Korean J Radiol.  2019 Jan;20(1):83-93. 10.3348/kjr.2018.0069.

Role of Myocardial Extracellular Volume Fraction Measured with Magnetic Resonance Imaging in the Prediction of Left Ventricular Functional Outcome after Revascularization of Chronic Total Occlusion of Coronary Arteries

  • 1Department of Radiology, Zhongshan Hospital, Fudan University; Department of Medical Imaging, Shanghai Medical School, Fudan University and Shanghai Institute of Medical Imaging, Shanghai, China. zengmengsu@outlook.com
  • 2Department of Nuclear Medicine, The First Affiliated Hospital of Soochow University, Suzhou, China.
  • 3Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China.
  • 4Siemens Healthcare GmbH, Erlangen, Germany.
  • 5Siemens Shenzhen Magnetic Resonance (C.F.), Shenzhen, China.
  • 6Department of Clinical Laboratory, Zhongshan Hospital, Fudan University, Shanghai, China.


The purpose of this study was to prospectively investigate the value of the myocardial extracellular volume fraction (ECV) in predicting myocardial functional outcome after revascularization of coronary chronic total occlusion (CTO).
Thirty patients with CTO underwent cardiovascular magnetic resonance (CMR) before and 6 months after revascularization. Three baseline markers of functional outcome were evaluated in the dysfunctional segments assigned to the CTO vessels: ECV, transmural extent of infarction (TEI), and unenhanced rim thickness (RIM). At the global level, the ECV values of the whole myocardium with and without a hyperenhanced region (global and remote ECV) were respectively measured.
In per-segment analysis, ECV was superior to TEI and RIM in predicting functional recovery (area under receiver operating characteristic curve [AUC]: 0.86 vs. 0.75 and 0.73, all p values < 0.010), and it emerged as the only independent predictor of regional functional outcome (odds ratio [OR] = 0.83, 95% confidence interval [CI]: 0.77-0.89; p < 0.001) independent of collateral circulation. In per-patient analysis, global baseline ECV was indicative of ejection fraction (EF) at the follow-up examination (β = −0.61, p < 0.001) and changes in EF (β = −0.57, p = 0.001) in multivariate regression analysis. A patient with global baseline ECV less than 30.0% (AUC, 0.93; sensitivity 94%, specificity 80%) was more likely to demonstrate significant EF improvement (OR: 0.38; 95% CI: 0.17-0.85; p = 0.019).
Extracellular volume fraction obtained by CMR may provide incremental value for the prediction of functional recovery both at the segmental and global levels in CTO patients, and may facilitate the identification of patients who can benefit from revascularization.


Magnetic resonance imaging; Cardiac; T1 mapping; Extracellular volume fraction; Chronic total occlusion; Coronary arteries; Myocardial infarction; Myocardial ischemia; Late gadolinium enhancement

MeSH Terms

Collateral Circulation
Coronary Vessels*
Follow-Up Studies
Magnetic Resonance Imaging*
Myocardial Infarction
Myocardial Ischemia
Prospective Studies
ROC Curve
Sensitivity and Specificity
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