Improved recovery of regional left ventricular function after PCI of chronic total occlusion in STEMI patients: a cardiovascular magnetic resonance study of the randomized controlled EXPLORE trial

Journal of Cardiovascular Magnetic Resonance

Research

Ivo M. van Dongen¹  Joëlle Elias¹  Jan G. Tijssen¹  Dagmar M. Ouweneel¹  Bimmer E. P. M. Claessen¹  Loes P. Hoebers¹  José P. S. Henriques²  Alexander Hirsch³  Erlend Eriksen⁴  Peep Laanmets⁵  René J. van der Schaaf⁶  Truls Råmunddal⁷  Dan Ioanes⁷  Robin Nijveldt⁸ 

[1] Academic Medical Center - University of Amsterdam, Amsterdam, the Netherlands;Academic Medical Center - University of Amsterdam, Amsterdam, the Netherlands;Department of Cardiology, Academic Medical Center - University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands;Erasmus Medical Center, Rotterdam, the Netherlands;Haukeland University Hospital, Bergen, Norway;North Estonia Medical Center, Tallinn, Estonia;Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands;Sahlgrenska University Hospital, Gothenburg, Sweden;VU Medical Center, Amsterdam, the Netherlands;

关键词: CTO;    STEMI;    PCI;    LV function;   

DOI  :  10.1186/s12968-017-0369-z

 received in 2017-04-05, accepted in 2017-06-29,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundThe Evaluating Xience and left ventricular function in PCI on occlusiOns afteR STEMI (EXPLORE) trial did not show a significant benefit of percutaneous coronary intervention (PCI) of the concurrent chronic total occlusion (CTO) in ST-segment elevation myocardial infarction (STEMI) patients on global left ventricular (LV) systolic function. However a possible treatment effect will be most pronounced in the CTO territory. Therefore, we aimed to study the effect of CTO PCI compared to no-CTO PCI on the recovery of regional LV function, particularly in the CTO territory.MethodsUsing cardiovascular magnetic resonance (CMR) we studied 180 of the 302 EXPLORE patients with serial CMR (baseline and 4 months follow-up). Segmental wall thickening (SWT) was quantified on cine images by an independent core laboratory. Dysfunctional segments were defined as SWT < 45%. Dysfunctional segments were further analyzed by viability (transmural extent of infarction (TEI) ≤50%.). All outcomes were stratified for randomization treatment.ResultsIn the dysfunctional segments in the CTO territory recovery of SWT was better after CTO PCI compared to no-CTO PCI (ΔSWT 17 ± 27% vs 11 ± 23%, p = 0.03). This recovery was most pronounced in the dysfunctional but viable segments(TEI < 50%) (ΔSWT 17 ± 27% vs 11 ± 22%, p = 0.02). Furthermore in the CTO territory, recovery of SWT was significantly better in the dysfunctional segments in patients with Rentrop grade 2–3 collaterals compared to grade 0–1 collaterals to the CTO (16 ± 26% versus 11 ± 24%, p = 0.04).ConclusionCTO PCI compared with no-CTO PCI is associated with a greater recovery of regional systolic function in the CTO territory, especially in the dysfunctional but viable segments. Further research is needed to evaluate the use of CMR in selecting post-STEMI patients for CTO PCI and the effect of regional LV function recovery on clinical outcome.Trial registrationTrialregister.nl NTR1108, Date registered NTR: 30-okt-2007.

【 授权许可】

CC BY   
© The Author(s). 2017