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

Journal of Cardiovascular Magnetic Resonance

Research

Victoria Martín¹  Susanna Prat-Gonzalez¹  Mónica Masotti¹  José Tomás Ortiz¹  Montserrat Cardona¹  Manel Sabaté¹  Félix Pérez-Villa¹  Rosario Jesús Perea²  Teresa Maria de Caralt² 

[1] Department of Cardiology, Cardiovascular Institute, Hospital Clínic de Barcelona, Institute of Biomedical Research August Pi i Sunyer (IDIBAPS), Villarroel 170, 08036, Barcelona, Spain;Department of Radiodiagnosis, Centro de Diagnóstico por la Imagen, Hospital Clínic de Barcelona, Institute of Biomedical Research August Pi i Sunyer (IDIBAPS), Barcelona, Spain;

关键词: Angioplasty;    Cardiovascular magnetic resonance;    Chronic total coronary occlusion;    Heart failure with reduced ejection fraction;    Myocardial viability;   

DOI  :  10.1186/s12968-016-0287-5

 received in 2016-05-10, accepted in 2016-09-28,  发布年份 2016

来源: Springer

【 摘 要 】

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.

【 授权许可】

CC BY   
© The Author(s). 2016