title: Early assessment of percutaneous coronary interventions for chronic total occlusions analyzed by novel echocardiographic techniques.
abstract: OBJECTIVE
  Successful revascularization of chronic total occlusions has been associated with improved left ventricular systolic function, reduced anginal symptoms, increased exercise capacity, and increased survival. This study was conducted to determine the impact of revascularization in chronic total occlusion on left ventricular function using novel echocardiographic techniques.
  
  
  METHODS
  A total of 129 patients with chronic total occlusion who underwent revascularization between April 2011 and November 2012 were included in this study. Echocardiographic assessments with two-dimensional speckle tracking echocardiography and real-time three-dimensional echocardiography were performed before the procedure and one month after the procedure. The left ventricular ejection fraction, left ventricular volumes, and three-dimensional systolic dyssynchrony index were quantified.
  
  
  RESULTS
  An immediate procedural success was obtained in 118 patients (91.5%). There were no acute or subacute stent thromboses during follow-up. The mean left ventricular ejection fraction significantly increased (p<0.001), while the left ventricular end-diastolic and end-systolic volumes significantly decreased (p = 0.001 and p<0.001, respectively). The three-dimensional systolic dyssynchrony index also decreased significantly (p<0.001). The global longitudinal strain showed a significant increase after successful revascularization (p<0.001). An increase in the global longitudinal strain was correlated with an increase in the left ventricular ejection fraction (r = 0.27, p = 0.02). The patients with a left ventricular ejection fraction ≥50% displayed a greater improvement in the global longitudinal strain, and the patients with diabetes showed less improvement.
  
  
  CONCLUSIONS
  Using novel echocardiographic techniques, our results showed that restoring the coronary blood flow in chronic total occlusion patients reduces the left ventricular volumes and improves the left ventricular ejection fraction and the global longitudinal strain of hibernating myocardium.
authors.affiliation: Bezmialem Foundation University, Faculty of Medicine, Department of Cardiology, Istanbul, Turkey.
authors.forename: Ercan
authors.initials: E
authors.lastname: Erdogan
authors.forename: Mehmet
authors.initials: M
authors.lastname: Akkaya
authors.forename: Ahmet
authors.initials: A
authors.lastname: Bacaksiz
authors.forename: Abdurrrahman
authors.initials: A
authors.lastname: Tasal
authors.forename: Osman
authors.initials: O
authors.lastname: Sönmez
authors.forename: Mehmet Ali
authors.initials: MA
authors.lastname: Elbey
authors.forename: Seref
authors.initials: S
authors.lastname: Kul
authors.forename: Mehmet Akif
authors.initials: MA
authors.lastname: Vatankulu
authors.forename: Murat
authors.initials: M
authors.lastname: Turfan
authors.forename: Ömer
authors.initials: Ö
authors.lastname: Göktekin
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D054059:Coronary Occlusion / Q000000981:diagnostic imaging / Q000601:surgery*; D003920:Diabetes Mellitus / Q000503:physiopathology; D019560:Echocardiography, Three-Dimensional / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D013318:Stroke Volume / Q000502:physiology; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left / Q000502:physiology*