P4352Usefulness of speckle tracking echocardiography in the detection of ventricular mechanics changes after percutaneous intervention of coronary chronic total occlusions

Abstract

Abstract Background Previous studies show contradictory results of the effect of chronic total occlusions (CTO) revascularization on LVEF. Deformation parameters based on speckle tracking (2D-ST) echo allows the evaluation of the systolic regional function. Purpose To examine the usefulness of 2D-ST to detect changes in regional ventricular mechanics in a consecutive cohort of patients with successful CTO percutaneous revascularization. Methods Prospective study that included 13 consecutive patients (72±8 y, 85% men). Revascularization was justified based on the evidence of viability of the underlying territory. 2D-ST was performed before, one and three months after of the procedure. Based on 16 segments model (n: 208), these were classified in two groups (dependent/non-dependent) according to their relationship with the treated CTO. Strain rate (Sr) and Strain (S) of the three myocardial layers were measured. Results 208 segments analyzed. 62 (30%) perfusion dependent, (mean 5 segments/patient), non-dependent: 146 (70%). During follow-up (median: 3.3 m), there were no significant differences with respect to LVEF (56±6 vs. 59±6, p: 0.2). Although non-dependent segments showed no significant changes of deformation parameters after the procedure, dependent segments showed an increase (Δ) of both the S and Sr, being statistically significant the Δ of the three layers S at 3 months vs. non-dependent. Table 1 PRE POST p Δ Non-Dependent segments (N: 146) S-epicardial −16.6±4.9 −16.0±4.0 0.06 0.6±4.0 S-mesocardiac −17.4±4.8 −16.8±4.2 0.08 0.6±3.9 S-endocardial −18.1±5.1 −17.7±4.9 0.337 0.4±4.5 Sr −1.15±0.4 −1.09±0.4 0.080 0.07±0.47 Dependent segments (N: 62) S-epicardial −13.7±5.8 −16.3±4.5 <0.001 −2.6±5.2* S-mesocardiac −14.7±6.1 −17.0±4.5 <0.05 −2.3±5.2* S-endocardial −15.8±6.7 −17.9±4.9 <0.05 −2.1±5.6* Sr −0.98±0.4 −1.03±0.4 0.353 −0.05±0.42 *p<0.05 ΔNon-dependents vs. ΔDependents. S (%) improvement post RCA CTO treatment Conclusions This study shows that CTO treatment improves regional myocardial function in LV segments dependent on CTO at three months of follow-up, without changes in LVEF. 2D-ST allows to examine the effect of flow restoration, providing new information on the potential short-term benefits of this strategy