TY - JOUR
T1 - Viability and functional recovery after chronic total occlusion percutaneous coronary intervention
AU - Schumacher, Stefan P.
AU - Everaars, Henk
AU - Stuijfzand, Wijnand J.
AU - van Diemen, Pepijn A.
AU - Driessen, Roel S.
AU - Bom, Michiel J.
AU - de Winter, Ruben W.
AU - Somsen, Yvemarie B. O.
AU - Huynh, Jennifer W.
AU - van Loon, Ramon B.
AU - van de Ven, Peter M.
AU - van Rossum, Albert C.
AU - Opolski, Maksymilian P.
AU - Nap, Alexander
AU - Knaapen, Paul
N1 - Publisher Copyright: © 2021 The Authors. Catheterization and Cardiovascular Interventions published by Wiley Periodicals LLC. Copyright: Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2021/11/1
Y1 - 2021/11/1
N2 - Objectives: This study evaluated myocardial viability as well as global and regional functional recovery after successful chronic coronary total occlusion (CTO) percutaneous coronary intervention (PCI) using sequential quantitative cardiac magnetic resonance (CMR) imaging. Background: The patient benefits of CTO PCI are being questioned. Methods: In a single high-volume CTO PCI center patients were prospectively scheduled for CMR at baseline and 3 months after successful CTO PCI between 2013 and 2018. Segmental wall thickening (SWT) and percentage late gadolinium enhancement (LGE) were quantitatively measured per segment. Viability was defined as dysfunctional myocardium (<2.84 mm SWT) with no or limited scar (≤50% LGE). Results: A total of 132 patients were included. Improvement of left ventricular ejection fraction was modest after CTO PCI (from 48.1 ± 11.8 to 49.5 ± 12.1%, p < 0.01). CTO segments with viability (N = 216, [31%]) demonstrated a significantly higher increase in SWT (0.80 ± 1.39 mm) compared to CTO segments with pre-procedural preserved function (N = 456 [65%], 0.07 ± 1.43 mm, p < 0.01) or extensive scar (LGE >50%, N = 26 [4%], −0.08 ± 1.09 mm, p < 0.01). Patients with ≥2 CTO segments viability showed more SWT increase in the CTO territory compared to patients with 0–1 segment viability (0.49 ± 0.93 vs. 0.12 ± 0.98 mm, p = 0.03). Conclusions: Detection of dysfunctional myocardial segments without extensive scar (≤50% LGE) as a marker for viability on CMR aids in identifying patients with significant regional functional recovery after CTO PCI.
AB - Objectives: This study evaluated myocardial viability as well as global and regional functional recovery after successful chronic coronary total occlusion (CTO) percutaneous coronary intervention (PCI) using sequential quantitative cardiac magnetic resonance (CMR) imaging. Background: The patient benefits of CTO PCI are being questioned. Methods: In a single high-volume CTO PCI center patients were prospectively scheduled for CMR at baseline and 3 months after successful CTO PCI between 2013 and 2018. Segmental wall thickening (SWT) and percentage late gadolinium enhancement (LGE) were quantitatively measured per segment. Viability was defined as dysfunctional myocardium (<2.84 mm SWT) with no or limited scar (≤50% LGE). Results: A total of 132 patients were included. Improvement of left ventricular ejection fraction was modest after CTO PCI (from 48.1 ± 11.8 to 49.5 ± 12.1%, p < 0.01). CTO segments with viability (N = 216, [31%]) demonstrated a significantly higher increase in SWT (0.80 ± 1.39 mm) compared to CTO segments with pre-procedural preserved function (N = 456 [65%], 0.07 ± 1.43 mm, p < 0.01) or extensive scar (LGE >50%, N = 26 [4%], −0.08 ± 1.09 mm, p < 0.01). Patients with ≥2 CTO segments viability showed more SWT increase in the CTO territory compared to patients with 0–1 segment viability (0.49 ± 0.93 vs. 0.12 ± 0.98 mm, p = 0.03). Conclusions: Detection of dysfunctional myocardial segments without extensive scar (≤50% LGE) as a marker for viability on CMR aids in identifying patients with significant regional functional recovery after CTO PCI.
KW - chronic total occlusion
KW - left ventricular ejection fraction
KW - myocardial viability
KW - percutaneous coronary intervention
UR - http://www.scopus.com/inward/record.url?scp=85111485582&partnerID=8YFLogxK
U2 - https://doi.org/10.1002/ccd.29888
DO - https://doi.org/10.1002/ccd.29888
M3 - Article
C2 - 34329539
SN - 1522-1946
VL - 98
SP - E668-E676
JO - Catheterization and cardiovascular interventions
JF - Catheterization and cardiovascular interventions
IS - 5
ER -