ANTARCTICA: analysis using novel signaling pathway and 3-tesla imaging of arteriogenesis in chronic total occlusive coronary arteries

Many clinical studies have implicated a functional significance of collateral
arteries in relation to preserving left ventricular function, reducing infarct
size and lowering future adverse cardiac events. Chronic total occluded
coronary arteries (CTO; chronic total occlusion) offer the unique opportunity
to measure collateral dependent perfusion. The current gold standard for
quantitative assessment of the human coronary collateral circulation is by
invasive cardiac examination. Based on such hemodynamic parameters, we propose
to identify genetic predispositions in patients with varying degrees of
collateralization, in order to ultimately identify novel therapeutic targets.
New avenues for collateral vessel growth also require sufficient means of
collateral vessel detection. Among the non-invasive diagnostic imaging systems,
MRI has been deemed as having the greatest versatility with regards to vascular
imaging due to its capacity to obtain morphologic and functional information
(Oostendorp et al. Radiology 2009; 251: 317-35). MRI has the capacity to
visualize vessel growth at varying spatial and temporal scales, with greater
sensitivity to small vessel function than other imaging modalities (Padhani. J
Magn Reson Imaging 2002; 16: 407-22). These capabilities could prove to be
advantageous for collateral vessel detection. There is a relative lack of data
correlating the intracoronary derived pressure-derived collateral flow index
(CFIp) and velocity-derived collateral flow index (CFIv) and MRI derived
estimates of collateral coronary circulation. Therefore the goal of this trial
is to study this correlation between these intracoronary derived parameters and
cardiac MRI estimates of collateral coronary circulation.

In this study we aim to develop new methods of non-invasive detection of
collateral vessels with MRI, along with identifying novel therapeutic targets
to influence arteriogenesis.

Multicenter observational prospective study

Burden:
-time:
1 time MRI of approximately 45-60 minutes. Procedure time is extended with 15
minutes.

Risk:
The risk of complications during intracoronay measurements is small in the
hands of experienced operators.
The radiation exposure is extended with 3 minutes.

Benefit:
No personal benefit for the included patients

Group Benefit:
-after completion of this study, the patients benefit lies in less need of
invasive measurements by means of cathaterization as cardiac MRI can be used
for determination of collateral function. This is of great importance in case
of monitoring future therapies for arteriogenesis.

-furthermore, genetic factors could be identified which can be therapeutic
targets for influencing arteriogenesis.