Coronary artery disease
Evaluation of Left Ventricular Function Three Years After Percutaneous Recanalization of Chronic Total Coronary Occlusions

https://doi.org/10.1016/j.amjcard.2007.07.060Get rights and content

We investigated early and late effects of percutaneous revascularization for chronic total coronary occlusion on left ventricular (LV) function and volumes. Magnetic resonance imaging was performed in 21 patients before and 5 months and 3 years after recanalization. Global LV function and volumes and segmental wall thickening (SWT) were quantified on cine images. The 2 viability indexes used were the transmural extent of infarction (TEI) on delayed contrast enhancement images and end-diastolic wall thickness at baseline. Significant decreases in mean end-diastolic (86 ± 14 to 78 ± 15 ml/m2; p = 0.02) and mean end-systolic volume indexes (35 ± 13 to 30 ± 13 ml/m2; p = 0.03) were observed 3 years after recanalization. Mean ejection fraction tended to improve (60 ± 9% to 63 ± 11%; p = 0.11). SWT significantly increased at 5-months’ follow-up (p <0.001), and an additional improvement was found at 3 years’ (p = 0.04) follow-up in segments with TEI <25%. In segments with TEI of 25% to 75%, SWT was unchanged at 5-month follow-up (p = 0.89), but improved at 3 years (p = 0.04). SWT was unchanged in segments with transmural scars. For segmental functional recovery, TEI was a better predictor than end-diastolic wall thickness at baseline (odds ratio 5.6, 95% confidence interval 1.5 to 21.1, p = 0.01 vs odds ratio 2.5, 95% confidence interval 0.7 to 8.3, p = 0.14). In conclusion, a positive effect on LV remodeling and ejection fraction was observed up to 3 years after recanalization. Both early and late improvements in regional LV function were observed in the perfusion territory of chronic total coronary occlusion and were related to the transmural extent of infarction on pretreatment magnetic resonance imaging.

Section snippets

Methods

Patients scheduled for percutaneous revascularization of a CTO of a native coronary artery were prospectively studied. Of these patients, 75% had a positive exercise test result and the remaining 25% had progressive anginal symptoms. All successfully treated patients received a drug-eluting stent. Forty-seven patients were included in this study. In 34 patients, percutaneous coronary intervention was successful. Follow-up at 3 years was obtained in 21 patients; 1 patient died, 1 patient had a

Results

The patient population consisted of 21 patients. In 11 patients, the CTO was located in the left anterior descending; in 8 patients, in the right coronary artery; and in 2 patients, in the circumflex artery. All images were good for analysis. Mean duration of occlusion was 7 ± 5 months. At follow-up, medication was similar to baseline except for clopidogrel, which was discontinued after 6 months.

A total of 336 myocardial segments were available for analysis, of which 106 were in the perfusion

Discussion

We report here that SWT improved in dysfunctional but viable segments 5 months after CTO recanalization, with even further improvement after 3 years of follow-up. Second, a reduction in remodeling was observed up to 3 years after recanalization, shown by decreased end-diastolic and end-systolic volumes. Third, improvement in regional function was related to the extent of myocardial fibrosis and could be predicted using delayed enhancement magnetic resonance imaging before revascularization.

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