Improvement of left ventricular contraction and relaxation synchronism after recanalization of chronic total coronary occlusion by angioplasty

Abstract

Twenty patients with a chronic total coronary artery occlusion were studied before and 1 to 48 months (mean 9) after successful recanalization by angioplasty and compared with a group of 20 normal subjects. Before angioplasty, 19 of these 20 patients had angina. Collateral vessels to the distal part of the occluded vessel were visible in all 20 patients. A previous myocardial infarction was documented in 14 patients (9 with a Q wave and 5 with a non-Q wave infarction). At the time of follow-up, three patients were symptomatic: one had unstable angina and two had a positive stress test. The follow-up angiogram showed a significant restenosis in six patients and reocclusion in two. The mean ejection fraction had improved slightly from 59 +/- 11% to 63 +/- 9% (p less than 0.05). Left ventricular wall motion synchronism was studied using two variables for 128 shortening segments: the "time of peak contraction" and the "time of peak relaxation," as obtained from biharmonic Fourier transformation for each segment. Their respective standard deviations reflect the synchronism of contraction and relaxation. The mean standard deviations of the two variables expressed in degrees of one cardiac cycle (360 degrees) were respectively: 5.5 +/- 0.4 degrees for the time of peak contraction and 6.0 +/- 0.5 degrees for the time of peak relaxation in the 20 normal subjects, 11.7 +/- 1.7 degrees and 23.0 +/- 3.0 degrees before recanalization and 9.6 +/- 1.8 degrees and 12.5 +/- 2.2 degrees at follow-up in the group of 20 patients. These values were significantly higher (p less than 0.05) in the patients than in the normal group.(ABSTRACT TRUNCATED AT 250 WORDS)

Determinants of Left Ventricular Systolic Function Improvement Following Coronary Artery Revascularization in Heart Failure Patients With Reduced Ejection Fraction (HFrEF)

“…[25][26][27] Successful revascularization of coronary CTO is associated with the improvement of left ventricular function in patients with angina pectoris or old myocardial infarction. [28][29][30] Recently, George and colleagues reported that successful CTO intervention was associated with a decrease in mortality as compared to unsuccessful CTO intervention using large registry data (n = 13,443). 31) Furthermore, Jang and colleagues reported the long-term survival benefit of CTO revascularization as compared to medical therapy using a propensity score-matched population.…”

Impact of the Presence of Chronic Total Occlusion in a Non-Infarct-Related Coronary Artery in Acute Myocardial Infarction Patients

“…1,2) Although the treatment of CTO remains a technical challenge and still 20-35% of CTOs are not recanalized by percutaneous coronary intervention (PCI) even when performed by experienced operators, 3,4) successful PCI for CTO has been shown to improve left ventricular (LV) systolic function, reduce angina, increase exercise capacity, and reduce the need for late bypass surgery. 3,5,6) On the other hand, CTO patients who were not revascularized had a significantly higher rate of cardiac mortality and sudden cardiac death compared with those who were revascularized. 7,8) Moreover, in acute myocardial infarction (AMI) patients, the presence of CTO in a non-infarct-related artery (IRA) is a strong and independent risk factor for short-and middle-term mortality.…”

“…The remaining 353 patients were divided into two groups; patients with CTO (n = 25) and those without CTO (n = 328), and clinical indices including patient demographics, clinical and angiographic characteristics, and in-hospital and 30-day outcomes were compared. Cardiogenic shock on admission was defined according to the following clinical criterion used in the SHOCK trial: 5) hypotension defined as systolic blood pressure < 90 mmHg for at least 30 minutes or the need for supportive measures to maintain systolic blood pressure ≥ 90 mmHg, and end-organ hypoperfusion defined as cold extremities or a urine output of < 30 mL/hour and a heart rate ≥ 60 beat/minute. In-hospital management: Coronary angiography and subsequent PCI were performed immediately after the diagnosis of AMI.…”

Evaluation of left ventricular function after percutaneous recanalization of chronic coronary occlusions

“…The myocardium in the perfusion territory of a CTO can be functional, dysfunctional but viable, or dysfunctional and nonviable [3,4]. Dysfunctional but viable myocardium in CTO may have restored function after percutaneous coronary intervention (PCI) [5][6][7][8][9].…”

“…Echocardiography was performed using a Philips IE33 ultrasound machine (Koninklijke Philips N.V., The Netherlands) with an M4S transducer according to the recommendations of the American Society of Echocardiography [4,13]. The percentage of the left ventricular ejection fraction (LVEF) was calculated by Simpson's biplane method of discs.…”