Early assessment of percutaneous coronary interventions for chronic total occlusions analyzed by novel echocardiographic techniques (original) (raw)
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The Egyptian Heart Journal, 2019
Background: Successful revascularization of chronic total occlusions has been associated with potential effects on left ventricular (LV) function. Strain and strain rate are more sensitive measures of LV mechanics than LV ejection fraction (LVEF). This study was conducted to investigate the impact of revascularization of chronic total occlusion (CTO) on LV function using tissue Doppler (TDI) strain echocardiography. Results: This study included 60 patients divided into two main groups: the percutaneous coronary intervention (PCI) group including patients who had a successful PCI of CTO on left anterior descending (LAD) artery and was presented for elective PCI with symptomatic angina and/or positive functional ischemic study. They included 18 males with a mean age of 57 ± 5 years. The optimum medical treatment (OMT) group, including 30 patients, had non-revascularized CTO-LAD and was kept on OMT alone; 20 of them were males with a mean age of 58 ± 4 years. In the PCI group, there was a significant improvement in all the TDI strain parameters of the LAD territory segments. Six months after PCI, the peak systolic strain rate improved from − 0.65 ± 0.21 to 1.05 ± 0.31 1/s (p value < 0.01), the peak systolic strain improved from 6.54 ± 2.48 to 11.51 ± 3.33% (p value < 0.001), and the end systolic strain improved from 7.88 ± 2.77 to 10.51 ± 3.14% (p value < 0.01). There was no significant improvement in the mean LVEF (60.70 ± 8.33 vs 61.91 ± 8.16% (p value = 0.6)). In the OMT group, there was no improvement in all the strain parameters and there was no change in the mean LVEF. In the PCI group, there was a significant improvement in the angina class (p value = 0.03) while, in the OMT group, there was no significant improvement (p value = 0.835). Conclusions: Successful PCI for CTO improved regional LV myocardial function assessed by TDI strain echocardiography. This improvement was associated with improvement in the angina class.
The American Journal of Cardiology, 2013
Previous studies have demonstrated improvement of regional wall motion and global left ventricular function after successful recanalization of chronic total occlusion in coronary artery. However, the difference of benefits of recanalization between infarct site and noninfarct site is unknown. This study assessed the changes in left ventricular ejection fraction, regional wall motion after successful angioplasty of chronic total occlusions with or without previous myocardial infarction. This study also evaluated the factors that influenced the outcome of left ventricular function. We retrospectively studied 75 patients with a successfully recanalized chronic total occlusion in native coronary artery. Left ventriculograms were obtained at baseline and after 6 months. Global and regional left ventricular function were determined. The patients were divided into two groups. Group 1 comprised patients without previous myocardial infarction in the territories of total occlusion vessel that was recanalized. Group 2 comprised patients with previous myocardial infarction in the territories of total occlusion vessel that was recanalized. Left ventricular ejection fraction increased from 53.2% ؎ 16.3% at baseline to 57.3% ؎ 20.1% at 6-month follow-up in the whole group (P ؍ 0.001). In group 1 patients, the evolution of left ventricular (LV) ejection fraction increased from 59.5% ؎ 13.7% to 67.3% ؎ 14.6% (P < 0.001). In group 2 patients, the evolution of LV ejection fraction increased, but not significantly, from 48.9% ؎ 16.2% to 50.5% ؎ 16.9% (P ؍ NS). The evolution of LV ejection fraction increased from 47.6% ؎ 17.4% to 50.8% ؎ 17.5% (P < 0.05) in the subgroup of recanalization in infarct-related vessel that had rich collateral circulation and had long-term patency. The regional wall motion all significantly improved in group 1 patients (P < 0.05). The regional wall motion did not change in group 2 patients (P ؍ NS). The influence of recanalization of chronic coronary occlusions on the improvement of left ventricular global function was different between myocardial infarction and nonmyocardial infarction patients. The left ventricular function did not improve in myocardial infarction patient. Regional wall motion improved in patients without previous myocardial infarction. For reliable improvement of left ventricular function after recanalization of chronic total occlusions, evidence (not only by symptom or treadmill test) of viable myocardium in recanalized vessel is important. It is also important to keep patency of infarct-related vessel that has good collateral circulation for improving the left ventricular function.
Catheterization and Cardiovascular Interventions, 2020
Objectives: The aim of the present analysis is to evaluate the clinical impact of chronic total occlusions (CTOs) recanalization in patients with left ventricular (LV) systolic dysfunction. Background According to contemporary knowledge, patient selection for percutaneous CTO revascularization is not yet standardized. In particular, data on outcomes in patients with LV systolic dysfunction undergoing percutaneous coronary intervention (PCI) for CTO are scarce. Methods: From a total of 2,421 consecutive patients with at least one CTO, 436 patients with ejection fraction (EF) ≤45%, who were referred for coronary angiography between January 1998 and September 2014, were selected. Patients with successful recanalization of the target CTO were assigned to CTO-revascularized group and those with failed or not attempted recanalization to the CTO-not revascularized (CTO-NR) group. Study endpoints were all-cause death, cardiac death, and occurrence of myocardial infarction on follow-up. Results: Out of 436 CTO patients with reduced EF, 228 (52.3%) were successfully recanalized and 208 patients (47.7%) were not, either due to CTO-PCI failure (n = 106, 24.3%) or because CTO-PCI was not attempted (n = 102, 23.4%). At longterm follow-up, CTO-NR patients had significantly higher rate of overall (p = .021) and cardiac mortality (p = .035) compared to those successfully revascularized. Conclusion: In patients with systolic LV dysfunction (EF ≤ 45%), CTO revascularization was associated with significant lower rate of total and cardiac mortality compared to those with nonrevascularized CTO.
Journal of interventional cardiology, 2018
We sought to examine the impact of coronary chronic total occlusion (CTO) percutaneous coronary intervention (PCI) on left ventricular (LV) function. We performed a systematic review and meta-analysis of studies published between January 1980 and November 2017 on the impact of successful CTO PCI on LV function. A total of 34 observational studies including 2735 patients were included in the meta-analysis. Over a weighted mean follow-up of 7.9 months, successful CTO PCI was associated with an increase in LV ejection fraction by 3.8% (95%CI 3.0-4.7, P < 0.0001, I = 45%). In secondary analysis of 15 studies (1248 patients) that defined CTOs as occlusions of at least 3-month duration and reported follow-up of at least 3-months after the procedure, successful CTO PCI was associated with improvement in LV ejection fraction by 4.3% (95%CI [3.1, 5.6], P < 0.0001). In the 10 studies (502 patients) that reported LV end-systolic volume, successful CTO PCI was associated with a decrease ...
Echocardiography, 2011
Background: Numerous studies show that percutaneous coronary intervention has no clinical benefit in patients with total occlusion. Both regional and global left ventricle (LV) functions may be evaluated in detail by strain (S) and strain rate (SR) echocardiography. The purpose of this study is to evaluate whether S and SR echocardiography may be used to determine the total occlusion. Method: Sixty stable patients who have total or subtotal occlusion in the infarct-related left anterior descending artery were enrolled (Total occlusion group: 35 and subtotal occlusion group: 25 patients). In all patients, LV longitudinal S and SR data were obtained from total 14 segments. Results: S values of middle and apical segments of LV were significantly lower in the total occlusion groups. In SR analysis, middle and apical values of all walls were significantly different between the groups. The total SR of the middle and apical segments was significantly lower in the total occlusion group (respectively, total SR in middle segments: −3.4 ± 0.8% vs. −4.6 ± 1.0%, P < 0.00001 and total SR in apical segments: −1.7 ± 0.5% vs. −2.8 ± 0.6%, P = 0.001). The total SR values of four walls were also significantly lower in the total occlusion group (−10.3 ± 2.0% vs. −13 ± 3.1%, P < 0.0001). For predicting total occlusion, the highest sensitivity levels (84%) were obtained in SR of middle-anterior segment. SR of middle-septum and middlelateral segments has the highest specificity levels (86%). Conclusion: Total occlusion in stable patients with acute coronary syndrome has an unfavorable effect on the LV regional and global functions. Patients with total occlusion may be identified by S and SR echocardiography.
The International Journal of Cardiovascular Imaging, 2021
To evaluate the effect of percutaneous coronary intervention (PCI) of coronary chronic total occlusions (CTOs) on left ventricular (LV) strain assessed using cardiac magnetic resonance (CMR) tissue tracking. In 150 patients with a CTO, longitudinal (LS), radial (RS) and circumferential shortening (CS) were determined using CMR tissue tracking before and 3 months after successful PCI. In patients with impaired LV strain at baseline, global LS (10.9 ± 2.4% vs 11.6 ± 2.8%; P = 0.006), CS (11.3 ± 2.9% vs 12.0 ± 3.5%; P = 0.002) and RS (15.8 ± 4.9% vs 17.4 ± 6.6%; P = 0.001) improved after revascularization of the CTO, albeit to a small, clinically irrelevant, extent. Strain improvement was inversely related to the extent of scar, even after correcting for baseline strain (B = − 0.05; P = 0.008 for GLS, B = − 0.06; P = 0.016 for GCS, B = − 0.13; P = 0.017 for GRS). In the vascular territory of the CTO, dysfunctional segments showed minor improvement in both CS (10.8 [6.9 to 13.3] % vs...
The International Journal of Cardiovascular Imaging, 2021
The right ventricle (RV) is frequently involved in ST-segment elevation myocardial infarction (STEMI) when the culprit or concurrent chronic total occlusion (CTO) is located in the right coronary artery (RCA). We investigated RV function recovery in STEMI-patients with concurrent CTO. In EXPLORE, STEMI-patients with concurrent CTO were randomized to CTO percutaneous coronary intervention (PCI) or no CTO-PCI. We analyzed 174 EXPLORE patients with serial cardiovascular magnetic resonance imaging RV data (baseline and 4-month follow-up), divided into three groups: CTO-RCA (CTO in RCA, culprit in non-RCA; n = 89), IRA-RCA (infarct related artery [IRA] in RCA, CTO in non-RCA; n = 56), and no-RCA (culprit and CTO not in RCA; n = 29). Tricuspid annular plane systolic excursion (TAPSE), RV ejection fraction (RVEF), RV global longitudinal strain (GLS) and free wall longitudinal strain (FWLS) were measured. We found that RV strain and TAPSE improved in IRA-RCA and CTO-RCA (irrespective of CTO...
Myocardial Viability in Coronary Artery Chronic Total Occlusion
Current Cardiology Reports, 2014
Coronary artery chronic total occlusion (CTO) has rapidly become a popular target of percutaneous coronary intervention (PCI). Technical and technological advances required for approaching these anatomically complex and challenging lesions have progressed at an extraordinary pace and have led to amazing success rates. Patient selection, however, has primarily focused on patient symptoms, lesion characteristics, as well as the state of collateral circulation. Multiple national and international registries have been established to follow the progress of percutaneous CTO recanalization and have provided valuable information. Concern, however, exists that this challenging procedure will become the "standard of care" before its effectiveness and appropriateness is tested in prospective controlled trials. This manuscript reviews the current state of patient selection and the need for careful assessment of the presence and extent of myocardial viability prior to lengthy, resource-intensive, and potentially high-risk procedures.