Benefits of chronic total coronary occlusion percutaneous intervention in patients with heart failure and reduced ejection fraction: insights from a cardiovascular magnetic resonance study

Background: chronic total occlusion percutaneous coronary intervention (cto-pci) can improve angina and left ventricular ejection fraction (lvef). these benefits were not assessed in populations with heart failure with reduced ejection fraction (hfref). we studied the effect of cto-pci on left ventricular function and clinical parameters in patients with hfref. methods: using cardiovascular magnetic resonance (cmr),we studied 29 patients with hfref and evidence of viability and/or ischemia in the territory supplied by a cto who were successfully treated with cto-pci. in patients with multi-vessel disease,non-cto pci was also performed. imaging parameters,clinical status,and brain natriuretic peptide (bnp) levels were evaluated before and 6 months after cto-pci. results: a decrease in left ventricular end-systolic volume (160 ± 54 ml vs. 143 ± 58 ml; p = 0.029) and an increase in lvef (31.3 ± 7.4 % vs. 37.7 ± 8 %; p < 0.001) were observed. there were no differences in lvef improvement between patients who underwent non-cto pci (n = 11) and those without this intervention (n = 18); (p = 0.73). the number of segments showing perfusion defects was significantly reduced (0.5 ± 1 vs. 0.2 ± 0.5; p = 0.043). angina (p = 0.002) and nyha functional class (p = 0.004) improved,and bnp levels decreased (p = 0.004) after cto-pci. conclusions: in this group of patients with hfref showing cmr evidence of viability and/or ischemia within the territory supplied by the cto,an improvement in ejection fraction,left ventricular end-systolic volume and ischemia burden was observed after cto-pci. clinical and laboratory parameters also improved. trial registration: clinicaltrials.gov nct02570087 . registered 6 october 2015. © 2016 the author(s).