The Impact of Percutaneous Coronary Intervention on Echocardiographic Parameters in Patients with Chronic Total Occlusion of the Coronary Arteries with Diverse Left Ventricular Ejection Fractions: A Single-Center Retrospective Study

Authors

  • Youyou Zhu Department of Ultrasound Medicinel, Taizhou Hospital, Zhejiang University, 317000 Taizhou, Zhejiang, China
  • Weiwei Ying Department of Ultrasound Medicinel, Taizhou Hospital, Zhejiang University, 317000 Taizhou, Zhejiang, China
  • Pintong Huang Department of Ultrasound Medicinel, The Second Affiliated Hospital Zhejiang University School of Medicine, 310009 Hangzhou, Zhejiang, China

DOI:

https://doi.org/10.59958/hsf.7857

Keywords:

echocardiographic parameters, chronic total occlusion, coronary arteries, left ventricular ejection fractions, PCI

Abstract

Background: Chronic total occlusion (CTO) of the coronary arteries presents a significant challenge in the management of coronary artery disease, with diverse clinical manifestations and implications for patients with varying left ventricular ejection fraction (LVEF). The aim of this study is to investigate the impact of percutaneous coronary intervention (PCI) on echocardiographic parameters in patients with CTO and different LVEF, so as to optimize the care and outcomes of patients. Methods: We selected patients with CTO of coronary arteries treated at our hospital from June 2021 to June 2023 consecutively in this study. The patients were divided into two groups based on their LVEF: the low to moderate LVEF (<50%) group and the high LVEF group. Echocardiographic parameters, medication use, and demographic characteristics were assessed before and after PCI. Statistical analyses were conducted to compare changes in LVEF, left ventricular end-systolic volume (LVESV), left ventricular end-diastolic volume (LVEDV), global longitudinal strain (GLS), and left ventricular wall motion score (LVWMS) between the two LVEF groups. Results: A total of 100 patients including 67 patients with Low & Mid-range LVEF and 33 patients with High LVEF were included. Patients in the low and mid-range LVEF group demonstrated significant improvements in LVEF (p = 0.010), LVESV (p = 0.013), LVEDV (p = 0.034), GLS (p = 0.014), and LVWMS (p = 0.014) following PCI. In contrast, no significant changes in these parameters were observed in the high LVEF group after PCI. Conclusion: This study demonstrates that PCI leads to significant improvements in LVEF, LVESV, LVEDV, GLS, and LVWMS in patients with low to moderate LVEF, indicating potential benefits of revascularization in this patient subset.

References

Anantha-Narayanan M, Garcia S. Contemporary Approach to Chronic Total Occlusion Interventions. Current Treatment Options in Cardiovascular Medicine. 2019; 21: 1.

Koelbl CO, Nedeljkovic ZS, Jacobs AK. Coronary Chronic Total Occlusion (CTO): A Review. Reviews in Cardiovascular Medicine. 2018; 19: 33–39.

Marechal P, Davin L, Gach O, Martinez C, Lempereur M, Lhoest N, et al. Coronary chronic total occlusion intervention: utility or futility. Expert Review of Cardiovascular Therapy. 2018; 16: 361–367.

Akbari T, Al-Lamee R. Percutaneous Coronary Intervention in Multi-Vessel Disease. Cardiovascular Revascularization Medicine: Including Molecular Interventions. 2022; 44: 80–91.

Hoole SP, Bambrough P. Recent advances in percutaneous coronary intervention. Heart (British Cardiac Society). 2020; 106: 1380–1386.

Sun LY, Gaudino M, Chen RJ, Bader Eddeen A, Ruel M. Long-term Outcomes in Patients With Severely Reduced Left Ventricular Ejection Fraction Undergoing Percutaneous Coronary Intervention vs Coronary Artery Bypass Grafting. JAMA Cardiology. 2020; 5: 631–641.

Kobayashi N, Ito Y, Kishi K, Muramatsu T, Okada H, Oikawa Y, et al. Procedural results and in-hospital outcomes of percutaneous coronary intervention for chronic total occlusion in patients with reduced left ventricular ejection fraction: Sub-analysis of the Japanese CTO-PCI Expert Registry. Catheterization and cardiovascular interventions: official journal of the Society for Cardiac Angiography & Interventions. 2022; 100: 30–39.

Levent F, Koca F. Impact of residual coronary artery disease on left ventricular function after percutaneous coronary intervention: a two-dimensional strain echocardiography study. Herz. 2023; 48: 152–158.

Simsek B, Rempakos A, Kostantinis S, Karacsonyi J, Rangan BV, Mastrodemos OC, et al. A Systematic Review of Periprocedural Risk Prediction Scores in Chronic Total Occlusion Percutaneous Coronary Intervention. The American Journal of Cardiology. 2023; 193: 118–125.

El Awady WS, Samy M, Al-Daydamony MM, Abd El Samei MM, Shokry KAEA. Periprocedural and clinical outcomes of percutaneous coronary intervention of chronic total occlusions in patients with low- and mid-range ejection fractions. The Egyptian Heart Journal: (EHJ): Official Bulletin of the Egyptian Society of Cardiology. 2020; 72: 28.

Samy M, El Awady WS, Al-Daydamony MM, Abd El Samei MM, Shokry KAEA. Echocardiographic assessment of left ventricular function recovery post percutaneous coronary intervention of chronic total occlusions in patients with low and mid-range left ventricular ejection fractions. Echocardiography (Mount Kisco, N.Y.). 2020; 37: 239–246.

Brilakis ES, Mashayekhi K, Tsuchikane E, Abi Rafeh N, Alaswad K, Araya M, et al. Guiding Principles for Chronic Total Occlusion Percutaneous Coronary Intervention. Circulation. 2019; 140: 420–433.

Nagashima Y, Iijima R, Nakamura M, Sugi K. Utility of the SYNTAX score in predicting outcomes after coronary intervention for chronic total occlusion. Herz. 2015; 40: 1090–1096.

Forouzandeh F, Suh J, Stahl E, Ko YA, Lee S, Joshi U, et al. Performance of J-CTO and PROGRESS CTO Scores in Predicting Angiographic Success and Long-term Outcomes of Percutaneous Coronary Interventions for Chronic Total Occlusions. The American Journal of Cardiology. 2018; 121: 14–20.

Rempakos A, Kostantinis S, Simsek B, Karacsonyi J, Yamane M, Alaswad K, et al. Update on Chronic Total Occlusion Percutaneous Coronary Intervention. The Journal of Invasive Cardiology. 2023; 35: E194–E204.

Schumacher SP, Stuijfzand WJ, Opolski MP, van Rossum AC, Nap A, Knaapen P. Percutaneous Coronary Intervention of Chronic Total Occlusions: When and How to Treat. Cardiovascular Revascularization Medicine: Including Molecular Interventions. 2019; 20: 513–522.

Ngu JMC, Ruel M, Sun LY. Left ventricular function recovery after revascularization: comparative effects of percutaneous coronary intervention and coronary artery bypass grafting. Current Opinion in Cardiology. 2018; 33: 633–637.

Cai X, Huang L, Chen X, Sun J, Gao F. Endovascular revascularization of chronically occluded vertebral artery: single-center experience. Wideochirurgia i Inne Techniki Maloinwazyjne = Videosurgery and other Miniinvasive Techniques. 2021; 16: 211–218.

Mulchan N, Yeun P, Frontera J, Farkas J, Berekashvili K, Sanger M, et al. Endovascular Revascularization of Multi Segment Chronically Occluded ICA. Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association. 2022; 31: 106551.

Dakik HA, Ghazzal Z, Haidar M. Screening asymptomatic patients post PCI with myocardial perfusion imaging. Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology. 2023; 30: 2248–2251.

Lyu WY, Qin CY, Wang XT, Shi SL, Liu HL, Wang JW. The application of myocardial contrast echocardiography in assessing microcirculation perfusion in patients with acute myocardial infarction after PCI. BMC Cardiovascular Disorders. 2022; 22: 233.

Hirai T, Grantham JA. Indications and Patient Selection for Percutaneous Coronary Intervention of Chronic Total Occlusions. Interventional Cardiology Clinics. 2021; 10: 1–5.

Vanneman MW. Anesthetic Considerations for Percutaneous Coronary Intervention for Chronic Total Occlusions-A Narrative Review. Journal of Cardiothoracic and Vascular Anesthesia. 2022; 36: 2132–2142.

Bhatt DL. Percutaneous Coronary Intervention in 2018. JAMA. 2018; 319: 2127–2128.

Simsek B, Kostantinis S, Karacsonyi J, Alaswad K, Karmpaliotis D, Masoumi A, et al. Outcomes of chronic total occlusion percutaneous coronary intervention in patients with reduced left ventricular ejection fraction. Catheterization and Cardiovascular Interventions: Official Journal of the Society for Cardiac Angiography & Interventions. 2022; 99: 1059–1064.

Otero-García O, Cid-Álvarez AB, Juskova M, Álvarez-Álvarez B, Tasende-Rey P, Gude-Sampedro F, et al. Prognostic impact of left ventricular ejection fraction recovery in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention: analysis of an 11-year all-comers registry. European Heart Journal Acute Cardiovascular Care. 2021; 10: 898–908.

Meng S, Qiu L, Wu J, Huang R, Wang H. Two-year left ventricular systolic function of percutaneous coronary intervention vs optimal medical therapy for patients with single coronary chronic total occlusion. Echocardiography (Mount Kisco, NY). 2021; 38: 368–373.

Shah S, Benedetto U, Caputo M, Angelini GD, Vohra HA. Comparison of the survival between coronary artery bypass graft surgery versus percutaneous coronary intervention in patients with poor left ventricular function (ejection fraction <30%): a propensity-matched analysis. European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery. 2019; 55: 238–246.

Yokoyama Y, Fukuhara S, Mori M, Noguchi M, Takagi H, Briasoulis A, et al. Network meta-analysis of treatment strategies in patients with coronary artery disease and low left ventricular ejection fraction. Journal of Cardiac Surgery. 2021; 36: 3834–3842.

Yu ZX, Yan J, Wang MY, Chen R, Luo JY, Li XM, et al. Effects of Percutaneous Coronary Intervention and Coronary Artery Bypass Grafting on Clinical Outcomes in Patients with Reduced Ejection Fraction Heart Failure and Coronary Heart Disease: A Meta-Analysis. The Heart Surgery Forum. 2023; 26: E062–E073.

Diletti R, den Dekker WK, Bennett J, Schotborgh CE, van der Schaaf R, Sabaté M, et al. Immediate versus staged complete revascularisation in patients presenting with acute coronary syndrome and multivessel coronary disease (BIOVASC): a prospective, open-label, non-inferiority, randomised trial. Lancet (London, England). 2023; 401: 1172–1182.

Werner GS, Hildick-Smith D, Martin Yuste V, Boudou N, Sianos G, Gelev V, et al. Three-year outcomes of A Randomized Multicentre Trial Comparing Revascularization and Optimal Medical Therapy for Chronic Total Coronary Occlusions (EuroCTO). EuroIntervention: Journal of EuroPCR in Collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology. 2023; 19: 571–579.

Published

2024-11-24

How to Cite

Zhu, Y., Ying, W., & Huang, P. (2024). The Impact of Percutaneous Coronary Intervention on Echocardiographic Parameters in Patients with Chronic Total Occlusion of the Coronary Arteries with Diverse Left Ventricular Ejection Fractions: A Single-Center Retrospective Study. The Heart Surgery Forum, 27(11), E1330-E1338. https://doi.org/10.59958/hsf.7857

Issue

Section

Article