Key result
Successful percutaneous coronary intervention for chronic total occlusion significantly improved left ventricular global longitudinal strain at 9 months (from -12.4% to -14.5%, P<0.01), whereas failed PCI did not.
Why the study?
The benefit of CTO revascularization in PCI remains controversial, while LV GLS offers a more sensitive assessment of myocardial ischemia and LV function than LVEF.
Does successful percutaneous coronary intervention (PCI) improve left ventricular global longitudinal strain (GLS) in patients with chronic total occlusion (CTO)?
Cohort (n=70)
Single-blind
No
Does successful percutaneous coronary intervention (PCI) improve left ventricular global longitudinal strain (GLS) in patients with chronic total occlusion (CTO)?
Absolute Event Rate: -14.5% vs -14%
p-value: p=<0.01
Successful percutaneous coronary intervention for chronic total occlusion significantly improves left ventricular function as assessed by global longitudinal strain, even when traditional measures like LVEF remain unchanged.
GLS may detect subtle LV recovery after successful CTO PCI; leaves open whether this improves outcomes in randomized trials.
The benefit of revascularization of chronic total occlusion (CTO) in percutaneous coronary intervention (PCI) is controversial. On the other hand, left ventricular (LV) global longitudinal strain (GLS) is a more sensitive marker of LV myocardial ischemia and LV function than LV ejection fraction (EF). The purpose of this study was to investigate the impact of revascularization of CTO on LV function using LV GLS. A total of 70 consecutive patients (65.1±8.9 years, 59 males, LVEF 51.0±12.0%) with CTO who had a positive functional ischemia and underwent PCI, were included in this study. Echocardiography was performed before and 9 months after the procedure with conventional assessment including LV end-diastolic and end-systolic volume (LVEDV, LVESV), LVEF, and with 2DSTE analysis of GLS. Successful PCI was obtained in 60 patients (86%). There were no stent thromboses during follow-up. GLS showed a significant improvement 9 months after successful PCI (pre-PCI -12.4±4.1% vs. post-PCI -14.5±4.1%, P< 0.01), whereas in failed PCI group that did not change significantly (pre-PCI -13.2±4.2% vs. post-PCI -14.0±4.7%, P = 0.64). LVEF, LVEDV and LVESV did not change significantly during follow-up in both successful and failed groups. Successful PCI for CTO improved LV function, assessed by LV GLS.
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Chimura et al. (2019) conducted a cohort in Chronic total occlusion (n=70). Successful percutaneous coronary intervention vs. Failed percutaneous coronary intervention was evaluated on Left ventricular global longitudinal strain (GLS) at 9 months (p=<0.01). Successful percutaneous coronary intervention for chronic total occlusion significantly improved left ventricular global longitudinal strain at 9 months (from -12.4% to -14.5%, P<0.01), whereas failed PCI did not.
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