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Assaf A, van der Graaf M, van Boven N, van Ettinger MJB, Diletti R, Hoogendijk MG, Szili-Torok T, Theuns DAMJ, Yap SC. Effect of myocardial scar size on the risk of ventricular arrhythmias in patients with chronic total coronary occlusion. Int J Cardiol 2023; 390:131205. [PMID: 37482094 DOI: 10.1016/j.ijcard.2023.131205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 06/28/2023] [Accepted: 07/19/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND The presence of an untreated chronic total coronary occlusion (CTO) is associated with a higher risk of ventricular arrhythmias (VAs). This increased risk may be modulated by the presence of an existing scar. OBJECTIVES To evaluate whether scar size is associated with VA in patients with an implantable cardioverter-defibrillator (ICD) and a CTO. METHODS In this retrospective study we included patients with a CTO that received an ICD between 2005 and 2015. Scar size was estimated using the Selvester QRS score on a baseline 12‑lead ECG. The primary endpoint was any appropriate ICD therapy. RESULTS Our study population comprised 148 CTO patients with a median scar size at baseline of 18% (IQR, 9-27%). Patients with a scar size ≥18% more often had a CTO located in the left anterior descending artery and a higher proportion of poor left ventricular function (<35%) and infarct-related CTO compared to patients with a smaller scar size (<18%). During a median follow-up of 35 months (interquartile range [IQR], 8-60 months), 42 patients (28%) received appropriate ICD therapy. The cumulative 5-year event rate was higher in the patients with a large scar in comparison to those with a smaller or no scar (36% versus 19%, P = 0.04). Multivariable Cox regression analysis demonstrated that large scar and diabetes mellitus were independent factors associated with appropriate ICD therapy. CONCLUSION In ICD recipients with an untreated CTO, a larger scar is an independent factor associated with an increased risk of VA.
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Affiliation(s)
- Amira Assaf
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Marisa van der Graaf
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Nick van Boven
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Maarten J B van Ettinger
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Roberto Diletti
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Mark G Hoogendijk
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Tamas Szili-Torok
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Dominic A M J Theuns
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Sing-Chien Yap
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
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Eertmans W, Hendrickx I, Pauwels R, Maeremans J, McCutcheon K, Kayaert P, Bataille Y, Bennett J, Dens J. Revascularisation of chronic total occlusions and recurrence rate of ventricular arrhythmias. Acta Cardiol 2021; 76:353-358. [PMID: 32138629 DOI: 10.1080/00015385.2020.1736762] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND The impact of revascularisation of chronic total occlusions (CTO) on the incidence of ventricular arrhythmias (VA) remains to be elucidated. METHODS Based on prospectively gathered data, the recurrence rate of VAs following CTO treatment was retrospectively investigated. Patients presenting with VAs as clinical indication for CTO revascularisation were retrospectively selected out of three Belgian CTO registries (i.e. Ziekenhuis Oost-Limburg, UZ Leuven and CHR de la Citadelle). Freedom of VAs was defined as absence of non-sustained or sustained tachycardias (VT), ventricular fibrillations (Vfib) and ventricular extrasystoles (VES; <2500 VES/24 h). Long-term outcome in terms of reoccurrence of VAs was evaluated by reviewing patient records. RESULTS Between 2011 and 2019, 912 patients underwent a CTO-PCI across three Belgian centres. In total 43 patients (5%) presented with VAs as clinical indication for CTO revascularisation. Overall follow-up was 723 (391 - 1144) days. Fourteen (33%), 18 (42%), 5 (11%) and 6 (14%) presented with >2500 VES/24 hrs, non-sustained VT, sustained VT and Vfib, respectively. In those patients with a one-year follow-up available (n = 34), overall recurrence rate of VAs was 38% (within VA group: VES: 25%, non-sustained VT: 46%; sustained VT: 25% and Vfib: 60%). CONCLUSION Based on this retrospective data analysis, CTO revascularisation, in patients presenting with VAs as the main clinical indication, seems to beneficially impact the incidence of VAs, which ultimately might result in improved patients' outcome.
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Affiliation(s)
- Ward Eertmans
- Department of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Ief Hendrickx
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Ruben Pauwels
- Department of Cardiovascular Medicine, Katholieke Universiteit, Leuven, Belgium
| | - Joren Maeremans
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Keir McCutcheon
- Department of Cardiovascular Medicine, Katholieke Universiteit, Leuven, Belgium
| | | | - Yoann Bataille
- Department of Cardiology, Jessa Ziekenhuis, Hasselt, Belgium
| | - Johan Bennett
- Department of Cardiovascular Medicine, Katholieke Universiteit, Leuven, Belgium
| | - Jo Dens
- Department of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium
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Assaf A, Diletti R, Hoogendijk MG, van der Graaf M, Zijlstra F, Szili-Torok T, Yap SC. Vulnerability for ventricular arrhythmias in patients with chronic coronary total occlusion. Expert Rev Cardiovasc Ther 2020; 18:487-494. [PMID: 32684000 DOI: 10.1080/14779072.2020.1793671] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The presence of a chronic total occlusion (CTO) is associated with an increased risk of ventricular arrhythmias. AREAS COVERED This review provides an overview of the relationship between CTO and ventricular arrhythmias, arrhythmogenic mechanisms, and the effect of revascularization. EXPERT OPINION Studies in recipients of an implantable cardioverter-defibrillator (ICD) have shown that a CTO is an independent predictor of appropriate ICD therapy. The myocardial territory supplied by a CTO is a pro-arrhythmogenic milieu characterized by scar tissue, large scar border zone, hibernating myocardium, residual ischemia despite collaterals, areas of slow conduction, and heterogeneity in repolarization. Restoring coronary flow by revascularization might be associated with electrical homogenization as reflected by a decrease in QT(c) dispersion, decrease in T wave peak-to-end interval, reduction of late potentials, and decrease in scar border zone area. Future research should explore whether CTO revascularization results in a lower burden of ventricular arrhythmias. Furthermore, risk stratification of CTO patients without severe LV dysfunction is interesting to identify potential ICD candidates. Potential tools for risk stratification are the use of electrocardiographic parameters, body surface mapping, electrophysiological study, and close rhythm monitoring using an insertable cardiac monitor.
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Affiliation(s)
- Amira Assaf
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam , Rotterdam, The Netherlands
| | - Roberto Diletti
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam , Rotterdam, The Netherlands
| | - Mark G Hoogendijk
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam , Rotterdam, The Netherlands
| | - Marisa van der Graaf
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam , Rotterdam, The Netherlands
| | - Felix Zijlstra
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam , Rotterdam, The Netherlands
| | - Tamas Szili-Torok
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam , Rotterdam, The Netherlands
| | - Sing-Chien Yap
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam , Rotterdam, The Netherlands
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Nikolakopoulos I, Vemmou E, Karacsonyi J, Xenogiannis I, Werner GS, Gershlick AH, Rinfret S, Yamane M, Avran A, Egred M, Garcia S, Burke MN, Brilakis ES. Latest developments in chronic total occlusion percutaneous coronary intervention. Expert Rev Cardiovasc Ther 2020; 18:415-426. [PMID: 32594784 DOI: 10.1080/14779072.2020.1787153] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Chronic Total Occlusion Percutaneous Coronary Intervention (CTO PCI) is now performed with high success rates and acceptable complication rates. AREAS COVERED We describe recent clinical and technological developments in CTO PCI from 2018 to 2020. EXPERT OPINION After publication of six randomized controlled trials, improving patient symptoms remains the principal indication for CTO PCI. Although good outcomes can be achieved with CTO PCI at experienced centers, success rates are significantly lower at less experienced centers, despite increased use in CTO crossing algorithms and development of novel and improved equipment and techniques.
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Affiliation(s)
- Ilias Nikolakopoulos
- Minneapolis Heart Institute Foundation and Minneapolis Heart Institute, Abbott Northwestern Hospital , Minneapolis, MN, USA
| | - Evangelia Vemmou
- Minneapolis Heart Institute Foundation and Minneapolis Heart Institute, Abbott Northwestern Hospital , Minneapolis, MN, USA
| | - Judit Karacsonyi
- Minneapolis Heart Institute Foundation and Minneapolis Heart Institute, Abbott Northwestern Hospital , Minneapolis, MN, USA
| | - Iosif Xenogiannis
- Minneapolis Heart Institute Foundation and Minneapolis Heart Institute, Abbott Northwestern Hospital , Minneapolis, MN, USA
| | - Gerald S Werner
- Medizinische Klinik I (Cardiology & Intensive Care), Klinikum Darmstadt GmbH , Darmstadt, Germany
| | - Anthony H Gershlick
- Department of Cardiovascular Sciences, University of Leicester and National Institute of Health Research Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital , Leicester, UK
| | - Stephane Rinfret
- McGill University Health Centre, McGill University , Montreal, Quebec, Canada
| | - Masahisa Yamane
- Cardiology Department, Saitama Sekishinkai Hospital , Saitama, Japan
| | - Alexandre Avran
- Department of Interventional Cardiology, Clinique Pasteur, Essey-lès-nancy , France
| | - Mohaned Egred
- Cardiothoracic Department, Freeman Hospital, Newcastle University , Newcastle-Upon-Tyne, UK
| | - Santiago Garcia
- Minneapolis Heart Institute Foundation and Minneapolis Heart Institute, Abbott Northwestern Hospital , Minneapolis, MN, USA
| | - M Nicholas Burke
- Minneapolis Heart Institute Foundation and Minneapolis Heart Institute, Abbott Northwestern Hospital , Minneapolis, MN, USA
| | - Emmanouil S Brilakis
- Minneapolis Heart Institute Foundation and Minneapolis Heart Institute, Abbott Northwestern Hospital , Minneapolis, MN, USA
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Bei Y, Shi C, Zhang Z, Xiao J. Advance for Cardiovascular Health in China. J Cardiovasc Transl Res 2018; 12:165-170. [PMID: 30535628 DOI: 10.1007/s12265-018-9852-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 12/03/2018] [Indexed: 01/14/2023]
Abstract
As the most populous country worldwide, China has ≈ 290 million patients with cardiovascular diseases (CVDs), representing the leading cause of death in Chinese population. The morbidity and mortality of CVDs are continuously rising. Here, we will first summarize the recent advance in the management of CVDs such as coronary arterial disease, arrhythmia, and heart failure in China. In particular, we will introduce the development of chest pain centers and indicate the novel techniques and methods applied for the management of CVDs. Then, we will discuss and point out the importance of improving the clinical and basic research for Traditional Chinese medicine in the treatment of CVDs. Finally, we will emphasize the efforts made to promote cardiac rehabilitation and cardiovascular prevention system in China. We are striving to establish a practical prevention-treatment-rehabilitation system and looking forward to a bright future with reduced morbidity and mortality from CVDs in China.
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Affiliation(s)
- Yihua Bei
- Institute of Cardiovascular Sciences, Shanghai University, 333 Nan Chen Road, Shanghai, 200444, China
| | - Chao Shi
- Institute of Cardiovascular Sciences, Shanghai University, 333 Nan Chen Road, Shanghai, 200444, China
| | - Zhongrong Zhang
- Institute of Cardiovascular Sciences, Shanghai University, 333 Nan Chen Road, Shanghai, 200444, China
| | - Junjie Xiao
- Institute of Cardiovascular Sciences, Shanghai University, 333 Nan Chen Road, Shanghai, 200444, China.
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