Determinants of Left Ventricular Ejection Fraction Improvement After Successful Percutaneous Coronary Intervention for Chronic Total Occlusion: A Study Using Myocardial Perfusion Imaging

BACKGROUND: Few studies have investigated the factors associated with left ventricular ejection fraction (LVEF) improvement after successful chronic total occlusion percutaneous coronary intervention (CTO-PCI), as assessed by myocardial perfusion imaging (MPI). AIMS: This study aimed to identify patient and lesion characteristics, and MPI findings that associated with LVEF improvement following CTO-PCI. METHODS: Among 100 consecutive patients who underwent CTO-PCI at our hospital between April 2013 and March 2023, 87 with a patent vessel at 1-year follow-up were included. LVEF improvement (ΔEF) was calculated for each patient. Patients in the highest quartile of ΔEF were defined as the "high ΔEF group," and the remaining quartiles as the "low ΔEF group." Factors associated with LVEF improvement were evaluated using group comparisons and multivariate logistic regression analysis. RESULTS: Pre-PCI transient ischemic dilatation (TID) was most strongly associated with inclusion in the high ΔEF group (Odds ratio [OR] 6.37, p = 0.017). In addition, female sex, lower baseline LVEF, and lower post-PCI summed stress score (SSS) were significantly associated with greater LVEF improvement (male sex: OR 0.025, p = 0.002; baseline EF: OR 0.871, p = 0.001; post-PCI SSS; OR 0.824, p = 0.005). CONCLUSIONS: Positive pre-PCI TID was the strongest predictor of LVEF improvement. Female sex, lower baseline LVEF, and lower post-PCI SSS also contributed significantly to greater improvement in LVEF.