Chronic Total Coronary Occlusions: Stress Echocardiography with Speckle Tracking Analysis Study

Chronic total coronary occlusions (CTO) are found in approximately 15-30% of patients who undergo coronary angiography for suspected or known coronary artery disease. Speckle Tracking Echocardiography (STE) is a novel technology to assessing modifications of myocardial deformation with higher accuracy than the simple visual of regional wall motion. Purpose: The study was to evaluate, using STE applied to dobutamine stress echocardiography (DSE), changes in echo parameters before and after successful recanalization of a CTO. Methods: Eleven patients with subacute or chronic coronary syndromes and angiographic evidence of CTO, scheduled for reopening by percutaneous coronary angioplasty, underwent DSE, using standard protocol, before and 3 months after CTO recanalization. The acquisition of Echo images was performed at baseline and peak stress. Left ventricular ejection fraction (EF), volumes, wall motion score index, parameters of diastolic flow, tissue velocities at mitral annulus, global longitudinal strain (GLS), strain rate (SR), systolic and diastolic longitudinal functional reserve (SLR and DLR respectively) were obtained at baseline and at peak stress before and after percutaneous coronary angioplasty (PCI). Results: The mean follow-up after PCI was 3.09 ± 1 months. Statistical analysis showed significant improvement after PCI in EF, comparing to baseline (P < 0.03) and stress peak (P < 0.001) in systolic SR from the 4 chamber-view (P < 0.02), in DLR (P < 0.01), but there were no significant changes for SLR, GLS and SR. Conclusion: Stress echocardiography associated with new imaging techniques, such as STE provides further improvements of diagnostic accuracy in CTO patients.