Abstract
BackgroundSuccessful 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.ResultsThis 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).ConclusionsSuccessful PCI for CTO improved regional LV myocardial function assessed by TDI strain echocardiography. This improvement was associated with improvement in the angina class.
Highlights
Successful revascularization of chronic total occlusions has been associated with potential effects on left ventricular (LV) function
The aim of this study was to evaluate the impact of percutaneous coronary intervention (PCI) of chronic total occlusion (CTO) on clinical outcome and regional myocardial function using Tissue Doppler imaging (TDI) strain echocardiography
They were divided into two groups: The PCI group, including thirty patients, was presented for elective PCI of CTO on left anterior descending (LAD) artery with symptomatic angina and/or positive functional ischemic study, had successful PCI with final thrombolysis in myocardial infarction (TIMI) flow more than II, and was kept on optimum medical treatment (OMT)
Summary
Successful revascularization of chronic total occlusions has been associated with potential effects on left ventricular (LV) function. This study was conducted to investigate the impact of revascularization of chronic total occlusion (CTO) on LV function using tissue Doppler (TDI) strain echocardiography. Coronary chronic total occlusions (CTOs) are defined as an occluded coronary segment with thrombolysis in myocardial infarction (TIMI) flow 0 for ≥ 3 months duration [1]. Two-dimensional (2D) echocardiography has been described as the ideal imaging modality for the assessment of global and regional ventricular function. Tissue Doppler (TDI) imaging has been introduced in an attempt to provide a more objective assessment of myocardial contractility but is subject to the confounding (2019) 71:8 effects of cardiac translational motion and passive pathological tethering [5]
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