Abstract
BackgroundChronic total occlusion percutaneous coronary intervention (CTO-PCI) can improve angina and left ventricular ejection fraction (LVEF). These benefits were not assessed in populations with heart failure with reduced ejection fraction (HFrEF). We studied the effect of CTO-PCI on left ventricular function and clinical parameters in patients with HFrEF.MethodsUsing cardiovascular magnetic resonance (CMR), we studied 29 patients with HFrEF and evidence of viability and/or ischemia in the territory supplied by a CTO who were successfully treated with CTO-PCI. In patients with multi-vessel disease, non-CTO PCI was also performed. Imaging parameters, clinical status, and brain natriuretic peptide (BNP) levels were evaluated before and 6 months after CTO-PCI.ResultsA decrease in left ventricular end-systolic volume (160 ± 54 ml vs. 143 ± 58 ml; p = 0.029) and an increase in LVEF (31.3 ± 7.4 % vs. 37.7 ± 8 %; p < 0.001) were observed. There were no differences in LVEF improvement between patients who underwent non-CTO PCI (n = 11) and those without this intervention (n = 18); (p = 0.73). The number of segments showing perfusion defects was significantly reduced (0.5 ± 1 vs. 0.2 ± 0.5; p = 0.043). Angina (p = 0.002) and NYHA functional class (p = 0.004) improved, and BNP levels decreased (p = 0.004) after CTO-PCI.ConclusionsIn this group of patients with HFrEF showing CMR evidence of viability and/or ischemia within the territory supplied by the CTO, an improvement in ejection fraction, left ventricular end-systolic volume and ischemia burden was observed after CTO-PCI. Clinical and laboratory parameters also improved.Trial registrationClinicalTrials.gov NCT02570087. Registered 6 October 2015.
Highlights
Chronic total occlusion percutaneous coronary intervention (CTO-PCI) can improve angina and left ventricular ejection fraction (LVEF)
The present study aimed to assess whether chronic total occlusion (CTO)-PCI in patients with chronic heart failure and reduced ejection fraction (HFrEF) is associated with an improvement in LVEF, angina status, New York Heart Association (NYHA) functional class for dyspnea (NYHA I-IV) and brain natriuretic peptide (BNP) levels
CTO recanalization was attempted in those with LVEF ≤40 % confirmed by cardiovascular magnetic resonance (CMR) and with evidence of myocardial viability and/or ischemia in at least two contiguous segments subtended by the CTO (n = 39)
Summary
Chronic total occlusion percutaneous coronary intervention (CTO-PCI) can improve angina and left ventricular ejection fraction (LVEF). A chronic total occlusion (CTO) is defined as a coronary obstruction with thrombolysis in myocardial infarction (TIMI) grade 0 flow that persists for at least 3 months [1]. CTO percutaneous coronary intervention (PCI) is performed infrequently likely due to technical complexity, the potential for major periprocedural complications, the relatively low procedural success rates and controversial data regarding the clinical benefit [3, 4]. Potential CTO-PCI benefits are ischemia reduction, angina relief, and improved left ventricular ejection function (LVEF) and long-term survival [7,8,9,10,11,12,13,14,15,16,17,18] These data come from studies enrolling patients with preserved LVEF, where clinical benefits of myocardial revascularization are potentially lower. The present study aimed to assess whether CTO-PCI in patients with chronic heart failure and reduced ejection fraction (HFrEF) is associated with an improvement in LVEF, angina status, New York Heart Association (NYHA) functional class for dyspnea (NYHA I-IV) and brain natriuretic peptide (BNP) levels
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