Regional contractility as predictor for left ventricular reverse remodeling after revascularization for chronic total occlusions - a 3D echocardiographic study

Introduction: The present study aims to identify 3D echocardiography-derived parameters to predict regression of LV remodeling in patients with chronic total occlusion (CTO) of Left Anterior Descending Artery (LAD), based on 3D assessment of regional and global contractility. Methods: In total, 38 subjects with succesful reopening of an LAD chronic total occlusion were enrolled. Regression of ventricular remodeling (RR) was defined as >15% reduction of LV end-diastolic diameter at 3 moths after reopening of the occluded LAD. Patient groups were: gr.1 - 22 pts with RR, gr.2 - 16 pts without RR. All patients underwent computerized 3D echocardiography with complex assesment of global and regional function and remodelling, based on classic parameters (EF, ventricular volumes) and on 3D regional index of contraction amplitude (RICA), defined as the sum of maximum contraction amplitude for those segments irrigated by the infarct-related artery divided by the number of these segments. Results: Group 1 presented lower baseline values for EF (46,60±6,09% vs 49,39%±3,46, p=0.008) and higher baseline values for EDV (49,39±3,46 ml versus 156,93±16,46 ml, p=0,2), ESV (87,09±8,41 ml vs 79,37±9,46 ml, p=0,01), and RICA (2,70 versus 2,05, p=0,01) compared with no RR group. Linear regression showed a statistically significant correlation between the index of regressive remodeling and the RICA (p=0.02) at 3 months post-revascularization. The logistical analysis based on ROC curve characteristics showed a good predictive value of RICA for prediction of regression of ventricular remodeling after revascularization, with a good area under the curve (AUC) of 0.72 (p=0.003). The cut-off point of 2.6 for the RICA had a sensitivity of 77%, and a specificity of 69% in predicting regression of ventricular remodeling after revascularization. Conclusions: This study demonstrates the correlation between changes in global and regional ventricular contractility and the regression of ventricular remodeling after revascularization of a chronic total LAD occlusion. A less severe impairment of regional contractility was associated with regression of the ventricle's remodeling process, while the regional index of contraction amplitude shows a good predictive value for prediction of left ventricular remodeling regression.