title: Prediction of functional recovery after percutaneous coronary revascularization for chronic total occlusion using late gadolinium enhanced magnetic resonance imaging.
abstract: BACKGROUND
  Limited data are available regarding the prediction for functional recovery using late gadolinium enhanced magnetic resonance imaging (LGE MRI) after coronary revascularization for chronic total occlusion (CTO PCI).
  
  
  METHODS
  We studied 59 patients (mean age, 66±11 years) who underwent successful CTO PCI. Two-dimensional echocardiography and strain measurements were performed before and 8±2 months after CTO PCI. The findings of segmental assessment were compared with the extent of LGE MRI using a 16-segment model.
  
  
  RESULTS
  From baseline to follow-up, ejection fraction (54.2±12.1% to 56.1±10.6%, p=0.010), global longitudinal strain (LS) (-15.1±5.1 to -16.7±5.1, p<0.001), global circumferential strain (CS) (-14.0±4.9 to -15.9±4.9, p<0.001), and wall motion score (WMS) index (1.45±0.53 to 1.33±0.39, p=0.014) significantly improved. In the territory of the CTO vessel, LS and CS significantly improved in segments of LGE ≤50%, but not in segments of LGE >50%. However, WMS improved only in segments of LGE 1-25%. At baseline and at follow-up, CS allowed better discrimination of segments of LGE >50% than WMS [at baseline; area under the curve (AUC) 0.79 vs. 0.68, respectively, p=0.001: at follow-up; AUC 0.84 vs. 0.69, respectively, p<0.001). Discriminatory ability of LS for segments of LGE >50% significantly improved from baseline to follow-up (AUC 0.73 vs. 0.83, p<0.001).
  
  
  CONCLUSIONS
  The cut-off value of the extent of LGE MRI is 50% to detect segments that will functionally recover after CTO PCI. Change in LS was more sensitive for removal of ischemia by CTO PCI, indicating the utility of LS to monitor the therapeutic effects of CTO recanalization.
authors.affiliation: Department of Cardiology, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Kanagawa, Japan. Electronic address: nakachi@kanagawa-junko.jp.
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Nakachi
authors.affiliation: Department of Cardiology, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Kanagawa, Japan.
authors.forename: Shingo
authors.initials: S
authors.lastname: Kato
authors.affiliation: Department of Cardiology, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Kanagawa, Japan.
authors.forename: Hidekuni
authors.initials: H
authors.lastname: Kirigaya
authors.affiliation: Department of Cardiology, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Kanagawa, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Iinuma
authors.affiliation: Department of Cardiology, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Kanagawa, Japan.
authors.forename: Kazuki
authors.initials: K
authors.lastname: Fukui
authors.affiliation: Department of Cardiology, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Kanagawa, Japan.
authors.forename: Naka
authors.initials: N
authors.lastname: Saito
authors.affiliation: Department of Radiology, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Kanagawa, Japan.
authors.forename: Tae
authors.initials: T
authors.lastname: Iwasawa
authors.affiliation: Division of Cardiology, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan.
authors.forename: Masami
authors.initials: M
authors.lastname: Kosuge
authors.affiliation: Division of Cardiology, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan.
authors.forename: Kazuo
authors.initials: K
authors.lastname: Kimura
authors.affiliation: Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan.
authors.forename: Kouichi
authors.initials: K
authors.lastname: Tamura
mesh_terms: D000368:Aged; D002908:Chronic Disease; D003287:Contrast Media; D054059:Coronary Occlusion / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D004452:Echocardiography / Q000379:methods; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention; D020127:Recovery of Function; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media; D019786:Gadolinium DTPA
keywords: Chronic total occlusion; Late gadolinium enhancement; Magnetic resonance imaging; Percutaneous coronary intervention; Two-dimensional speckle tracking echocardiography