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Journal of Cardiovascular Magnetic Resonance
Published in: Journal of Cardiovascular Magnetic Resonance 1/2017

Open Access 01-12-2017 | Research

Improved recovery of regional left ventricular function after PCI of chronic total occlusion in STEMI patients: a cardiovascular magnetic resonance study of the randomized controlled EXPLORE trial

Authors: Joëlle Elias, Ivo M. van Dongen, Loes P. Hoebers, Dagmar M. Ouweneel, Bimmer E. P. M. Claessen, Truls Råmunddal, Peep Laanmets, Erlend Eriksen, René J. van der Schaaf, Dan Ioanes, Robin Nijveldt, Jan G. Tijssen, Alexander Hirsch, José P. S. Henriques, on behalf of the EXPLORE investigators

Published in: Journal of Cardiovascular Magnetic Resonance | Issue 1/2017

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Abstract

Background

The Evaluating Xience and left ventricular function in PCI on occlusiOns afteR STEMI (EXPLORE) trial did not show a significant benefit of percutaneous coronary intervention (PCI) of the concurrent chronic total occlusion (CTO) in ST-segment elevation myocardial infarction (STEMI) patients on global left ventricular (LV) systolic function. However a possible treatment effect will be most pronounced in the CTO territory. Therefore, we aimed to study the effect of CTO PCI compared to no-CTO PCI on the recovery of regional LV function, particularly in the CTO territory.

Methods

Using cardiovascular magnetic resonance (CMR) we studied 180 of the 302 EXPLORE patients with serial CMR (baseline and 4 months follow-up). Segmental wall thickening (SWT) was quantified on cine images by an independent core laboratory. Dysfunctional segments were defined as SWT < 45%. Dysfunctional segments were further analyzed by viability (transmural extent of infarction (TEI) ≤50%.). All outcomes were stratified for randomization treatment.

Results

In the dysfunctional segments in the CTO territory recovery of SWT was better after CTO PCI compared to no-CTO PCI (ΔSWT 17 ± 27% vs 11 ± 23%, p = 0.03). This recovery was most pronounced in the dysfunctional but viable segments(TEI < 50%) (ΔSWT 17 ± 27% vs 11 ± 22%, p = 0.02). Furthermore in the CTO territory, recovery of SWT was significantly better in the dysfunctional segments in patients with Rentrop grade 2–3 collaterals compared to grade 0–1 collaterals to the CTO (16 ± 26% versus 11 ± 24%, p = 0.04).

Conclusion

CTO PCI compared with no-CTO PCI is associated with a greater recovery of regional systolic function in the CTO territory, especially in the dysfunctional but viable segments. Further research is needed to evaluate the use of CMR in selecting post-STEMI patients for CTO PCI and the effect of regional LV function recovery on clinical outcome.

Trial registration

Trialregister.nl NTR1108, Date registered NTR: 30-okt-2007.
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Metadata
Title
Improved recovery of regional left ventricular function after PCI of chronic total occlusion in STEMI patients: a cardiovascular magnetic resonance study of the randomized controlled EXPLORE trial
Authors
Joëlle Elias
Ivo M. van Dongen
Loes P. Hoebers
Dagmar M. Ouweneel
Bimmer E. P. M. Claessen
Truls Råmunddal
Peep Laanmets
Erlend Eriksen
René J. van der Schaaf
Dan Ioanes
Robin Nijveldt
Jan G. Tijssen
Alexander Hirsch
José P. S. Henriques
on behalf of the EXPLORE investigators
Publication date
01-12-2017
Publisher
BioMed Central
Published in
Journal of Cardiovascular Magnetic Resonance / Issue 1/2017
Electronic ISSN: 1532-429X
DOI
https://doi.org/10.1186/s12968-017-0369-z

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