| Objective: Percutaneous coronary intervention(PCI)opened coronary chronic total occlusion(CTO)lesions related to its regional influence of ischemic myocardium in patients with cardiac function and cardiac magnetic resonance imaging(CMR)on the clinical value of opening strategy.Methods: Included in December 2015-June 2017 in sichuan province people's hospital confirmed by coronary angiography for coronary artery chronic total occlusion lesions and in 56 patients with preoperative complete cardiac magnetic resonance imaging.According to the result of delayed-enhancement magnetic resonance imaging can be divided into group A(Transmural extent of cardiomyocyte equal to or greater than 50% of the patients with CTO)and group B(Transmural extent of cardiomyocyte below 50% of the patients with CTO),according to whether the CTO-PCI opening is divided into the CTO opening group and CTO not open group.The patients' basic medical history,PCI preoperative and 6months of cardiac ultrasound results were collected,and the effect of CTO-PCI on prognosis of CTO patients was evaluated by comparison between groups.Results:(1)Compared with the unopened group,the improvement of LVEF and LVEDD in the two groups was statistically significant [LVEF(56.35±7.38 vs.50.63±6.99,P=0.007),LVEDD(49.11±4.33 vs.52.00±4.10,P =0.019)].The LVEF and LVEDD of patients with CTO open group were statistically significant compared with that of the group before operation[LVEF(52.38±8.59 vs.56.35±7.38,P=0.000),LVEDD(51.70±5.21 vs.49.11±4.33,P=0.000)].However,the difference was not significant among patients with CTO unopened group [LVEF(51.47±8.04 vs.50.63±6.99,P=0.218),LVEDD(51.63±4.51 vs.52.00±4.10,P=0.340)].(2)In group A patients,the LVEF and LVEDD in the CTO open group were significantly improved compared with the CTO unopened group.[LVEF(58.45±7.18 vs.50.20±6.46,P=0.004),LVEDD(47.95±3.55 vs.52.00±3.89,P=0.007)].The LVEF and LVEDD of patients with CTO open group were statistically significant compared with that of the group before operation [LVEF(58.45±7.18 vs.52.09±10.17,P=0.000),LVEDD(47.95±3.55 vs.51.73±5.43,P=0.000)].However,The LVEF and LVEDD of patients with CTO unopened group were not statistically significant compared with that of the group before operation [LVEF(50.20±6.46 vs.50.40±7.78,P=0.847),LVEDD(52.00±3.89 vs.51.70±4.55,P=0.434)].(3)In group B patients,there was no significant difference in LVEF and LVEDD between CTO open group and unopened group [LVEF(53.27±6.76 vs.51.11±7.90,P=0.485),LVEDD(50.80±4.90 vs.52.00±4.56,P=0.558)].The LVEF and LVEDD of patients with CTO open group were not statistically significant compared with that of the group before operation [LVEF(53.27±6.76 vs.52.80±5.85,P=0.477),LVEDD(50.80±4.90 vs.51.67±5.07,P=0.066)].The LVEF and LVEDD of patients with CTO unopened group were not statistically significant compared with that of the group before operation [LVEF(51.11±7.90 vs.52.67±8.62,P=0.094),LVEDD(52.00±4.56 vs.51.56±4.75,P=0.548)].(4)In the patients with LAD-CTO group,the LVEF and LVEDD in the CTO open group were significantly improved compared with the CTO unopened group [LVEF(56.38±7.08 vs.49.78±8.36,P=0.047),LVEDD(48.44±4.41 vs.52.22±4.29,P=0.049)].The LVEF and LVEDD of patients with CTO open group were statistically significant compared with that of the group before operation [LVEF(56.38±7.08 vs.49.69±9.91,P=0.000),LVEDD(48.44±4.41 vs.52.31±6.37,P=0.000)].However,The LVEF and LVEDD of patients with CTO unopened group were not statistically significant compared with that of the group before operation [LVEF(49.78±8.36 vs.50.67±9.21,P=0.338),LVEDD(52.22±4.29 vs.51.67±4.27,P=0.139)].(5)In the patients with RCA-CTO group,the LVEF and LVEDD in the CTO open group were significantly improved compared with the CTO unopened group [LVEF(57.24±7.70 vs.49.50±5.05,P=0.033),LVEDD(48.94±3.23 vs.52.83±4.02,P=0.027)].The LVEF and LVEDD of patients with CTO open group were statistically significant compared with that of the group before operation [LVEF(57.24±7.70 vs.54.88±6.73,P=0.011),LVEDD (48.94±3.23 vs.50.82±3.21,P=0.001)].However,The LVEF and LVEDD of patients with CTO unopened group were not statistically significant compared with that of the group before operation [LVEF(49.50±5.05 vs.50.33±6.65,P=0.633),LVEDD(52.83±4.02 vs.52.67±4.18,P=0.862)].(6)In the patients with LCX-CTO group,there was no significant difference in LVEF and LVEDD between CTO open group and unopened group [LVEF(52.50±7.94 vs.54.25±6.45,P=0.744),LVEDD(52.50±7.33 vs.50.25±4.35,P=0.616)].The LVEF and LVEDD of patients with CTO open group were not statistically significant compared with that of the group before operation [LVEF(52.50±7.94 vs.52.50±8.89,P=1.000),LVEDD(52.50±7.33 vs.53.00±7.70,P=0.731)].The LVEF and LVEDD of patients with CTO unopened group were not statistically significant compared with that of the group before operation [LVEF(54.25±6.45 vs.55.00±8.17,P=0.519),LVEDD(50.25±4.35 vs.50.00±6.22,P=0.836)].Conclusion:(1)CTO-PCI can significantly improve the LVEF and LVEDD of the patients when the Transmural extent of cardiomyocyte equal to or greater than 50%.However,CTO-PCI did not improve cardiac function significantly when the Transmural extent of cardiomyocyte below 50%.(2)Cardiac magnetic resonance(CMR)preoperative evaluation of survival myocardium can predict the effect of CTO-PCI on the prognosis of patients with coronary heart disease,and the preoperative evaluation of CMR is of clinical value.(3)The cardiac function of patients with LAD-CTO and RCA-CTO was significantly improved after the opening of the CTO vessel,and the improvement of cardiac function of LCX-CTO was not obvious. |
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