Department for Internal Medicine, Deputy for Sports and Rehabilitation Medicine, University Hospital Ulm, University of Ulm, Leimgrubenweg 14, 89071, Ulm, Deutschland.
Heart Clinic Ulm, Ulm, Germany.
Int J Cardiovasc Imaging. 2023 Nov;39(11):2205-2215. doi: 10.1007/s10554-023-02916-9. Epub 2023 Jul 12.
Chronic total occlusion (CTO) is a common finding in patients with known or suspected coronary artery disease and has a distinctive role in these patients' quality of life. However, there is still a lack of evidence of correct patient selection for percutaneous coronary intervention (PCI). From July 2017 to August 2020, 68 patients with successful PCI of a CTO and previous evidence of viability for PCI by cardiovascular magnetic resonance imaging (CMR) were prospectively included in this single-centre observational study. Of these patients, 62 underwent follow-up CMR, and 56 underwent surveys using the Seattle Angina Questionnaire before PCI and 3, 12 and 24 months after PCI. The CMR results were assessed for volumetric, functional and deformation parameters. From the baseline to the follow-up, there was a significant reduction in the left ventricular volumes (all p < 0.001) and an increase in the left ventricular ejection fraction (57.6 ± 11.6% vs. 60.3 ± 9.4%, p = 0.006). Among the deformation parameters, only the left ventricular radial strain showed significant improvement. The SAQ showed an early improvement that emphasised angina stability and frequency as well as a summary score, which persisted after 24 months. A low SAQ summary score before PCI was the best predictive factor of good clinical improvement thereafter. Improvements in myocardial function and quality of life can be achieved with PCI of a CTO. Patient selection for PCI should be performed primarily among relevantly symptomatic patients when evidence of viability for PCI is present. The SAQ can help guide such patient selection.Trial registration ISRCTN, identifier: ISRCTN33203221. Retrospectively registered on 01.04.2020. https://www.isrctn.com/ISRCTN33203221.
慢性完全闭塞（CTO）是已知或疑似冠心病患者的常见发现，在这些患者的生活质量中具有独特的作用。然而，对于经皮冠状动脉介入治疗（PCI）的正确患者选择，仍然缺乏证据。从 2017 年 7 月到 2020 年 8 月，前瞻性纳入了 68 例 CTO 经皮冠状动脉介入治疗成功且心血管磁共振成像（CMR）先前有 PCI 存活证据的患者进行这项单中心观察性研究。其中 62 例患者接受了随访 CMR，56 例患者在 PCI 前、PCI 后 3、12 和 24 个月接受了西雅图心绞痛问卷调查。CMR 结果评估了容积、功能和变形参数。从基线到随访，左心室容积显著减少（均 p<0.001），左心室射血分数增加（57.6±11.6%比 60.3±9.4%，p=0.006）。在变形参数中，只有左心室径向应变明显改善。SAQ 显示早期改善，强调心绞痛稳定性和频率以及综合评分，在 24 个月后仍持续存在。PCI 前 SAQ 综合评分低是 PCI 后临床改善良好的最佳预测因素。CTO 的 PCI 可实现心肌功能和生活质量的改善。当存在 PCI 存活证据时，应主要在相关症状患者中进行 PCI 患者选择。SAQ 可以帮助指导这种患者选择。试验注册 ISRCTN，标识符：ISRCTN33203221。于 2020 年 4 月 1 日进行回顾性注册。https://www.isrctn.com/ISRCTN33203221。
