CMR Guidance for Recanalization of Coronary Chronic Total Occlusion

Abstract

In this small group of patients showing CMR evidence of significant myocardial inducible perfusion defect and viability, CTO recanalization reduces ischemic burden, favors reverse remodeling, and ameliorates quality of life.

Benefits of chronic total coronary occlusion percutaneous intervention in patients with heart failure and reduced ejection fraction: insights from a cardiovascular magnetic resonance study

“…All three mentioned studies [9–11] showed that the improvement in regional wall thickening after a successful CTO-PCI was indirectly related to the transmurality of LGE in a myocardial segment. More recently and in consonance with our findings, Bucciarelli-Ducci et al [12] reported a significant improvement in LVESV and LVEF after successful CTO-PCI in a group of 32 patients with preserved LVEF showing CMR evidence of myocardial viability and ischemia. Other than older studies assessing LVEF with contrast ventriculography [13, 14], Valenti et al published the only large study to date showing improved LVEF after successful CTO recanalization [15].…”

“…The proportion of patients with history of previous myocardial infarction and the high prevalence of classic cardiovascular risk factors in this cohort are consistent with previous published data [22, 23]. Improvement in angina status after CTO-PCI has also been shown in previous studies in patients with preserved LVEF [7, 8, 12, 16, 18]. …”

“…Pujadas et al [7] showed a reduction in the number of ischemic segments in 33 patients who underwent successful PCI of a single CTO. Similarly, Bucciarelli-Ducci et al [12] described a complete or almost complete resolution of perfusion defect after CTO-PCI along with an increased myocardial perfusion reserve in the CTO territory. It is worth mentioning that in both studies LVEF was preserved in most of the patients before the PCI procedure and mean necrotic mass was much lower than in the present study (6 and 11 g vs. 22 g).…”

Meta‐analysis of the impact of successful chronic total occlusion percutaneous coronary intervention on left ventricular systolic function and reverse remodeling

“…Thirty‐four observational studies [including two abstracts ] with a total of 2804 patients met our inclusion criteria . Cardiac magnetic resonance imaging (CMR) was used to assess LVEF in nine studies while echocardiography was used in 10 studies . Other studies used left ventriculography or nuclear imaging, or did not specify the method used for assessing LVEF .…”

Meta-analyses and randomized trials investigating percutaneous coronary intervention of chronic total occlusions: what is left to explore?

“…Regional myocardial function, measured as segmental wall thickening (SWT), improved in segments with a transmural extent of infarction (TEI) of <75%, and was unchanged in patients with TEI ≥75%. A study of 50 consecutive patients with a CTO who underwent contrast enhanced CMR showed that 32 patients (64%) had inducible ischemia and myocardial viability within the CTO territory (12). These 32 patients underwent a second CMR at 3 months after CTO PCI.…”