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Quantification of strain analysis in coronary chronic total occlusion: A cardiovascular magnetic resonance imaging follow-up study1Department of Radiology, Beijing AnZhen Hospital, Capital Medical University, Beijing, China, 2Department of Cardiology, Beijing AnZhen Hospital, Capital Medical University, Beijing, China, 33Siemens Shenzhen Magnetic Resonance Ltd, Beijing, China, 4Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
Synopsis
This study investigated the benefits of percutaneous coronary intervention (PCI) in patients with chronic total occlusions (CTOs) by using cardiac magnetic resonance imaging (CMR)-feature tracking (CMR-FT).The results showed the infarct size and LVEF did not increase significantly from baseline to 1 year of follow-up.However, global peak strains improved over time, and GCS showed significant treatment effect of CTO-PCI in the entire CMR population,which indicated improvement in left ventricular function.
Purpose
The present study aimed to investigate the benefits of percutaneous coronary intervention (PCI) in patients with chronic total occlusions (CTOs) by using cardiac magnetic resonance imaging (CMR)-feature tracking (CMR-FT).Methods
Fifty-two patients with successful CTO-PCI underwent CMR (3T, MAGNETOM Verio, Siemens Healthineers, Erlangen, Germany) at baseline and 12 months after successful PCI. CMR-FT was applied to cine images to measure left ventricle (LV) global radial, circumferential, and longitudinal peak strains (GRS, GCS, and GLS, respectively), and grayscale thresholds of 5 standard deviations (SDs) were used to quantify late gadolinium enhancement (LGE). We categorized patients with CTOs into the viable and nonviable groups (with the cutoff of segmental infarct extent (SIE) < 50%). Major adverse cardiac events were defined as cardiac death, acute myocardial infarction, and hospitalization for heart failure.Figure 1 shows example of CMR feature tracking (FT) for quantification of myocardial deformation.Results
From December 2014 to November 2019, 64 of the 192 patients with CTO underwent baseline and follow-up CMR. Among them, 52 patients underwent PCI successfully. Four patients with acute MI within 3 months before PCI and seven patients with limited MR images were excluded. Over a median follow-up period of 12 months (range: 8–29 months), 41 patients (55.3 ± 10.9 years, 82.9% males) with successful CTO-PCI were included in data analysis. During the follow-up (median,12 months), no patient experienced major adverse events.In the total CMR population, the mean baseline left ventricular ejection fraction (LVEF) was 60.4 ± 11.2%, left ventricular end diastolic volume (LVEDV) was 115.2 ± 30.1 ml, and total enhanced mass (TEM) was 10.5 ± 11.0 g. Furthermore, 73% of patients with CTOs showed no reduction in LVEF (>50%). Left ventricle GRS, GCS, and GLS were 32.1 ± 10.3%, -18.2 ± 3.7%, and -14.8 ± 3.2%, respectively (Table 1). GRS, GCS, and GLS by CMR-FT were strongly correlated with LVEF (r = 0.83, r = 0.83, r = 0.67, respectively, p < 0.05 for all). GRS and GCS were moderately correlated with TEM (r = 0.48, r = 0.49, respectively, p < 0.05 for both). Baseline characteristics of the study population are shown in Tables 1 and 2.
The LVEF of the viable group was higher than that of the nonviable group (63.3 ± 12.1 vs. 56.3 ± 8.8, p = 0.05). The TEM of the nonviable group was significantly higher than that of the viable group (19.7 ± 11.8 g vs. 4.6 ± 4.3 g, p < 0.001) (Table 2). Mean baseline GRS and GCS values of the viable group were significantly higher than those of the nonviable group (35.4 ± 11.5% vs. 27.4 ± 6.0%, -19.3 ± 3.9% vs. -16.6 ± 2.6%, all p < 0.05). However, there were no significant differences between the two groups in mean baseline GLS and LVEDV values (Table 3).
In this study of CTO-PCI, in the entire CMR population and subgroup analysis, the infarct size did not increase significantly from baseline to 1 year of follow-up (p > 0.05 for all). LVEF did not show significant improvement in the 1-year follow-up (60.4 ± 11.2% vs. 62.9 ± 0.1%, p = 0.09) in the entire CMR population. However, global peak strains improved over time, and GCS showed significant treatment effect of CTO-PCI in the entire CMR population (Δ GRS 3.0 ± 9.3%, p = 0.05; Δ GCS -1.3 ± 3.4%, p = 0.02; ΔGLS − 0.8 ± 3.1%, p = 0.12) (Table 1).
In the subgroup analysis, the mean follow-up GRS and GCS values of the viable group were significantly higher than those of the nonviable group (38.0 ± 8.3% vs. 30.9 ± 8.0%, -20.5 ± 2.6% vs. -18.0 ± 3.0%, all p < 0.05). However, the mean GLS value of the viable group was not significantly higher than that of the nonviable group at follow-up (-16.1 ± 2.5% vs. -14.8 ± 2.5%, p = 0.12) (Figure 2).
Discussion
LVEF reflects the global function of the LV, but it cannot distinguish the regional myocardial strain in different directions, and it cannot reflect the early damaged function of heart disease. CMR-FT technology provides an incremental value for risk stratification in various cardiac diseases.In our present study, the mean GLS at baseline (-14.8%) was lower than -20%, without significant improvement after PCI. Therefore, although LVEF of most CTOs in the present study did not decrease significantly during the 1-year follow-up, GLS decreased and did not improve after successful PCI, which may be considered as a potential risk factor.The independent prognostic value of GCS is controversial. GCS in our study showed treatment effect of CTO-PCI on the recovery of global strain parameters. Kenneth et al showed that circumferential strain has independent prognostic importance in study participants with acute ST-segment elevation myocardial infarction. However, other follow-up studies of acute MI did not support this finding. Thus, more evidence needs to be provided in the future.
Conclusions
In this single center study, GCS showed treatment effect of successful CTO-PCI at 1-year follow-up in our study, which indicated improvement in left ventricular function.Acknowledgements
No acknowledgement found.References
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