Viability and functional recovery after chronic total occlusion percutaneous coronary intervention

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
R De Winter ◽  
S.P Schumacher ◽  
H Everaars ◽  
W.J Stuijfzand ◽  
P.A Van Diemen ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Functional Recovery ◽  
Coronary Intervention ◽  
Left Ventricular ◽  
Lv Function ◽  
Wall Thickening ◽  
Total Occlusion ◽  
Systolic Volume ◽  
End Diastolic Volume ◽  
Percutaneous Coronary

Abstract Background Current guidelines advocate viability assessment to guide percutaneous coronary intervention (PCI) of chronic coronary total occlusions (CTO). Purpose Aim of the present study was to evaluate viability as well as global and regional functional recovery after successful CTO PCI using quantitative cardiac magnetic resonance (CMR) imaging. Methods 132 patients with sequential CMR at baseline and 3-months after successful CTO PCI were prospectively recruited 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 (<2.84mm SWT) with no or limited scar (≤50% LGE). Results Significant improvements in left ventricular (LV) ejection fraction (from 48.1±11.8 to 49.5±12.1%, p<0.01), LV end-diastolic volume (from 99.1±31.8 to 95.7±30.2ml, p<0.01), and LV end-systolic volume (from 54.4±30.5 to 51.2±29.3ml, p<0.01) were observed after CTO PCI. CTO segments with viability (N=216, (31%)) demonstrated a significantly higher increase in SWT (0.80±1.39mm) compared to CTO segments with pre-procedural preserved function (N=456 (65%), 0.07±1.43mm, p<0.01) or extensive scar (LGE >50%, N=26 (4%), −0.08±1.09mm, p<0.01). Improvement in SWT was comparable between segments with viability if further stratified to 0, >0–25, and >25–50% hyperenhancement (p=0.94). 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±0.98mm, p=0.03). Conclusions Improvements in LV function and volumes were significant but modest following CTO PCI. Detection of dysfunctional myocardial segments without extensive scar (≤50% LGE) as a marker for viability may aid in identifying subjects with significant regional functional recovery after CTO PCI. Funding Acknowledgement Type of funding source: None

Đánh giá tình trạng suy tim ở bệnh nhân nhồi máu cơ tim cấp ST chênh lên trước và sau can thiệp động mạch vành

2021 ◽  
Author(s):  
Anh Binh Ho
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Ejection Fraction ◽  
Left Ventricular Mass ◽  
Coronary Intervention ◽  
Left Ventricular ◽  
Systolic Volume ◽  
Ventricular Mass ◽  
Percutaneous Coronary ◽  
End Systolic Volume

Mục tiêu: Khảo sát sự biến đổi hình thái và chức năng thất trái của bệnh nhân nhồi máu cơ tim cấp ST chênh lên trước và sau can thiệp tại thời điểm 48 giờ và 3 tháng bằng siêu âm tim. Đối tượng nghiên cứu: Trong thời gian từ tháng 02/2020 đến 09/2020 chúng tôi đã tiến hành nghiên cứu trên 97 bệnh nhân bệnh nhồi máu cơ tim cấp ST chênh lên được can thiệp động mạch vành qua da. Phương pháp nghiên cứu: nghiên cứu tiến cứu quan sát. Kết quả: khối lượng cơ thất trái giảm từ 195,2 ± 65,8 gr xuống 170,2 ± 51,1 gr, thể tích thất trái cuối tâm trương giảm từ 105,2 ± 37,4 mm xuống 95,5 ± 41,3 mm, thể tích thất trái cuối tâm thu giảm từ 57,3 ± 45,2 mm xuống 49,8 ± 50,3 mm. Chức năng tâm thu thất trái (EF) sau 3 tháng can thiệp động mạch vành qua da của nhóm EF ≤ 45 % tăng lên đáng kể từ 39,3 ± 11,2 % lên 45,85 ± 7,56 %, (p < 0,05), ngược lại nhóm EF > 45 % cũng có sự biến đổi từ 57,7 ± 14,4% lên 60,1 ± 13,3 %, (p > 0,05). Kết luận: Sau can thiệp động mạch vành qua da ở thời điểm 3 tháng, khối lượng cơ thất trái, thể tích thất trái cuối tâm thu và cuối tâm trương có sự thay đổi đáng kể. Chức năng tâm thu thất trái (EF) sau 3 tháng can thiệp động mạch vành qua da nhóm EF ≤ 45 % tăng lên có ý nghĩa thống kê. ABSTRACT EVALUATION OF HEART FAILURE IN ST - ELEVATED MYOCADIAL INFARCTION BEFORE AND AFTER PERCUTANEOUS CORONARY INTERVENTION Objectives: Assess the function of left ventricle in ST elevation myocardial infarction before, 48 - hour and 3 - month after primary percutaneous coronary intervention by cardiac ultrasound. Patients: 97 patients who underwent PCI for ST elevated myocardial infarction from 02/2021 to 09/2020. Methods: Prospective observational study. Results: Left ventricular mass index decreased from 195.2 ± 65.8 gr/m2 to 170.2 ± 51.1 gr/m2, end - diastolic left ventricular volume decreased from 105.2 ± 37.4 mm to 95.5 ± 41.3 mm. End systolic volume decreased from 57.3 ± 45.2 mm to 49.8 ± 50.3 mm. Ejection fraction 3 month after the intervention of the EF ≤ 45 % group significantly increased from 39.3 ± 11.2 % to 45.85 ± 7.56 % (p < 0.05). In contrast, there were a rise of the ejection fraction among the EF > 45% group from 57.7 ± 14.4% to 60.1 ± 13.3 % (p > 0.05). Conclusion: 3 month after PCI, left ventricular mass, end - systolic and diastolic volume changed remarkably. The ejection fraction of EF ≤ 45 % group increased with a statical significance. Keywords: PCI, cardiac ultrasonography, ejection fraction, left ventricular mass, end systolic volume end diastolic volume.

Early Improvement of Left Ventricular Dyssynchrony After Percutaneous Coronary Intervention in Patients with Single Chronic Total Occlusion Vessel

2020 ◽  
Author(s):  
Shaoping Wang ◽  
Shiying Li ◽  
Yijia Li ◽  
Yejing Zhao ◽  
Tong Liu ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Chronic Total Occlusion ◽  
Coronary Intervention ◽  
Left Ventricular ◽  
Doppler Imaging ◽  
Left Ventricular Dyssynchrony ◽  
Total Occlusion ◽  
Early Improvement ◽  
Ventricular Dyssynchrony ◽  
Percutaneous Coronary

Abstract Background The effect of percutaneous coronary intervention (PCI) of chronic total occlusion (CTO) on left ventricular dyssynchrony was unclear. Methods Patients with one CTO vessel were included. Tissue Doppler imaging was used to assess the left ventricular dyssynchrony index (DI) in twelve segments before and after successful CTO PCI. Multiple regression was used to identify independent correlates of DI reduction. Results 41 patients were included with the mean age of 65.88 years. 39(95.12%) had left ventricular DI more than 33. It decreased significantly from 67.48 ± 28.73 to 44.69 ± 23.90 (P < 0.01) after successful CTO PCI. PCI of infarct-relative CTO was associated with less percentage of DI reduction (Coefficient [Coef.], 25.60; 95% confidence interval [CI], 8.13–43.08; P < 0.01). Higher initial DI was associated with more percentage of DI reduction (Coef., -0.35; 95% CI, -0.67- -0.03; P = 0.03). Percentage of DI reduction was associated with ejection fraction (EF) improvement (Coef., -5.09; 95% CI, -7.45- -2.72; P < 0.01) with linear relationship (P < 0.01). Conclusion Left ventricular dyssynchrony was reduced early after successful CTO PCI, which predicted EF improvement. The association between dyssynchrony reduction and long-term benefits of CTO PCI are expected.

P1964Impact of successful coronary intervention for chronic total occlusion on long-term clinical outcome of patients with impaired and preserved left ventricular ejection fraction

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
H Tanaka ◽  
T Tada ◽  
Y Fuku ◽  
T Goto ◽  
K Kadota
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Chronic Total Occlusion ◽  
Coronary Intervention ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Total Occlusion ◽  
Ventricular Ejection Fraction ◽  
Percutaneous Coronary ◽  
Procedural Success

Abstract Background Successful recanalisation of percutaneous coronary intervention for chronic total occlusion lesions has been associated with improved survival. Purpose This study aimed to assess the impact of successful percutaneous coronary intervention for chronic total occlusion lesions on the long-term outcome of patients with impaired and preserved left ventricular ejection fraction (LVEF). Methods The study sample consisted of 842 consecutive patients (928 chronic total occlusion lesions) undergoing percutaneous coronary intervention at our institution between October 2005 and December 2009. We divided them into 3 groups by the degree of LVEF: less than 40% (severely reduced LVEF, n=140), 40% to 59% (moderately reduced LVEF, n=470), and 60% and above (normal LVEF, n=232). We evaluated mortality during the 10-year follow-up period the basis of procedural success and failure. Results The overall procedural success rate was 89.1%. Median follow-up duration was 7.9 years. The 10-year cumulative incidences of cardiac death in each degree of LVEF are shown in the Figure. Conclusions Successful recanalisation for chronic total occlusion lesions in patients with impaired LVEF may be associated with reduced cardiac mortality.

scholarly journals Echocardiographic Evaluation of left Ventricular Function Following Late Percutaneous Coronary Intervention after Acute Anterior Myocardial Infarction with Left Ventricular Systolic Dysfunction

2018 ◽  
Vol 33 (2) ◽  
pp. 90-93
Author(s):  
Md Tufazzal Hossen ◽  
Sayed Ali Ahsan ◽  
Md Abu Salim ◽  
Khurshed Ahmed ◽  
Md Mukhlesur Rahman ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
Left Ventricular ◽  
Coronary Stenting ◽  
Lv Function ◽  
P Value ◽  
Anterior Myocardial Infarction ◽  
Late Intervention ◽  
Percutaneous Coronary

Background: The effect of late percutaneous coronary intervention on left ventricular function is incompletely understood. Objectives: To evaluate the effect of late Percutaneous Coronary Intervention on LV systolic function following coronary stenting after acute anterior myocardial infarction. Methods: A total of 60 patients, > 24 hours to 6 weeks after anterior AMI who attended in UCC, BSMMU between July 2014 to June 2015 were included in this study. They underwent coronary stenting. After coronary stenting all patients were in TIMI flow-3. Serial echocardiographic assessment of LV function before and after late intervention with modified Simpson’s rule in apical 4 chamber view as well as comparison between baseline result with that of after intervention were done. The patients were on standard medical therapy in post intervention period. Result: Mean age was 54.3±8.91 years with minimum 30 years and maximum 75 years. Most of the patients were male (67%). LVESV was 60.0±14.4 ml before PCI and 58.3±15.3 ml at discharge (p value 0.091) & 44.1±17.6 ml after 3 months (p value <0.001). LVEF was 40.2±3.1% before PCI, 40.2±3.3% at discharge (p value 0.509) & 47.6±5.9% after 3 months (p value <0.001). There was no significant improvement of LV function from baseline till discharge but significant improvement occurred after 3months. Conclusion: Using echocardiographic techniques, our results showed that left ventricular volume decreased and the left ventricular ejection fraction increased significantly after three months of late intervention. Bangladesh Heart Journal 2018; 33(2) : 90-93

scholarly journals Agreement in Left Ventricular Function Measured by Echocardiography and Cardiac Magnetic Resonance in Patients With Chronic Coronary Total Occlusion

2021 ◽  
Vol 8 ◽  
Author(s):  
Jiahui Li ◽  
Lijun Zhang ◽  
Yueli Wang ◽  
Huijuan Zuo ◽  
Rongchong Huang ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Pearson Correlation ◽  
Left Ventricular ◽  
Lv Function ◽  
Total Occlusion ◽  
Systolic Volume ◽  
End Diastolic Volume ◽  
End Systolic Volume ◽  
The Difference ◽  
Ventricular Motion

Aims: To determine the agreement between two-dimensional transthoracic echocardiography (2DTTE) and cardiovascular magnetic resonance (CMR) in left ventricular (LV) function [including end-systolic volume (LVESV), end-diastolic volume (LVEDV), and ejection fraction (LVEF)] in chronic total occlusion (CTO) patients.Methods: Eighty-eight CTO patients were enrolled in this study. All patients underwent 2DTTE and CMR within 1 week. The correlation and agreement of LVEF, LVESV, and LVEDV as measured by 2DTTE and CMR were assessed using Pearson correlation, Kappa analysis, and Bland–Altman method.Results: The mean age of patients enrolled was 57 ± 10 years. There was a strong correlation (r = 0.71, 0.90, and 0.80, respectively, all P &lt; 0.001) and a moderately strong agreement (Kappa = 0.62, P &lt; 0.001) between the two modalities in measurement of LV function. The agreement in patients with EF ≧50% was better than in those with an EF &lt;50%. CTO patients without echocardiographic wall motion abnormality (WMA) had stronger intermodality correlations (r = 0.84, 0.96, and 0.87, respectively) and smaller biases in LV function measurement.Conclusions: The difference in measurement between 2DTTE and CMR should be noticed in CTO patients with EF &lt;50% or abnormal ventricular motion. CMR should be considered in these conditions.

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