31 Assessment of left ventricular function with cardiac MRI after percutaneous coronary intervention for chronic total occlusion
Bibliographic record
Abstract
Objective To assess the role of CMR in the treatment of true chronic total occlusions (CTO) with percutaneous coronary intervention (PCI) and drug eluting stent implantation. Introduction Successful PCI for CTO may confer an improved prognosis and a reduction in major adverse cardiac events (MACE). However most trials have included occlusions of short duration (less than 4 weeks). In this study we assessed the impact of PCI on LV function in patients with true CTOs (TIMI flow grade 0 and greater than 12 weeks duration) using serial CMR imaging as well as the predictive value of late gadolinium enhancement when performed prior to revascularisation. Methods Thirty patients referred for PCI to a single vessel CTO underwent CMR examination prior to and 6 months after PCI. Technical success was defined as recanalisation of the occluded vessel and DES implantation with a final residual diameter stenosis <30%. LV function and infarct size were assessed using a 1.5T GE MRI system. Segmental wall thickening (SWT) was measured within the perfusion territory of the CTO using the 16-segment model and segments were dysfunctional if the SWT was ≤45%. The transmural extent of infarction (TEI) was calculated by dividing the hyperenhanced area by the total area×100; a score of ≤25% were considered viable. Results Technical success was achieved in 19 of the 30 patients (63%). CTO duration was greater in patients with failed revascularisation but other baseline demographics were well matched between groups (Abstract 31 table 1). PCI-CTO success resulted in a significant increase in LVEF when compared to both baseline (50±13 vs 54±11; p<0.01) and with PCI-CTO failure (11.8±19.8 vs -2.3±5.1, p<0.01, Abstract 31 figure 1). In dysfunctional but viable segments only PCI success conferred a significant improvement in SWT compared to baseline (26±6 vs 40±10; p<0.001, Abstract 31 figure 2). There were no episodes of MACE in either group at 21 months follow-up. Abstract 31 Table 1 Total (n=30) CTO-PCI Success (n=19) CTO-PCI Failure (n=11) p value Age/ years 62.2±10.2 62.4±9.8 61.8±11.4 0.89 Male, n (%) 25 (83) 14 (74) 11 (100) 0.13 CCS Anginal Class 2.13±0.68 2.21±0.63 2.0±0.77 0.42 LVEF/ % 53.0±11.6 50.3±12.6 57.6±8.1 0.09 CTO duration, months 36.9±70.8 12.6±26.4 78.8±101.1 0.01 Vessel, n (%) RCA 16 (53) 9 (47) 7 (64) 0.35 LAD 11 (37) 7 (37) 4 (36) LCx 3 (10) 3 (16) 0 Prior MI, n (%) 17 (59) 11 (58) 6 (56) 0.61 Diabetes Mellitus, n (%) 7 (23) 5 (26) 2 (18) 0.61 Hypertension 23 (77) 14 (74) 9 (82) 0.61 Abstract 31 Figure 1 Abstract 31 Figure 2 Conclusion PCI-CTO success of true CTOs can improve global LV function. The TEI, assessed with CMR, can be used to help predict improvements in regional wall function. PCI-CTO failure was not associated with increased MACE at medium-term follow-up.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".