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Influence of diabetes mellitus on ischaemia burden and collateralization in chronic total coronary artery occlusion

Session Poster session 2

Speaker Ahmed Mohamed Salah Eldin Khedr Abdelaty

Event : EuroCMR 2019

  • Topic : imaging
  • Sub-topic : Cardiac Magnetic Resonance: Coronary Imaging
  • Session type : Poster Session

Authors : AMKD Khedr (Leicester,GB), CA Budgeon (Leicester,GB), A Ladwiniec (Leicester,GB), S Hetherington (Kettering,GB), G Gulsin (Leicester,GB), A Singh (Leicester,GB), AH Gershlick (Leicester,GB), GP Mccann (Leicester,GB), JR Arnold (Leicester,GB)

AMKD Khedr1 , CA Budgeon1 , A Ladwiniec2 , S Hetherington3 , G Gulsin1 , A Singh1 , AH Gershlick1 , GP Mccann1 , JR Arnold1 , 1University of Leicester, Cardiovascular sciences - Leicester - United Kingdom of Great Britain & Northern Ireland , 2University Hospitals of Leicester NHS Trust, Cardiovascular department - Leicester - United Kingdom of Great Britain & Northern Ireland , 3Kettering General Hospital, Cardiovascular department - Kettering - United Kingdom of Great Britain & Northern Ireland ,

European Heart Journal - Cardiovascular Imaging ( 2019 ) 20 ( Supplement 2 ), ii365

Background: Coronary chronic total occlusions (CTO) are present in up to one third of patients with coronary artery disease referred for invasive coronary angiography. In CTO-subtended myocardial territories, the development of collateral connections may mitigate against ischaemia and prevent necrosis. Type 2 diabetes mellitus (T2DM) is increasingly prevalent, and represents a potential risk factor for impaired collateral vessel growth. Using multiparametric cardiac magnetic resonance imaging (CMR),
Purpose: To ascertain the influence of T2DM on ischaemia burden, collateralization and infarction in patients with CTO.
Methods: We retrospectively studied 397 consecutive patients with CTO identified on invasive coronary angiography who were referred for clinical stress CMR at our institution between 2011-2018. CMR assessment comprised visual evaluation of myocardial first-pass perfusion, infarction and left ventricular systolic function. Using invasive coronary angiography, the degree of collateralisation distal to the CTO from contralateral vessels was graded according to the Rentrop classification.
Results: Of the 397 patients in the cohort (mean age 65±11 years, 84% male), 128 (32%) had T2DM. No significant between-group difference was observed in ejection fraction (50.6±12.4% in those with T2DM and 51.3±13.5%in those without T2DM, p=0.61). Similarly no differences were observed in wall motion score index (1.6±0.6 versus 1.5±0.5, respectively, p=0.16)or in the prevalence of infarction (71% versus 70%, p=0.76). In those with infarction, there was no difference in infarct size (as a percentage of left ventricular mass, 11.0±9.7%in subjects with T2DM and 10.5±8.3% in those without, p=0.65). However, in those subjects with T2DM, significant (= 10%) ischaemia burden was more prevalent (53% vs 40%, p=0.03, and well-formed collaterals (Rentrop grade 3) were less prevalent (34% versus 45%, respectively, p=0.03). 
Conclusion: In this observational study involving patients with CTOs, the presence of T2DM was associated with less well developed coronary collaterals and higher ischaemia burden. Whether the presence of coexisting T2DM in patients with CTOs may impact long-term clinical outcome and revascularization decisions requires further study

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