LEFT VENTRICULAR FUNCTION IN PATIENTS WITH CHRONIC TOTAL OCCULSION OF LAD: LONG-TERM FOLLOW-UP


Maria Prokudina, M.D., Ph.D., Federal Center of Heart, Blood and Endocrinology, St. Petersburg, Russia

Background: There is no agreement regarding the revascularization of patients with chronic total occlusions (CTO) of left descending artery (LAD) and signs of ischemia. One of the treatment goals is improvement of left ventricle (LV) function.

Methods: 32 patients with CTO of LAD were included. All patients had positive result of exercise stress echocardiography (SE) with the ischemia in LAD zone. 12 patients underwent CABG - LIMA to LAD, 9 patients had PCI of LAD and 11 patients did not get any revascularization. Mean follow-up period was 6 years. Diastolic diameter, diastolic volume, systolic volume and ejection fraction (EF) of LV were estimated. Exercise SE was performed and wall motion score index (WMSI) was evaluated before and after the stress.

Results: End-diastolic diameter, end-diastolic volume reduction and end-systolic volume reduction were observed among the patients with medical treatment (p<0.05). No significant changes of LV structure parameters were found in groups of patients after CABG or PCI. EV and WMSI did not change significantly in any group. ?WMSI parameter significantly decreased in all three groups (p<0,05), especially in the PCI group (p<0,01).

Conclusion: In spite of absence of revascularization patients with isolated CTO of LAD demonstrate improvement of LV parameters and reduction of ischemia level.