Noninvasive evaluation of coronary collateral arterial flow by coronary computed tomographic angiography

Jin Ho Choi, Eun Kyoung Kim, Sung Mok Kim, Young Bin Song, Joo Yong Hahn, Seung Hyuk Choi, Hyeon Cheol Gwon, Sang Hoon Lee, Yeon Hyeon Choe, Jae Kuen Oh

Research output: Contribution to journalArticle

20 Citations (Scopus)

Abstract

Background-Coronary collateral fow is an alternative source of myocardial perfusion in patients with totally occluded coronary arteries. Clinical evaluation of collateral fow has been limited by the need of invasive measurements. We investigated whether noninvasive coronary computed tomographic angiography can evaluate the angiographic extent of coronary collateral fow. Methods and Results-We enrolled 325 coronary computed tomographic angiography cases with angiographically confrmed chronic total occlusion (median age, 63 years; men 83%). Transluminal attenuation gradient (TAG), which refects the kinetics of contrast media in coronary artery, of an entire artery as well as of a distal vessel was assessed to evaluate the fow in entire vessel and distal vessel. TAGs were validated against visually assessed angiographic collateral connection and Rentrop grading. TAG of an entire artery increased consistently according to the angiographic extent of collateral fow (P<0.001). Well-developed collaterals, defned by highest collateral connection and Rentrop grades (n=103), could be predicted by TAG of an entire artery (cutoff, ≥-7.6 Hounsfeld units/10 mm; c-statistics, 0.72; sensitivity, 65%; specifcity, 73%; positive predictive value, 52%; negative predictive value, 82%). TAG of a distal vessel could discriminate the antegrade (n=143) and retrograde (n=182) fows in distal artery (cutoff, 0.0 Hounsfeld unit/10 mm; c-statistics, 0.88; sensitivity, 78%; specifcity, 85%; positive predictive value, 87%; negative predictive value, 75%). Conclusions-TAG, an intracoronary attenuation-based analysis of coronary computed tomographic angiography, moderately refected the functional extent and direction of collateral fow.

Original languageEnglish (US)
Pages (from-to)482-490
Number of pages9
JournalCirculation: Cardiovascular Imaging
Volume7
Issue number3
DOIs
StatePublished - 2014
Externally publishedYes

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Angiography
Arteries
Coronary Vessels
Contrast Media
Perfusion

Keywords

  • Collateral circulation
  • Coronary artery disease
  • Multidetector computed tomography

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging
  • Medicine(all)

Cite this

Noninvasive evaluation of coronary collateral arterial flow by coronary computed tomographic angiography. / Choi, Jin Ho; Kim, Eun Kyoung; Kim, Sung Mok; Song, Young Bin; Hahn, Joo Yong; Choi, Seung Hyuk; Gwon, Hyeon Cheol; Lee, Sang Hoon; Choe, Yeon Hyeon; Oh, Jae Kuen.

In: Circulation: Cardiovascular Imaging, Vol. 7, No. 3, 2014, p. 482-490.

Research output: Contribution to journalArticle

Choi, Jin Ho ; Kim, Eun Kyoung ; Kim, Sung Mok ; Song, Young Bin ; Hahn, Joo Yong ; Choi, Seung Hyuk ; Gwon, Hyeon Cheol ; Lee, Sang Hoon ; Choe, Yeon Hyeon ; Oh, Jae Kuen. / Noninvasive evaluation of coronary collateral arterial flow by coronary computed tomographic angiography. In: Circulation: Cardiovascular Imaging. 2014 ; Vol. 7, No. 3. pp. 482-490.
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abstract = "Background-Coronary collateral fow is an alternative source of myocardial perfusion in patients with totally occluded coronary arteries. Clinical evaluation of collateral fow has been limited by the need of invasive measurements. We investigated whether noninvasive coronary computed tomographic angiography can evaluate the angiographic extent of coronary collateral fow. Methods and Results-We enrolled 325 coronary computed tomographic angiography cases with angiographically confrmed chronic total occlusion (median age, 63 years; men 83{\%}). Transluminal attenuation gradient (TAG), which refects the kinetics of contrast media in coronary artery, of an entire artery as well as of a distal vessel was assessed to evaluate the fow in entire vessel and distal vessel. TAGs were validated against visually assessed angiographic collateral connection and Rentrop grading. TAG of an entire artery increased consistently according to the angiographic extent of collateral fow (P<0.001). Well-developed collaterals, defned by highest collateral connection and Rentrop grades (n=103), could be predicted by TAG of an entire artery (cutoff, ≥-7.6 Hounsfeld units/10 mm; c-statistics, 0.72; sensitivity, 65{\%}; specifcity, 73{\%}; positive predictive value, 52{\%}; negative predictive value, 82{\%}). TAG of a distal vessel could discriminate the antegrade (n=143) and retrograde (n=182) fows in distal artery (cutoff, 0.0 Hounsfeld unit/10 mm; c-statistics, 0.88; sensitivity, 78{\%}; specifcity, 85{\%}; positive predictive value, 87{\%}; negative predictive value, 75{\%}). Conclusions-TAG, an intracoronary attenuation-based analysis of coronary computed tomographic angiography, moderately refected the functional extent and direction of collateral fow.",
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T1 - Noninvasive evaluation of coronary collateral arterial flow by coronary computed tomographic angiography

AU - Choi, Jin Ho

AU - Kim, Eun Kyoung

AU - Kim, Sung Mok

AU - Song, Young Bin

AU - Hahn, Joo Yong

AU - Choi, Seung Hyuk

AU - Gwon, Hyeon Cheol

AU - Lee, Sang Hoon

AU - Choe, Yeon Hyeon

AU - Oh, Jae Kuen

PY - 2014

Y1 - 2014

N2 - Background-Coronary collateral fow is an alternative source of myocardial perfusion in patients with totally occluded coronary arteries. Clinical evaluation of collateral fow has been limited by the need of invasive measurements. We investigated whether noninvasive coronary computed tomographic angiography can evaluate the angiographic extent of coronary collateral fow. Methods and Results-We enrolled 325 coronary computed tomographic angiography cases with angiographically confrmed chronic total occlusion (median age, 63 years; men 83%). Transluminal attenuation gradient (TAG), which refects the kinetics of contrast media in coronary artery, of an entire artery as well as of a distal vessel was assessed to evaluate the fow in entire vessel and distal vessel. TAGs were validated against visually assessed angiographic collateral connection and Rentrop grading. TAG of an entire artery increased consistently according to the angiographic extent of collateral fow (P<0.001). Well-developed collaterals, defned by highest collateral connection and Rentrop grades (n=103), could be predicted by TAG of an entire artery (cutoff, ≥-7.6 Hounsfeld units/10 mm; c-statistics, 0.72; sensitivity, 65%; specifcity, 73%; positive predictive value, 52%; negative predictive value, 82%). TAG of a distal vessel could discriminate the antegrade (n=143) and retrograde (n=182) fows in distal artery (cutoff, 0.0 Hounsfeld unit/10 mm; c-statistics, 0.88; sensitivity, 78%; specifcity, 85%; positive predictive value, 87%; negative predictive value, 75%). Conclusions-TAG, an intracoronary attenuation-based analysis of coronary computed tomographic angiography, moderately refected the functional extent and direction of collateral fow.

AB - Background-Coronary collateral fow is an alternative source of myocardial perfusion in patients with totally occluded coronary arteries. Clinical evaluation of collateral fow has been limited by the need of invasive measurements. We investigated whether noninvasive coronary computed tomographic angiography can evaluate the angiographic extent of coronary collateral fow. Methods and Results-We enrolled 325 coronary computed tomographic angiography cases with angiographically confrmed chronic total occlusion (median age, 63 years; men 83%). Transluminal attenuation gradient (TAG), which refects the kinetics of contrast media in coronary artery, of an entire artery as well as of a distal vessel was assessed to evaluate the fow in entire vessel and distal vessel. TAGs were validated against visually assessed angiographic collateral connection and Rentrop grading. TAG of an entire artery increased consistently according to the angiographic extent of collateral fow (P<0.001). Well-developed collaterals, defned by highest collateral connection and Rentrop grades (n=103), could be predicted by TAG of an entire artery (cutoff, ≥-7.6 Hounsfeld units/10 mm; c-statistics, 0.72; sensitivity, 65%; specifcity, 73%; positive predictive value, 52%; negative predictive value, 82%). TAG of a distal vessel could discriminate the antegrade (n=143) and retrograde (n=182) fows in distal artery (cutoff, 0.0 Hounsfeld unit/10 mm; c-statistics, 0.88; sensitivity, 78%; specifcity, 85%; positive predictive value, 87%; negative predictive value, 75%). Conclusions-TAG, an intracoronary attenuation-based analysis of coronary computed tomographic angiography, moderately refected the functional extent and direction of collateral fow.

KW - Collateral circulation

KW - Coronary artery disease

KW - Multidetector computed tomography

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