Early assessment of percutaneous coronary interventions for chronic total occlusions analyzed by novel echocardiographic techniques

Abstract

OBJECTIVE:Successful revascularization of chronic total occlusions has been associated with improved left ventricular systolic function, reduced anginal symptoms, increased exercise capacity, and increased survival. This study was conducted to determine the impact of revascularization in chronic total occlusion on left ventricular function using novel echocardiographic techniques.METHODS:A total of 129 patients with chronic total occlusion who underwent revascularization between April 2011 and November 2012 were included in this study. Echocardiographic assessments with two-dimensional speckle tracking echocardiography and real-time three-dimensional echocardiography were performed before the procedure and one month after the procedure. The left ventricular ejection fraction, left ventricular volumes, and three-dimensional systolic dyssynchrony index were quantified.RESULTS:An immediate procedural success was obtained in 118 patients (91.5%). There were no acute or subacute stent thromboses during follow-up. The mean left ventricular ejection fraction significantly increased (p<0.001), while the left ventricular end-diastolic and end-systolic volumes significantly decreased (p = 0.001 and p<0.001, respectively). The three-dimensional systolic dyssynchrony index also decreased significantly (p<0.001). The global longitudinal strain showed a significant increase after successful revascularization (p<0.001). An increase in the global longitudinal strain was correlated with an increase in the left ventricular ejection fraction (r = 0.27, p = 0.02). The patients with a left ventricular ejection fraction ≥50% displayed a greater improvement in the global longitudinal strain, and the patients with diabetes showed less improvement.CONCLUSIONS:Using novel echocardiographic techniques, our results showed that restoring the coronary blood flow in chronic total occlusion patients reduces the left ventricular volumes and improves the left ventricular ejection fraction and the global longitudinal strain of hibernating myocardium.

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 .…”

“…Successful CTO PCI was associated with a significant decrease in LVESV (−4.0 mL, 95%CI −6.0, −2.1, P < 0.0001, I 2 = 0%) (Figure ). LVEDV was analyzed in nine studies including 403 patients . Successful CTO PCI was not associated with a decrease in LVEDV (−2.2 mL, 95%CI −5.7 to 1.1, P = 0.19, I 2 = 0%) (Figure ).…”

“…Successful CTO PCI was associated with a significant increase in LVEF LVESV was analyzed in 10 studies including 502 patients. [15][16][17]24,26,29,36,38,40,44 Successful CTO PCI was associated with a significant decrease in LVESV (−4.0 mL, 95%CI −6.0, −2.1, P < 0.0001, I 2 = 0%) ( Figure 4). LVEDV was analyzed in nine studies including 403 patients.…”

“…Cardiac magnetic resonance imaging (CMR) was used to assess LVEF in nine studies [14][15][16][17]29,32,33,40,41 while echocardiography was used in 10 studies. 22,24,26,31,36,37,39,[43][44][45] Other studies used left ventriculography 13,20,21,23,25,28,34,35,42,46 or nuclear imaging, 27,38 or did not specify the method used for assessing LVEF. 18,19,30 The…”

Chronic Total Coronary Occlusions: Stress Echocardiography with Speckle Tracking Analysis Study

“…(performed at rest) a significant improvements in terms of EF, myocardial contractility and survival from major cardiac events in patients with successfully reperfused CTO. Erdogan, et al [10], using 3D echocardiography and STE in 118 patients at one-month follow-up from CTO recanalization, showed improvements in EF, EDV and EDS volumes, and GLS values in patients with EF > 50%. Wei-Yue, et al [11], using 3D Real Time echocardiography, assessed EF modifications of 32 patients with and without prior myocardial infarction and successful CTO recanalization.…”