Multimodality imaging for predicting regional wall motion recovery after percutaneous coronary intervention for chronic total occlusion.

BACKGROUND

Predicting regional left ventricular (LV) functional recovery is essential for optimizing patient selection for percutaneous coronary intervention (PCI) in chronic total occlusion (CTO), yet direct comparisons of imaging modalities remain limited. We aimed to compare the predictive performance of dobutamine stress echocardiography (DSE), cardiac magnetic resonance (CMR) imaging, and single-photon emission computed tomography (SPECT), alone and in combination, for regional LV wall motion recovery after PCI for CTO.

METHODS AND

RESULTS

We prospectively examined 66 patients with CTO undergoing successful PCI. Multimodality imaging was performed within 3 months prior to PCI. Wall motion recovery was defined as an improvement of ≥1 grade in segmental wall motion score assessed by resting echocardiography at 6 to 8 months post-PCI. Among 153 dysfunctional segments within the CTO territory, recovery was observed in 115 (75%). DSE at 20 μg/kg/min demonstrated high sensitivity (96.5%), CMR demonstrated high specificity (68.4%), and SPECT showed moderate sensitivity (76.5%) and specificity (52.6%). The area under the curve (AUC) for the combination of CMR and DSE (0.819) was comparable to that of all three modalities combined (0.825) and significantly exceeded that of any single modality (CMR: 0.738, DSE: 0.733; both P < 0.05).

CONCLUSIONS

In patients with CTO undergoing PCI, multimodality imaging provides complementary information for predicting regional LV wall motion recovery. An imaging strategy in which modalities are selected and combined according to the clinical context may help optimize decision-making for revascularization.

TRIAL REGISTRATION: UMIN Clinical Trials Registry (UMIN000046847). Short tweet: Can multimodality imaging predict LV wall motion recovery after PCI for chronic total occlusion? Combining dobutamine stress echo and cardiac MRI matched 3-modality performance, aiding CTO revascularization decisions. #CTO #CardioTwitter.