Benefits of chronic total coronary occlusion percutaneous intervention in patients with heart failure and reduced ejection fraction: insights from a cardiovascular magnetic resonance studyReport as inadecuate




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Journal of Cardiovascular Magnetic Resonance

, 18:78

First Online: 05 November 2016Received: 10 May 2016Accepted: 28 September 2016

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.

KeywordsAngioplasty Cardiovascular magnetic resonance Chronic total coronary occlusion Heart failure with reduced ejection fraction Myocardial viability AbbreviationsBNPBrain natriuretic peptide

CMRCardiovascular magnetic resonance

CTOChronic total occlusion

HFrEFHeart failure with reduced ejection fraction

LADLeft anterior descending artery

LCXLeft circumflex artery

LGELate gadolinium-enhancement

LVLeft ventricle

LVEDVLeft ventricular end-diastolic volume

LVEFLeft ventricular ejection fraction

LVESVLeft ventricular end-systolic volume

NYHANew York Heart Association

PCIPercutaneous coronary intervention

RCARight coronary artery

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Author: Montserrat Cardona - Victoria Martín - Susanna Prat-Gonzalez - José Tomás Ortiz - Rosario Jesús Perea - Teresa Maria 

Source: https://link.springer.com/article/10.1186/s12968-016-0287-5







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