Improvement of left ventricular function assessment by global longitudinal strain after successful percutaneous coronary intervention for chronic total occlusion.

Misato Chimura,Shinichiro Yamada,Yoshinori Yasaka,Hiroya Kawai,Yoshiaki Taniyama

doi:10.1371/journal.pone.0217092

Abstract

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.

Highlights

Chronic total occlusions (CTO) are defined as lesions with thrombolysis in myocardial infarction (TIMI) (Thrombolysis in Myocardial Infarction) grade 0 flow for more than three months
CTO lesions are identified in 18.4% in patients undergoing elective percutaneous coronary intervention (PCI) in the absence of previous coronary artery bypass surgery or those presenting with acute myocardial infarction [1]
CTO was defined as a coronary artery obstruction with thrombolysis in myocardial infarction (TIMI) grade 0 and all patients had a native vessel occlusion estimated to be of at least 3 months duration based on the time from diagnosis made on coronary angiography [15]

Summary

Introduction

Chronic total occlusions (CTO) are defined as lesions with TIMI (Thrombolysis in Myocardial Infarction) grade 0 flow for more than three months. CTO lesions are identified in 18.4% in patients undergoing elective percutaneous coronary intervention (PCI) in the absence of previous coronary artery bypass surgery or those presenting with acute myocardial infarction [1]. Several previous studies reported the effect of successful PCI for CTO, such as improvement of quality of life, exercise capacity, and reducing the need for late CABG surgery [2, 3]. Two-dimensional speckle-tracking echocardiography (2DSTE) is emerging as a novel technique to allow the assessment of LV systolic and diastolic function through the quantification of active myocardial deformation [4,5,6]. The global longitudinal strain (GLS) assessed with 2DSTE, which

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