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Left ejection fraction following chronic total coronary occlusion recanalization - appropriate patient selection needed?
Session:
Sessão de Posters 24 - Biomarcadores em Cardiologia
Speaker:
Gonçalo Terleira Batista
Congress:
CPC 2024
Topic:
J. Preventive Cardiology
Theme:
28. Risk Factors and Prevention
Subtheme:
28.14 Risk Factors and Prevention - Other
Session Type:
Cartazes
FP Number:
---
Authors:
Gonçalo Terleira Batista; Ana L Silva; Mariana Rodrigues Simões; Tatiana Pereira Dos Santos; Gonçalo Ferraz Costa; Diogo Fernandes; Rafaela Fernandes; Vanessa Lopes; José Luís Martins; Joana Delgado Silva; Marco Costa; Lino Gonçalves
Abstract
<p><span style="font-size:14px"><strong>Background: </strong></span>Despite theoretical rationale, recanalization trials for chronic coronary disease and chronic complete coronary occlusions (CTO) have yielded disappointing results, often demonstrating negligible or no impact on clinical or echocardiographic endpoints related to heart failure.</p> <p> </p> <p><span style="font-size:14px"><strong>Purpose:</strong></span> To evaluate differences on left ventricular ejection fraction (LVEF) following CTO recanalization.</p> <p> </p> <p><strong><span style="font-size:14px">Methods:</span></strong> This retrospective study at a tertiary center involved 40 patients undergoing CTO angioplasty (January 2017 to May 2023). Baseline and follow-up data and pre/post-procedural echocardiographic data were gathered from hospital and primary care center’s records. The most recent echocardiogram conducted prior to the procedure was designated as the pre-procedural assessment, while the post-procedural echocardiogram was the first performed at least three months after the procedure.</p> <p>LVEF variations were calculated using paired-samples T-test. Subpopulation analyses were conducted for gender, diabetes, hypertension, complex disease, complete revascularization, past MI or angioplasty, age and body mass index, using appropriate tests based on distribution normality.</p> <p>An additional analysis excluded patients who started optimal medical therapy (OMT) for heart failure (HF) with reduced LVEF between echocardiograms. Statistical significance was set at p < 0.05.<br /> </p> <p><span style="font-size:14px"><strong>Results: </strong></span></p> <p>A total of 40 patients were included and followed for a mean 4.7 years. Mean age at time of procedure was 65.3 years, with 80% being male, mean BMI of 28.2Kg/m2 and high rates of hypertension (90%), diabetes (65%) and dyslipidemia (85%). </p> <p>Mean LVEF significantly increased from baseline (47.5%) to post-procedure (51.5%), showing a mean increase of 4% (p=0.001; 95% Confidence Interval: 1.7%-6.2%). This increase remained statistically significant for diabetics (p=0.037) and hypertensives (p=0.009).<br /> Individuals over 65 years did not experience a significant increase (p=0.44), while those under 65 years showed the highest increase in LVEF (mean 6.3%; 95% CI: 3.6%-8.9%, p<0.001). Additionally, individuals with BMI > 30Kg/m2 did not exhibit an increase in LVEF (p=0.097), while those with BMI <30Kg/m2 did, by a mean 4.6% (p=0.005).</p> <p>After excluding patients with LVEF <40% who initiated OMT for HF, the association between CTO recanalization and increased LVEF remained significant (p=0.004).</p> <p> </p> <p><span style="font-size:14px"><strong>Conclusion:</strong></span></p> <p>Our findings imply potential advantages of CTO angioplasty, particularly for younger and non-obese patients.</p>
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