title: Effects of late REopening of Coronary total Occlusion on micRovascular perfusion and myocarDial function: the RECORD study.
abstract: OBJECTIVE
  The effects of the reopening of a coronary total occlusion (CoTO) on microvascular perfusion in subacute or chronic coronary syndromes are actually unclear. We aimed at evaluating the microvascular perfusion pattern by myocardial contrast echocardiography (MCE), in addition to contractile function, before and after CoTO reopening.
  
  
  METHODS
  Twenty four patients with subacute and chronic coronary syndromes and CoTO datable >7 days underwent evaluation of microvascular perfusion and left ventricular (LV) function by MCE (Acuson Sequoia, with Sonovue, Bracco) before the reopening of the CoTO and at 9 ± 3 months of follow-up. Microvascular perfusion was semi-quantitatively assessed by the contrast score index (CSI), whereas the endocardial length of the perfusion defect [contrast defect length (CDL)], measured in three apical views and averaged, was expressed as a percentage of the total LV endocardial border. The wall motion score index (WMSI), LV volumes, and ejection fraction were also calculated.
  
  
  RESULTS
  At baseline, a mild impairment of LV contractile function was observed, which corresponded to a similar impairment of the coronary microvascular perfusion in the overall study population. At follow-up, a significant reduction of CDL% [8.23 (0-19.63) vs. 0 (0-3.68), P = 0.005], improvement of the CSI (1.41 ± 0.29 vs. 1.12 ± 0.17, P = 0.001) and the WMSI (1.73 ± 0.41 vs. 1.33 ± 0.34, P = 0.0004), and increase in the ejection fraction (47.48% ± 8.66 vs. 55.60% ± 8.29, P = 0.0001) were found.
  
  
  CONCLUSIONS
  Reopening of a CoTO in patients with clinical indications to myocardial revascularization is associated with the improvement of coronary microvascular perfusion and the recovery of contractile function.
authors.affiliation: Institute of Cardiology, Catholic University of the Sacred Heart, Policlinico A. Gemelli, Largo A. Gemelli, 8 00168 Rome, Italy. lgaliuto@rm.unicatt.it
authors.forename: Leonarda
authors.initials: L
authors.lastname: Galiuto
authors.forename: Sabrina
authors.initials: S
authors.lastname: Barchetta
authors.forename: Elisa
authors.initials: E
authors.lastname: Fedele
authors.forename: Alberto R
authors.initials: AR
authors.lastname: De Caterina
authors.forename: Gabriella
authors.initials: G
authors.lastname: Locorotondo
authors.forename: Antonio M
authors.initials: AM
authors.lastname: Leone
authors.forename: Francesco
authors.initials: F
authors.lastname: Burzotta
authors.forename: Giampaolo
authors.initials: G
authors.lastname: Niccoli
authors.forename: Antonio G
authors.initials: AG
authors.lastname: Rebuzzi
authors.forename: Filippo
authors.initials: F
authors.lastname: Crea
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D015331:Cohort Studies; D017023:Coronary Angiography / Q000379:methods; D003326:Coronary Circulation / Q000502:physiology*; D023921:Coronary Stenosis / Q000000981:diagnostic imaging* / Q000628:therapy*; D004452:Echocardiography / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction / Q000502:physiology; D009204:Myocardial Revascularization / Q000379:methods; D011446:Prospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency / Q000502:physiology; D016277:Ventricular Function, Left / Q000502:physiology