scholarly journals Impact of recanalization of chronic total occlusion on left ventricular electrical remodeling

2019 ◽  
Vol 42 (6) ◽  
pp. 712-721 ◽  
Author(s):  
Kennosuke Yamashita ◽  
Wataru Igawa ◽  
Morio Ono ◽  
Takehiko Kido ◽  
Toshitaka Okabe ◽  
...  
Keyword(s):  
Chronic Total Occlusion ◽  
Left Ventricular ◽  
Electrical Remodeling ◽  
Total Occlusion ◽  
Ventricular Electrical Remodeling

scholarly journals Ionic bases for electrical remodeling of the canine cardiac ventricle

2013 ◽  
Vol 305 (3) ◽  
pp. H410-H419 ◽  
Author(s):  
Darwin Jeyaraj ◽  
Xiaoping Wan ◽  
Eckhard Ficker ◽  
Julian E. Stelzer ◽  
Isabelle Deschenes ◽  
...  
Keyword(s):  
Ion Channels ◽  
Ion Channel ◽  
Phase 1 ◽  
Myocardial Strain ◽  
Ionic Currents ◽  
Left Ventricular ◽  
Electrical Remodeling ◽  
Cardiac Ventricle ◽  
Ionic Mechanisms ◽  
Ventricular Electrical Remodeling

Emerging evidence suggests that ventricular electrical remodeling (VER) is triggered by regional myocardial strain via mechanoelectrical feedback mechanisms; however, the ionic mechanisms underlying strain-induced VER are poorly understood. To determine its ionic basis, VER induced by altered electrical activation in dogs undergoing left ventricular pacing ( n = 6) were compared with unpaced controls ( n = 4). Action potential (AP) durations (APDs), ionic currents, and Ca2+ transients were measured from canine epicardial myocytes isolated from early-activated (low strain) and late-activated (high strain) left ventricular regions. VER in the early-activated region was characterized by minimal APD prolongation, but marked attenuation of the AP phase 1 notch attributed to reduced transient outward K+ current. In contrast, VER in the late-activated region was characterized by significant APD prolongation. Despite marked APD prolongation, there was surprisingly minimal change in ion channel densities but a twofold increase in diastolic Ca2+. Computer simulations demonstrated that changes in sarcolemmal ion channel density could only account for attenuation of the AP notch observed in the early-activated region but failed to account for APD remodeling in the late-activated region. Furthermore, these simulations identified that cytosolic Ca2+ accounted for APD prolongation in the late-activated region by enhancing forward-mode Na+/Ca2+ exchanger activity, corroborated by increased Na+/Ca2+ exchanger protein expression. Finally, assessment of skinned fibers after VER identified altered myofilament Ca2+ sensitivity in late-activated regions to be associated with increased diastolic levels of Ca2+. In conclusion, we identified two distinct ionic mechanisms that underlie VER: 1) strain-independent changes in early-activated regions due to remodeling of sarcolemmal ion channels with no changes in Ca2+ handling and 2) a novel and unexpected mechanism for strain-induced VER in late-activated regions in the canine arising from remodeling of sarcomeric Ca2+ handling rather than sarcolemmal ion channels.

Early Improvement of Left Ventricular Dyssynchrony After Percutaneous Coronary Intervention in Patients with Single Chronic Total Occlusion Vessel

2020 ◽  
Author(s):  
Shaoping Wang ◽  
Shiying Li ◽  
Yijia Li ◽  
Yejing Zhao ◽  
Tong Liu ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Chronic Total Occlusion ◽  
Coronary Intervention ◽  
Left Ventricular ◽  
Doppler Imaging ◽  
Left Ventricular Dyssynchrony ◽  
Total Occlusion ◽  
Early Improvement ◽  
Ventricular Dyssynchrony ◽  
Percutaneous Coronary

Abstract Background The effect of percutaneous coronary intervention (PCI) of chronic total occlusion (CTO) on left ventricular dyssynchrony was unclear. Methods Patients with one CTO vessel were included. Tissue Doppler imaging was used to assess the left ventricular dyssynchrony index (DI) in twelve segments before and after successful CTO PCI. Multiple regression was used to identify independent correlates of DI reduction. Results 41 patients were included with the mean age of 65.88 years. 39(95.12%) had left ventricular DI more than 33. It decreased significantly from 67.48 ± 28.73 to 44.69 ± 23.90 (P < 0.01) after successful CTO PCI. PCI of infarct-relative CTO was associated with less percentage of DI reduction (Coefficient [Coef.], 25.60; 95% confidence interval [CI], 8.13–43.08; P < 0.01). Higher initial DI was associated with more percentage of DI reduction (Coef., -0.35; 95% CI, -0.67- -0.03; P = 0.03). Percentage of DI reduction was associated with ejection fraction (EF) improvement (Coef., -5.09; 95% CI, -7.45- -2.72; P < 0.01) with linear relationship (P < 0.01). Conclusion Left ventricular dyssynchrony was reduced early after successful CTO PCI, which predicted EF improvement. The association between dyssynchrony reduction and long-term benefits of CTO PCI are expected.

P1964Impact of successful coronary intervention for chronic total occlusion on long-term clinical outcome of patients with impaired and preserved left ventricular ejection fraction

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
H Tanaka ◽  
T Tada ◽  
Y Fuku ◽  
T Goto ◽  
K Kadota
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Chronic Total Occlusion ◽  
Coronary Intervention ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Total Occlusion ◽  
Ventricular Ejection Fraction ◽  
Percutaneous Coronary ◽  
Procedural Success

Abstract Background Successful recanalisation of percutaneous coronary intervention for chronic total occlusion lesions has been associated with improved survival. Purpose This study aimed to assess the impact of successful percutaneous coronary intervention for chronic total occlusion lesions on the long-term outcome of patients with impaired and preserved left ventricular ejection fraction (LVEF). Methods The study sample consisted of 842 consecutive patients (928 chronic total occlusion lesions) undergoing percutaneous coronary intervention at our institution between October 2005 and December 2009. We divided them into 3 groups by the degree of LVEF: less than 40% (severely reduced LVEF, n=140), 40% to 59% (moderately reduced LVEF, n=470), and 60% and above (normal LVEF, n=232). We evaluated mortality during the 10-year follow-up period the basis of procedural success and failure. Results The overall procedural success rate was 89.1%. Median follow-up duration was 7.9 years. The 10-year cumulative incidences of cardiac death in each degree of LVEF are shown in the Figure. Conclusions Successful recanalisation for chronic total occlusion lesions in patients with impaired LVEF may be associated with reduced cardiac mortality.

scholarly journals A case report of right ventricular compression from a septal haematoma during retrograde coronary intervention to a chronic total occlusion

2019 ◽  
Vol 3 (3) ◽  
Author(s):  
Darshan Doshi ◽  
Raja Hatem ◽  
Amirali Masoumi ◽  
Dimitri Karmapaliotis
Keyword(s):  
Right Ventricle ◽  
Right Ventricular ◽  
Chronic Total Occlusion ◽  
Coronary Intervention ◽  
Left Ventricular ◽  
Outflow Obstruction ◽  
Assist Device ◽  
Total Occlusion ◽  
Ventricular Outflow Obstruction ◽  
Ventricle Assist Device

Abstract Background Septal haematomas causing left ventricular or biventricular outflow obstruction are rare but known complications of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) and can be life-threatening. Case summary In this case, we describe the formation of a septal haematoma during retrograde CTO PCI. The patient was initially managed conservatively but became progressively unstable, for which she underwent coiling of the inflow and outflow of the septal perforator. Despite coiling, she developed near complete right ventricular outflow obstruction (based on echocardiography). She was successfully managed with a percutaneous right ventricle assist device, with subsequent resolution of the outflow obstruction. Discussion Septal haematomas with resultant outflow obstruction have been uniformly fatal. In our case, the use of a percutaneous right ventricle assist device was life-saving.

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