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Prediction of left ventricular function after drug-eluting stent implantation for chronic total coronary occlusions
Timo Baks1, Robert-Jan van Geuns, Dirk J Duncker
1Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands.
Insights
Drug-eluting stent implantation for chronic total coronary occlusion (CTO) improves left ventricular volumes. Magnetic resonance imaging (MRI) before the procedure predicts these beneficial changes in cardiac function.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiovascular Imaging
Background:
- The long-term impact of recanalizing chronic total coronary occlusion (CTO) on left ventricular function remains unclear.
- The utility of magnetic resonance imaging (MRI) for assessing myocardial viability before revascularization for CTO is not fully understood.
Purpose of the Study:
- To evaluate the effect of drug-eluting stent implantation for CTO on left ventricular volumes and function.
- To determine the predictive value of pre-revascularization MRI for assessing outcomes.
Main Methods:
- Twenty-seven patients with CTO underwent contrast-enhanced MRI before and 5 months after successful drug-eluting stent implantation.
- CTO was defined as a complete occlusion of a major epicardial coronary artery for at least six weeks.
- Left ventricular volumes and myocardial wall thickening were quantified using cine-MRI; transmural extent of infarction (TEI) was assessed via delayed-enhancement imaging.
Main Results:
- Successful drug-eluting stent implantation for CTO led to a significant reduction in end-systolic and end-diastolic left ventricular volumes, while ejection fraction remained unchanged.
- The degree of dysfunctional but viable myocardium identified by MRI before revascularization correlated with improvements in end-systolic volume index and ejection fraction.
- Segmental wall thickening improved significantly in myocardial segments with less than 25% transmural extent of infarction (TEI).
Conclusions:
- Drug-eluting stent implantation for CTO positively impacts left ventricular volumes and function.
- Pre-revascularization MRI can predict the beneficial effects of CTO treatment on left ventricular remodeling and function.
Objectives:
We studied the effect of drug-eluting stent implantation for chronic total coronary occlusion (CTO) on left ventricular volumes and function and assessed the predictive value of magnetic resonance imaging (MRI) performed before revascularization.
Background:
The effect of recanalization of CTO on long-term left ventricular function and the value of myocardial viability assessment with MRI is incompletely understood.
Methods:
Twenty-seven patients underwent contrast-enhanced MRI before and five months after successful drug-eluting stent implantation for CTO. A CTO was defined as a complete occlusion of a major epicardial coronary artery existing for at least six weeks (mean, 7 +/- 5 months). Myocardial wall thickening and left ventricular volumes were quantified on cine-images, and the transmural extent of infarction (TEI) was scored on delayed-enhancement images.
Results:
A significant decrease in mean end-systolic volume index (34 +/- 13 ml/m2 to 31 +/- 13 ml/m2; p = 0.02) and mean end-diastolic volume index (84 +/- 15 ml/m2 to 79 +/- 15 ml/m2; p < 0.002) was observed, whereas the mean ejection fraction did not change significantly (61 +/- 9% to 62 +/- 11%; p = 0.54). The extent of the left ventricle that was dysfunctional but viable before revascularization was related to improvement in end-systolic volume index (R = 0.46; p = 0.01) and ejection fraction (R = 0.49; p = 0.01) but not to the end-diastolic volume index (R = 0.10; p = 0.53). Segmental wall thickening improved significantly in segments with <25% TEI (21 +/- 15% to 35 +/- 25%; p < 0.001), tended to improve in segments with 25% to 75% TEI (18 +/- 22% to 27 +/- 22%; p = 0.10), whereas segments with >75% TEI did not improve (4 +/- 14% to -9 +/- 14%; p = 0.54).
Conclusions:
Drug-eluting stent implantation for a CTO has a beneficial effect on left ventricular volumes and function that can be predicted by performing MRI before revascularization.
