnostic imaging ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Tomography, X-Ray Computed ; methods

OBJECTIVETo investigate the changes in plasma matrix metalloproteinases-2 and -9 (MMP2 and MMP9, respectively) levels in patients with different types of coronary heart diseases (CHD), and assess the value of MMP2/MMP9 detection in predicting acute coronary syndrome (ACS).

METHODSAccording to the findings by coronary angiography and the clinical manifestations, 118 patients were divided in ACS group including 30 patients with unstable angina pectoris (UAP) and 19 with acute myocardial infarction (AMI) and non-ACS group including 23 patients with stable angina pectoris (SAP) and 21 with chronic total occlusion (CTO) of the coronary artery. Twenty-five individuals with normal coronary artery (NCA) served as the control group. Plasma levels of MMP9 and MMP2 were determined in these subjects using enzyme-linked immunosorbent assay (ELISA).

RESULTSBoth the ACS and non-ACS groups showed significantly higher MMP9 and MMP2 levels than the NCA group (P<0.05), and MMP2 and MMP9 levels were significantly higher in ACS group than in non-ACS group (P<0.05). Compared with the NCA group, the UAP, AMI and CTO subgroups showed obvious increases in plasma MMP2 and MMP9 levels (P<0.01). Significantly increased MMP9, but not MMP2 level was noted in AMI subgroup in comparison with SAP (P<0.01) and UAP subgroups (P<0.05); both MMP2 and MMP9 levels were elevated in CTO subgroup in comparison with those in SAP (P<0.001), UAP (P<0.01), and AMI subgroups (P<0.05).

CONCLUSIONIncreased MMP2 and MMP9 levels in patients with CHD suggest the instability of the atherosclerotic plaque in correlation to the severity of ACS, and may serve as good indicators for the prediction of ACS and diagnosis of CTO of the coronary artery.

Acute Coronary Syndrome ; blood ; diagnostic imaging ; Aged ; Angina, Unstable ; blood ; diagnostic imaging ; Chronic Disease ; Coronary Angiography ; Coronary Occlusion ; blood ; diagnostic imaging ; Female ; Humans ; Male ; Matrix Metalloproteinase 2 ; blood ; Matrix Metalloproteinase 9 ; blood ; Metamorphosis, Biological ; Middle Aged ; Myocardial Infarction ; blood ; diagnostic imaging

Angioplasty, Balloon, Coronary ; Coronary Occlusion ; diagnostic imaging ; therapy ; Fluoroscopy ; adverse effects ; Humans ; Male ; Middle Aged ; Radiodermatitis ; etiology ; Treatment Failure

OBJECTIVETo evaluate the diagnostic accuracy in the assessment of coronary artery bypass grafts using 64 multi-slice computed tomography angiography (64-MSCTA) technology.

METHODSThere were 228 patients post coronary artery bypass grafting (CABG) underwent 64-MSCTA from July 2005 to April 2007. Thirty-one patients with 82 bypass grafts performed coronary angiography (CAG) because of angina or grafts lesion showed by 64-MSCTA.

RESULTSAll bypass grafts could be visualized by 64-MSCTA. Thirteen bypass graft occlusions and fourteen significant stenosis were detected by 64-MSCTA and confirmed by CAG. One venous grafts distal anastomosis was missed and another one was miss diagnosed as stenosis. One false negative and one false positive CT-finding resulted in a sensitivity of 93.3%, a specificity of 98.1%, a positive predictive value of 93.3%, a negative predictive value of 98.1% and an accuracy of 97.1% for grafts stenosis. As to the grafts lesion, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy for grafts occlusion were 96.4%, 98.1%, 96.4%, 98.1% and 97.6%, respectively.

CONCLUSION64-MSCTA demonstrates high diagnostic accuracy in the assessment of graft patency and suitable for the follow-up of patients post CABG.

Aged ; Coronary Angiography ; methods ; Coronary Artery Bypass ; Female ; Graft Occlusion, Vascular ; diagnostic imaging ; Humans ; Male ; Middle Aged ; Postoperative Complications ; diagnostic imaging ; Sensitivity and Specificity ; Tomography, Spiral Computed

Aged ; Angioplasty, Balloon, Coronary ; methods ; Coronary Angiography ; Coronary Occlusion ; diagnostic imaging ; therapy ; Humans ; Male ; Middle Aged ; Stents

OBJECTIVETo compare the coronary artery bypass graft (CABG) imaging between 16-slice spiral CT and 64-slice spiral CT.

METHODSTotally 27 patients with CABG received multi-slice spiral CT imaging and the results were retrospectively analyzed. Among them, 8 patients received 16-slice spiral CT scanning, 19 patients received 64-slice spiral CT scanning.

RESULTSThe evaluability rates of 64-slice spiral CT in evaluating the proximal anastomosis, bypass graft, distal anastomosis, and distal blood vessel were 100%, 100%, 90.2%, and 93.9%, respectively, while those of 16-slice spiral CT were 92.3%, 95.2%, 90.0%, and 90.0%, respectively. The patency rates of the above four aspects of 64-slice spiral CT were 66.7%, 70.0%, 71.7%, and 70.0%, respectively, while those of 16-slice spiral CT were 83.3%, 85.0%, 83.3%, and 88.9% .

CONCLUSIONS64-slice spiral CT is superior to 16-slice spiral CT in CABG imaging. It can be used as a non-invasive tool for the post-operative follow-up of CABG.

Aged ; Coronary Angiography ; methods ; Coronary Artery Bypass ; Coronary Disease ; diagnostic imaging ; surgery ; Female ; Graft Occlusion, Vascular ; diagnostic imaging ; Humans ; Male ; Middle Aged ; Postoperative Period ; Retrospective Studies ; Sensitivity and Specificity ; Tomography, Spiral Computed ; methods