Key result
Percutaneous coronary intervention of chronic total occlusion significantly improved peak systolic strain to 11.51% at 6 months compared to optimal medical therapy.
Why the study?
Successful CTO revascularization is associated with potential effects on LV function, and strain and strain rate provide more sensitive measures of LV mechanics than LVEF.
Does percutaneous coronary intervention of chronic total occlusion improve regional myocardial function and angina class in patients with CTO of the LAD artery?
Observational (n=60)
No
Does percutaneous coronary intervention of chronic total occlusion improve regional myocardial function and angina class in patients with CTO of the LAD artery?
Absolute Event Rate: 11.51% vs 6.9%
p-value: p=<0.001
Successful PCI of chronic total occlusions in the LAD artery improves regional left ventricular myocardial function and angina symptoms compared to optimal medical therapy alone.
PCI of LAD CTO was associated with improved strain; hypothesis-generating for regional function and requires RCTs before practice change.
BACKGROUND: Successful revascularization of chronic total occlusions has been associated with potential effects on left ventricular (LV) function. Strain and strain rate are more sensitive measures of LV mechanics than LV ejection fraction (LVEF). This study was conducted to investigate the impact of revascularization of chronic total occlusion (CTO) on LV function using tissue Doppler (TDI) strain echocardiography. RESULTS: This study included 60 patients divided into two main groups: the percutaneous coronary intervention (PCI) group including patients who had a successful PCI of CTO on left anterior descending (LAD) artery and was presented for elective PCI with symptomatic angina and/or positive functional ischemic study. They included 18 males with a mean age of 57 ± 5 years. The optimum medical treatment (OMT) group, including 30 patients, had non-revascularized CTO-LAD and was kept on OMT alone; 20 of them were males with a mean age of 58 ± 4 years. In the PCI group, there was a significant improvement in all the TDI strain parameters of the LAD territory segments. Six months after PCI, the peak systolic strain rate improved from - 0.65 ± 0.21 to 1.05 ± 0.31 1/s (p value < 0.01), the peak systolic strain improved from 6.54 ± 2.48 to 11.51 ± 3.33% ( p value < 0.001 ), and the end systolic strain improved from 7.88 ± 2.77 to 10.51 ± 3.14% (p value < 0.01 ). There was no significant improvement in the mean LVEF (60.70 ± 8.33 vs 61.91 ± 8.16% (p value = 0.6)). In the OMT group, there was no improvement in all the strain parameters and there was no change in the mean LVEF. In the PCI group, there was a significant improvement in the angina class (p value = 0.03) while, in the OMT group, there was no significant improvement (p value = 0.835). CONCLUSIONS: Successful PCI for CTO improved regional LV myocardial function assessed by TDI strain echocardiography. This improvement was associated with improvement in the angina class.
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Kholeif et al. (2019) conducted an observational in Chronic total occlusion of the left anterior descending artery (n=60). Percutaneous coronary intervention (PCI) vs. Optimum medical treatment (OMT) was evaluated on Peak systolic strain at 6 months (p=<0.001). Percutaneous coronary intervention of chronic total occlusion significantly improved peak systolic strain to 11.51% at 6 months compared to optimal medical therapy.
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