title: Impact of revascularization of coronary chronic total occlusion on left ventricular function and electrical stability: analysis by speckle tracking echocardiography and signal-averaged electrocardiogram.
abstract: The present study aimed to assess the mechanisms of effects of percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) from two different aspects: left ventricular (LV) systolic function assessed by two-dimensional speckle tracking echocardiography (2D-STE) and electrical stability evaluated by late potential on signal-averaged electrocardiogram (SAECG). We conducted a prospective observational study with consecutive CTO-PCI patients. 2D-STE and SAECG were performed before PCI, and after 1-day and 3-months of procedure. 2D-STE computed global longitudinal strain (GLS) and regional longitudinal strain (RLS) in CTO area, collateral blood-supplying donor artery area, and non-CTO/non-donor area. A total of 37 patients (66 ± 11 years, 78% male) were analyzed. RLS in CTO and donor areas and GLS were significantly improved 1-day after the procedure, but these improvements diminished during 3 months. The improvement of RLS in donor area remained significant after 3-months the index procedure (pre-PCI -13.4 ± 4.8% vs. post-3M -15.1 ± 4.5%, P = 0.034). RLS in non-CTO/non-donor area and LV ejection fraction were not influenced. Mitral annulus velocity was improved at 3-month follow-up (5.0 ± 1.4 vs. 5.6 ± 1.7 cm/s, P = 0.049). Before the procedure, 12 patients (35%) had a late potential. All components of the late potential (filtered QRS duration, root-mean-square voltage in the terminal 40 ms, and duration of the low amplitude signal <40 μV) were not improved. CTO-PCI improved RLS in the donor area at 3-month follow-up without changes of LV ejection fraction. Although higher prevalence of late potential in the current population compared to healthy population was observed, late potential as a surrogate of arrhythmogenic substrate was not influenced by CTO-PCI.
authors.affiliation: Department of Cardiology, Sakurabashi-Watanabe Hospital, 2-4-32, Umeda, Kita-ku, Osaka, Japan. sotomiyohei@gmail.com.
authors.forename: Yohei
authors.initials: Y
authors.lastname: Sotomi
authors.affiliation: Department of Cardiology, Sakurabashi-Watanabe Hospital, 2-4-32, Umeda, Kita-ku, Osaka, Japan.
authors.forename: Atsunori
authors.initials: A
authors.lastname: Okamura
authors.affiliation: Department of Cardiology, Sakurabashi-Watanabe Hospital, 2-4-32, Umeda, Kita-ku, Osaka, Japan.
authors.forename: Katsuomi
authors.initials: K
authors.lastname: Iwakura
authors.affiliation: Department of Cardiology, Sakurabashi-Watanabe Hospital, 2-4-32, Umeda, Kita-ku, Osaka, Japan.
authors.forename: Motoo
authors.initials: M
authors.lastname: Date
authors.affiliation: Department of Cardiology, Sakurabashi-Watanabe Hospital, 2-4-32, Umeda, Kita-ku, Osaka, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Nagai
authors.affiliation: Department of Cardiology, Sakurabashi-Watanabe Hospital, 2-4-32, Umeda, Kita-ku, Osaka, Japan.
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Yamasaki
authors.affiliation: Department of Cardiology, Sakurabashi-Watanabe Hospital, 2-4-32, Umeda, Kita-ku, Osaka, Japan.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Koyama
authors.affiliation: Department of Cardiology, Sakurabashi-Watanabe Hospital, 2-4-32, Umeda, Kita-ku, Osaka, Japan.
authors.forename: Koichi
authors.initials: K
authors.lastname: Inoue
authors.affiliation: Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, 1-1, Yamadaoka, Suita-shi, Osaka, Japan.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Sakata
authors.affiliation: Department of Cardiology, Sakurabashi-Watanabe Hospital, 2-4-32, Umeda, Kita-ku, Osaka, Japan.
authors.forename: Kenshi
authors.initials: K
authors.lastname: Fujii
mesh_terms: D000200:Action Potentials; D000368:Aged; D002908:Chronic Disease; D054059:Coronary Occlusion / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D018619:Echocardiography, Doppler, Pulsed; D004562:Electrocardiography; D005260:Female; D006329:Heart Conduction System / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention; D011237:Predictive Value of Tests; D011446:Prospective Studies; D020127:Recovery of Function; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left
keywords: Chronic total occlusion; Percutaneous coronary intervention; Signal-averaged electrocardiogram; Speckle tracking echocardiography