Effects of successful percutaneous coronary intervention of chronic total occlusions on myocardial perfusion and left ventricular function

AIMS: The aim of the present study was to investigate the effects of successful PCI CTO on absolute myocardial blood flow (MBF) and functional recovery.

METHODS AND RESULTS: Patients with a documented CTO were prospectively examined for ischaemia and viability with [15O]H2O positron emission tomography (PET) and late gadolinium enhancement cardiac magnetic resonance imaging (LGE-CMR). Sixty-nine consecutive patients, in whom PCI was successful, underwent follow-up PET and CMR after approximately 12 weeks to evaluate potential improvement of MBF as well as systolic function. After PCI, stress MBF in the CTO area increased from 1.22±0.36 to 2.40±0.90 mL·min-1·g-1 (p<0.001), whilst stress MBF in the remote area also increased significantly between baseline and follow-up PET (2.58±0.68 to 2.77±0.77 mL·min-1·g-1, p=0.01). The ratio of stress MBF between CTO and remote area was 0.49±0.13 at baseline and increased to 0.87±0.24 at follow-up (p<0.001). The MBF defect size of the CTO area decreased from 5.12±1.69 to 1.91±1.75 myocardial segments after PCI (p<0.001). Left ventricular ejection fraction (LVEF) increased significantly (46.4±11.0 vs. 47.5±11.4%, p=0.01) at follow-up.

CONCLUSIONS: The vast majority of CTO patients with documented ischaemia and viability showed significant improvement in stress MBF and a reduction of ischaemic burden after successful percutaneous revascularisation with only minimal effect on LVEF.