CTO-PCI in selected high-risk patients with ischemic HFrEF improved NYHA class, NT-proBNP, and quality of life at 6 and 12 months, despite modest ejection fraction improvement.
Case Report
Does CTO-PCI improve clinical symptoms, biomarkers, and quality of life in patients with ischemic HFrEF and viable myocardium?
In selected patients with ischemic HFrEF and viable myocardium, CTO-PCI may provide significant clinical, biomarker, and quality of life improvements despite limited LVEF recovery.
Background/Objectives: Revascularization of chronic total occlusions (CTO) in patients with heart failure and reduced ejection fraction (HFrEF) remains controversial, as randomized trials have not demonstrated a clear prognostic benefit. Methods: We present an imaging-guided case series of patients with ischemic HFrEF who underwent CTO percutaneous coronary intervention (PCI) following myocardial viability assessment using single-photon emission computed tomography (SPECT). Contemporary antegrade and retrograde techniques were employed. Results: At 6- and 12-month follow-ups, all patients demonstrated marked improvement in NYHA (New York Heart Association) functional class, significant reductions in NT-proBNP (N-terminal pro-brain natriuretic peptide) levels, and substantial improvement in quality of life assessed by the Minnesota Living with Heart Failure Questionnaire (MLHFQ). These benefits occurred despite only modest improvement in left ventricular (LV) ejection fraction (EF) and limited reverse remodeling. SPECT enabled identification of viable but ischemic myocardium, supporting individualized revascularization decisions. Conclusions: In selected high-risk patients with ischemic HFrEF, CTO-PCI was associated with meaningful clinical and biomarker improvement independent of substantial EF recovery. Careful patient selection, incorporating myocardial viability assessment, may refine individualized clinical decision-making in selected patients. These findings support an imaging-guided approach and warrant further prospective evaluation.
Blaj-Tunduc et al. (Sat,) conducted a case report in Ischemic heart failure with reduced ejection fraction (HFrEF) and chronic total occlusions (CTO). CTO percutaneous coronary intervention (PCI) was evaluated on NYHA functional class, NT-proBNP levels, and quality of life (MLHFQ). CTO-PCI in selected high-risk patients with ischemic HFrEF improved NYHA class, NT-proBNP, and quality of life at 6 and 12 months, despite modest ejection fraction improvement.