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Improvement of myocardial function and perfusion after successful percutaneous revascularization in patients with
Sandra Pujadas1, Victoria Martin, Xavier Rosselló
1Cardiology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
Insights
Successful percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) significantly reduces myocardial ischemia and improves heart function. This leads to better clinical outcomes for patients undergoing the complex procedure.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiovascular Imaging
Background:
- Percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) offers potential benefits but is complex with variable success rates.
- Accurate assessment of myocardial function, ischemia, and viability is crucial for evaluating PCI outcomes.
- Cardiac magnetic resonance (CMR) is a reliable diagnostic tool for assessing these parameters.
Purpose of the Study:
- To evaluate ventricular function and myocardial ischemia before and after PCI for CTO using CMR.
- To assess changes in NYHA functional class following PCI for CTO.
Main Methods:
- Cardiac magnetic resonance (CMR) imaging was performed on 43 patients with CTO before and 6 months after PCI.
- Myocardial perfusion, regional contractile function, and viability were assessed.
- NYHA functional class was recorded pre- and post-procedure.
Main Results:
- PCI was successful in 77% of patients.
- Successful PCI significantly reduced inducible perfusion defects (79% to 30%) and the number of affected segments.
- Regional contractile function improved in viable segments post-successful PCI.
- NYHA functional class improved in patients with successful revascularization.
Conclusions:
- Successful CTO PCI effectively reduces myocardial ischemia.
- Improved regional wall motion and reduced ischemia following successful CTO PCI correlate with clinical improvement.
Background:
Percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) of a coronary artery can provide benefits in terms of myocardial function and survival but the procedure is complex and the success rate is relatively low. To assess these benefits, myocardial function, ischemia and viability should be clearly determined by means of a reliable diagnostic test. This study aimed to assess ventricular function and myocardial ischemia before and after PCI for CTO using cardiac magnetic resonance (CMR). NYHA functional class was also assessed before and after PCI.
Methods And Results:
CMR studies were performed in 43 consecutive patients (7 females; aged 64 ± 9.6 y.o.) with CTO scheduled for PCI and repeated 6 months post-PCI. PCI was successful in 33 (77%) of them. In this group CMR had shown inducible perfusion defects in 26 (79%) before PCI, while they were observed in 10 (30%) post-PCI CMR study (p < 0.001). The number of segments showing inducible perfusion defect (3.4 ± 2 prevs. 2.9 ± 4.5 post-PCI, p = 0.002) was significantly reduced in this group. Regional contractile function of segments showing viability also improved significantly in the group with successful CTO PCI compared to the group with an unsuccessful procedure. NYHA functional class for angina also improved in patients with successful revascularization while it remained unchanged in the group with unsuccessful procedures.
Conclusions:
A successful CTO PCI leads to a reduction in inducible myocardial ischemia and to an improvement in regional wall motion, which results in clinical improvement.
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