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

• Chen Y
• Zheng X
• Jin H
• Deng S
• Ren D
• Greiser A
• Fu C
• Gao H
• Zeng M

• KMID: 2429922
• DOI: http://doi.org/10.3348/kjr.2018.0069

Abstract

OBJECTIVE
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).
MATERIALS AND METHODS
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.
RESULTS
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).
CONCLUSION
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.

Keyword

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
Humans
Infarction
Magnetic Resonance Imaging*
Myocardial Infarction
Myocardial Ischemia
Myocardium
Prospective Studies
ROC Curve
Sensitivity and Specificity

Figure

• 

  Fig. 1 Measurement of ECV based on AHA 16-segment model in patients with right coronary artery chronic total occlusion.A. “T1 Calculation” module required endocardial and epicardial contours, segmentation points and blood-pool contour in all slices in both T1 maps. B. “Map Analysis” module generated ECV map and polar map when hematocrit was entered and long axis extent was defined. Note that AHA 2 and 3 segments were located at outflow tract. C. In another case with chronic fatty infiltration (arrow), contours were drawn avoiding zone with abnormal low native T1 times, and copied to matched post-contrast T1 map. AHA = American Heart Association, ECV = extracellular volume fraction

• 

  Fig. 2 Bar chart reveals inverse correlation between TEI and improvement in SWT.Bars and error bars represent means and 1 standard error of mean respectively. PCI = percutaneous coronary intervention, SWT = segmental wall thickening, TEI = transmural extent of infarction

• 

  Fig. 3 ROC curves demonstrating diagnostic performance of baseline imaging markers in predicting segmental function recovery.RIM = unenhanced rim thickness, ROC = receive operating characteristic

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  Fig. 4 Correlation between baseline segmental ECV, SWT at follow-up (A, C), and change in SWT from follow-up to baseline (B, D).

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  Fig. 5 ROC curves for prediction of significant improvement in ejection fraction based on global ECV at baseline.AUC = area under receiver operating characteristic curve

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