Article Text

Download PDFPDF
Recovery of impaired microvascular function in collateral dependent myocardium after recanalisation of a chronic total coronary occlusion
  1. G S Werner,
  2. U Emig,
  3. P Bahrmann,
  4. M Ferrari,
  5. H R Figulla
  1. Clinic for Internal Medicine I, Friedrich Schiller University Jena, Jena, Germany
  1. Correspondence to:
    Professor Gerald S Werner
    Klinik für Innere Medizin I, Friedrich-Schiller-Universität, Erlanger Allee 101, D-07740 Jena, Germany;


Objective: To assess the potential for recovery of impaired microvascular function in collateral dependent myocardium after recanalisation of a chronic total coronary occlusion and the determinants of this recovery.

Patients and design: 120 patients underwent a successful recanalisation of a chronic total coronary occlusion (duration > 2 weeks) and a follow up angiography after a mean (SD) of 5.0 (1.2) months. The coronary flow velocity reserve (CFVR) and the fractional flow reserve were measured after recanalisation and at follow up. Global and regional left ventricular (LV) function were analysed by quantitative angiography.

Results: Microvascular dysfunction, defined by a CFVR < 2.0 and a fractional flow reserve ⩾ 0.75, was observed in 55 (46%) patients after recanalisation. Microvascular function improved during follow up in 24 (20%). The CFVR increased during follow up from 2.01 (0.58) to 2.50 (0.79) (p < 0.001), due to a decrease in basal average peak velocity from 30.7 (14.9) cm/s to 25.5 (13.3) cm/s (p  =  0.001). Improved microvascular function was associated with an improved regional LV function, shown by a correlation between increased wall motion severity index and increased CFVR (r  =  0.38, p  =  0.003). The major determinant of microvascular dysfunction at baseline was the presence of diabetes mellitus (odds ratio 4.3, 95% confidence interval 1.8 to 10.2), which remained so at follow up (odds ratio 4.1, 95% confidence interval 1.3 to 13.4). Improvement of LV function was not impaired by the presence of microvascular dysfunction after recanalisation.

Conclusions: The frequently observed microvascular dysfunction after recanalisation of a chronic total coronary occlusion is a transient phenomenon in most patients and is influenced by the presence of diabetes mellitus. It does not impede the recovery of LV function. Improved regional LV function is associated with improved microvascular function.

  • APV, average peak velocity
  • CFVR, coronary flow velocity reserve
  • CI, confidence interval
  • FFR, fractional flow reserve
  • LV, left ventricular
  • LVEF, left ventricular ejection fraction
  • OR, odds ratio
  • PCI, percutaneous coronary intervention
  • WMSI, wall motion severity index
  • chronic coronary occlusion
  • coronary flow reserve
  • fractional flow reserve
  • left ventricular function
  • microcirculation

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.