الفهرس 
cardiac MRIOnly 14 pages are availabe for public view
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Abstract
Chronic total occlusion (CTO) is a common condition in patients with coronary artery disease, and represents one of the most challenging targets of lesion recanalization for percutaneous coronary interventions. The rationale for the recanalization of a chronic total coronary occlusion is the possible improvement of left ventricular (LV) function through the recovery of hibernating myocardium.
Aim of the work:
To compare between different imaging modalities (conventional echo, tissues Doppler, speckle tracking echocardiography and CMR) in detection of myocardial recovery after successful revascularization of CTO .
Patients and methods:
This was a prospective observational multicenter (four tertiary centers in Jeddah. KSA) study that included 30 patients who have ischemic heart disease and diagnosed with coronary angiography to have a chronic total occlusion. The study was performed from February 2020 to May 2022. Informed consent was taken from patients after full explanation of the purpose and nature of the study.
A CTO is defined as an atherosclerotic complete vessel occlusion with Thrombolysis in Myocardial Infarction (TIMI) grade 0 flow within the occluded segment, and an estimated occlusion duration of ≥ 3 months.
Conventional echo, tissues Doppler, speckle tracking echocardiography and CMR done for all patients and four months after successful PCI to CTO vessel.
Results
Patients age ranged from 43 to 66 years with a mean of 52.7 ± 6.7. There was male predominance, with 73.3% (22 patients) of the study patients were males. Concerning comorbidities, 22 patients had hypertension, diabetes mellitus, and dyslipidemia (73.3%). Eighteen patients (60%) were past smokers and eight patients previous MI (26.7%). In regard to used medications, all the 30 patients were on antiplatelet drugs (100%), 24 patients on beta blockers (80%), 22 patients on ACE inhibitors (73.3%), and the same number (73.3%) were on statins.
Results showed statically significant improvement in GLS 4 months after successful PCI to CTO vessel ( (-16.5 ± 2.9 vs. -12.8 ± 1.75 , % of changes 28.91%; p <0.001).there non-statistically significant different improvement in
LVEF (49.5 ± 5.8 vs. 46.9 ± 5.6, % of changes 5.54% ; p=0.08), LVEDV (117.6 ± 49.3 vs. 121.6 ± 50.2 , % of changes 3.28% ; p=0.75), LVESV (62.1 ± 34.2 vs. 66.3 ± 35.2, % of changes 6.33% ; p=0.64), E/A (1.23 ± 0.38 vs. 1.11 ± 60.4, % of changes 10.81% ; p=0.36), E/e′ (9.8 ± 2.11 vs. 11 ± 2.44, % of changes 10.91% ; p=0.053), CMR LVEF(48.8 ± 6 vs. 46.6 ± 5.7, % of changes 4.72% , p=0.15), CMR LVEDV (117.7 ± 49.8 vs. 122.1 ± 50.6, % of changes 3.6%, p=0.74), and CMR LVESV (62.6 ± 36.1 vs. 67.1 ± 36.3, % of changes 8.2% p=0.63).
The improvement notice only on patient with late GE < 50%.with statically significant improvement in GLS 4 months after successful PCI to CTO vessel.
Conclusion:
The results of this study provide evidence to support the clinical use of 2D-STE to monitor the early changes of LV function. In patients undergoing CTO revascularization, change in LS and GLS was more sensitive predictors for LV function improvement at 4 months follow-up.