Improvement of left ventricular function after successful chronic total occlusion recanalization in patients with evidence of ischemia by stress myocardial perfusion imaging

Abstract

Backgroud: Several observational studies have suggested survival advantages after successful chronic total occlusion (CTO) recanalization by percutaneous coronary intervention (PCI). However, controversy persists and it is unclear whether CTO recanalization ameliorates left ventricular ejection fraction (LVEF), generally considered to be a predictor of mortality in patients with ischemic heart disease. Method: Enrolled were 88patients (67.5±8.6years old, 67males) having CTO lesions on their coronary arteries. In each patients, stress myocardial perfusion imaging (MPI) using Thallium-201 were performed before PCI. LVEF was assessed echocardiographically before and 6 months after PCI procedure. According to the results of PCI and preexisting ischemia, patients were divided into 4 groups as the followings; 1) recanalization(+) ischemia(+) group (n=55), 2) recanalization(+) ischemia(-) group (n=12), 3) recanalization(-) ischemia(+) group (n=7), 4) recanalization(-) ischemia(-) group (n=14) groups. Result: In the recanalization(+) ischemia(+) group, LVEF increased significantly 6 months after PCI (61.3±12.0%), compared with baseline (56.9±11.8%). However, such improvement of LVEF was not observed in the other three groups. View this table: Result of LVEF at baseline and follow up Conclusion: Stress MPI could be a good indicator of appropriate PCI to CTO lesions. It should be notified that recanalization of CTO site not responsible for myocardial ischemia dose not contribute to the left ventricular functional recovery.