Benefits of chronic total coronary occlusion percutaneous intervention in patients with heart failure and reduced ejection fraction: insights from a cardiovascular magnetic resonance study.
BACKGROUND
Chronic total occlusion percutaneous coronary intervention (CTO-PCI) can improve angina and left ventricular ejection fraction (LVEF). These benefits were not assessed in populations with heart failure with reduced ejection fraction (HFrEF). We studied the effect of CTO-PCI on left ventricular function and clinical parameters in patients with HFrEF.


METHODS
Using cardiovascular magnetic resonance (CMR), we studied 29 patients with HFrEF and evidence of viability and/or ischemia in the territory supplied by a CTO who were successfully treated with CTO-PCI. In patients with multi-vessel disease, non-CTO PCI was also performed. Imaging parameters, clinical status, and brain natriuretic peptide (BNP) levels were evaluated before and 6 months after CTO-PCI.


RESULTS
A decrease in left ventricular end-systolic volume (160 ± 54 ml vs. 143 ± 58 ml; p = 0.029) and an increase in LVEF (31.3 ± 7.4 % vs. 37.7 ± 8 %; p < 0.001) were observed. There were no differences in LVEF improvement between patients who underwent non-CTO PCI (n = 11) and those without this intervention (n = 18); (p = 0.73). The number of segments showing perfusion defects was significantly reduced (0.5 ± 1 vs. 0.2 ± 0.5; p = 0.043). Angina (p = 0.002) and NYHA functional class (p = 0.004) improved, and BNP levels decreased (p = 0.004) after CTO-PCI.


CONCLUSIONS
In this group of patients with HFrEF showing CMR evidence of viability and/or ischemia within the territory supplied by the CTO, an improvement in ejection fraction, left ventricular end-systolic volume and ischemia burden was observed after CTO-PCI. Clinical and laboratory parameters also improved.


BACKGROUND
ClinicalTrials.gov NCT02570087 . Registered 6 October 2015.
Department of Cardiology, Cardiovascular Institute, Hospital Clínic de Barcelona, Institute of Biomedical Research August Pi i Sunyer (IDIBAPS), Villarroel 170, 08036, Barcelona, Spain. mocardon@clinic.ub.es.
Montserrat
M
Cardona
Department of Cardiology, Cardiovascular Institute, Hospital Clínic de Barcelona, Institute of Biomedical Research August Pi i Sunyer (IDIBAPS), Villarroel 170, 08036, Barcelona, Spain.
Victoria
V
Martín
Department of Cardiology, Cardiovascular Institute, Hospital Clínic de Barcelona, Institute of Biomedical Research August Pi i Sunyer (IDIBAPS), Villarroel 170, 08036, Barcelona, Spain.
Susanna
S
Prat-Gonzalez
Department of Cardiology, Cardiovascular Institute, Hospital Clínic de Barcelona, Institute of Biomedical Research August Pi i Sunyer (IDIBAPS), Villarroel 170, 08036, Barcelona, Spain.
José Tomás
JT
Ortiz
Department of Radiodiagnosis, Centro de Diagnóstico por la Imagen, Hospital Clínic de Barcelona, Institute of Biomedical Research August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
Rosario Jesús
RJ
Perea
Department of Radiodiagnosis, Centro de Diagnóstico por la Imagen, Hospital Clínic de Barcelona, Institute of Biomedical Research August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
Teresa Maria
TM
de Caralt
Department of Cardiology, Cardiovascular Institute, Hospital Clínic de Barcelona, Institute of Biomedical Research August Pi i Sunyer (IDIBAPS), Villarroel 170, 08036, Barcelona, Spain.
Mónica
M
Masotti
Department of Cardiology, Cardiovascular Institute, Hospital Clínic de Barcelona, Institute of Biomedical Research August Pi i Sunyer (IDIBAPS), Villarroel 170, 08036, Barcelona, Spain.
Félix
F
Pérez-Villa
Department of Cardiology, Cardiovascular Institute, Hospital Clínic de Barcelona, Institute of Biomedical Research August Pi i Sunyer (IDIBAPS), Villarroel 170, 08036, Barcelona, Spain.
Manel
M
Sabaté
D000368:Aged; D015415:Biomarkers / Q000097:blood; D002908:Chronic Disease; D003287:Contrast Media / Q000008:administration & dosage; D017023:Coronary Angiography; D054059:Coronary Occlusion / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D006304:Health Status; D006333:Heart Failure / Q000000981:diagnostic imaging* / Q000473:pathology / Q000503:physiopathology; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology; D020097:Natriuretic Peptide, Brain / Q000097:blood; D009942:Organometallic Compounds / Q000008:administration & dosage; D062645:Percutaneous Coronary Intervention; D011237:Predictive Value of Tests; D011446:Prospective Studies; D020127:Recovery of Function; D013318:Stroke Volume; D013997:Time Factors; D014022:Tissue Survival; D016896:Treatment Outcome; D016277:Ventricular Function, Left
D015415:Biomarkers; D003287:Contrast Media; D009942:Organometallic Compounds; D020097:Natriuretic Peptide, Brain; C090600:gadobutrol
Angioplasty; Cardiovascular magnetic resonance; Chronic total coronary occlusion; Heart failure with reduced ejection fraction; Myocardial viability