Key result
Chronic total coronary occlusion was associated with a modestly lower absolute global longitudinal strain compared to non-occluded multivessel disease (median 14.0% vs 15.5%), though this difference attenuated after clinical adjustment.
Why the study?
The association of chronic total coronary occlusion with LV deformation and pressure-strain-loop-derived myocardial work beyond global LVEF in advanced CAD is uncertain.
Does the presence of chronic total occlusion worsen absolute global longitudinal strain in patients with multivessel coronary artery disease?
Cross-Sectional (n=148)
No
Does the presence of chronic total occlusion worsen absolute global longitudinal strain in patients with multivessel coronary artery disease?
In patients with multivessel coronary artery disease, the presence of a chronic total occlusion is associated with a modestly adverse global left ventricular mechanical profile, but this difference is largely attenuated after accounting for prior myocardial infarction and LVEF.
GLS reduction with CTO attenuates after LVEF adjustment; leaves open independent effects on deformation in multivessel CAD.
Chronic total coronary occlusion (CTO) occurs within advanced coronary artery disease (CAD), but its association with left ventricular (LV) deformation and pressure–strain-loop-derived myocardial work beyond global LV ejection fraction (LVEF) is uncertain. We performed a retrospective cross-sectional analysis of 148 unique patients with multivessel or left-main CAD, including 70 with and 78 without CTO. Absolute global longitudinal strain (GLS) was the principal endpoint; global work index (GWI), constructive work (GCW), wasted work (GWW), and work efficiency (GWE) were secondary endpoints. Sequential CTO coefficients were estimated using HC3 heteroscedasticity-consistent linear models in a pool of patients with complete global mechanics and LVEF data. A history of myocardial infarction was more frequent with CTO (42.9% vs. 23.1%), with lower LVEF and larger LV volumes. In crude distributional comparisons among 136 patients with global mechanics data, median GLS was 14.0% versus 15.5% (p = 0.021), while median GCW was 1723 versus 1997 mmHg% (p = 0.026). In the multivariable regression analysis, the CTO-minus-non-CTO GLS coefficient was −1.40 percentage points (95% CI, −2.80 to 0.00) unadjusted, −1.10 (95% CI, −2.58 to 0.38) after clinical adjustment, and −0.16 (95% CI, −1.24 to 0.92) after adding LVEF. CTO status marked a modest adverse global LV mechanical phenotype, but clinically adjusted estimates were imprecise and markedly attenuated after accounting for LVEF. Prospective studies integrating ischemia, scar, viability, and longitudinal follow-up are needed.
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Madunic et al. (2026) conducted a cross-sectional in Multivessel or left-main coronary artery disease (CAD) (n=148). Chronic total coronary occlusion (CTO) vs. Multivessel or left-main CAD without CTO was evaluated on Absolute global longitudinal strain (GLS) (MD -1.40, 95% CI -2.80 to 0.00, p=0.051). Chronic total coronary occlusion was associated with a modestly lower absolute global longitudinal strain compared to non-occluded multivessel disease (median 14.0% vs 15.5%), though this difference attenuated after clinical adjustment.
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