Resting 12-lead electrocardiogram as a reliable predictor of functional recovery after recanalization of chronic total coronary occlusions

Abstract

SummaryBackground: A major goal of revascularization is the recovery of left ventricular (LV) function. Nuclear imaging techniques are widely used for detecting recovery of function with a good sensitivity, but only moderate specificity. Predictors of recovery in chronic total coronary occlusions (CTO) are not investigated.Hypothesis: The 12-lead-resting electrocardiogram (ECG) is a predictor of LV recovery after successful recanalization of CTO.Methods: Successful recanalization of CTO was performed in 127 patients. Of these, 62 patients, who constitute the study group, had impaired regional wall motion prior to recanalization. The 12-lead resting ECG was evaluated for Q-wave areas and parameters of QT dispersion. Impairment of regional wall motion was evaluated by LV angiogram at baseline and at follow-up.Results: Angiographic follow-up after 5 ± 1.4 months documented reocclusion in eight patients. Complete follow-up with a patent coronary artery and an ECG without bundlebranch block was available in 43 patients. Wall motion severity index (WMSI) improved from Ϫ2.92 ± 0.28 to Ϫ1.34 ± 0.61 (p < 0.001) in patients without Q waves, whereas it was unchanged in patients with Q waves (Ϫ3.01 ± 0.30 and Ϫ2.81 ± 0.32). Absence of Q waves at baseline predicted recovery of regional wall motion with 89% sensitivity and 67% specifici-

Ventricular Arrhythmias Among Implantable Cardioverter-Defibrillator Recipients for Primary Prevention

“…However, indirect data, such as absence of electrocardiographic Q waves or dyskinesia in the myocardium supplied by the occluded artery, support a viable myocardium or a possible recovery after recanalization. 36 Device setting was not done by an independent core laboratory and was left to the physician's discretion. However, all arrhythmic events were reviewed by the same electrophysiologist in a second stage and classified subsequently.…”

Assessment of the Human Coronary Collateral Circulation

“…The possibility of LV functional recovery with its beneficial effect on survival provides the rationale for the technically demanding attempt to recanalize a CTO. 35 The recovery of impaired systolic LV function after revascularization of a CTO appears not to depend on the quality of collateral function, 36 suggesting that collateral development does not depend on the presence of viable myocardium. Simultaneous assessment of regional LV function with the use of transthoracic tissue Doppler imaging and invasive collateral function has shown a statistically relevant association between systolic as well as diastolic LV function and collateral function in patients with CAD (Table).…”

What do Polish interventional cardiologists know about indications and qualification for recanalisation of chronic total coronary artery occlusions?

“…It has been reported that the absence of the Q-waves in a 12-lead ECG could predict the recovery of regional wall motion after the CTO PCI; nevertheless, only 22% answered that in such situation there is a need to prove the viability of akinetic region of myocardium [18]. The preferred test for viability assessment in our study was dobutamine stress echocardiography; we can presume that the availability and costs place this test above MRI.…”