Objectives: Coronary chronic total occlusion (CTO) is encountered in about 15-25% of patients with coronary artery disease undergoing coronary angiography. In recent years, the number of CTO PCIs has increased due to improved success rates with new techniques and materials. The safety of the procedure could be ameliorated and the complication rate is decreasing. Nevertheless, nowadays it remains unclear which benefit patient clinically gain from a successful CTO PCI. In particular, reduction of mortality and improvement of right or left ventricular cardiac function are ongoing questions, because the impact of a successful CTO PCI on cardiac function of the right and left heart is incompletely understood. In our study, we aimed to evaluate right and left ventricular function after successful RCA CTO PCI using transthoracic echocardiography with additional strain assessment.

Methods & Results: At the University Medical Center in Mainz 92 patients were included in the study. We evaluated demographic, clinical, angiographic, and periprocedural information. Right and left ventricular function were assessed by two-dimensional speckle-tracking echocardiography before and 6 months after successful RCA CTO PCI. The median age of the total collective was 65,5 (40-84) years.  

Mean right ventricular free wall longitudinal strain (RVFWSL) was -19.91± 5.81 at index procedure and -22.63± 5.26 (p< 0.001) and mean  right ventricular global longitudinal strain (RVGLS) was -15.52± 4.45 pre CTO-PCI and -17.64± 3.99 at 6 month follow-up (p< 0.001). Compared to the right heart function, we found no improvement in left heart function after successful CTO PCI. Mean global longitudinal strain (GLS) before CTO PCI was -16 (-7- (-23)) und after 6 months -15.9 (-5- (-26) (p 0.176).

Conclusion: Successful CTO PCI of the RCA improves RV function assed by echocardiography and additional RV GLS strain analysis, nevertheless we did not find an improvement of left ventricular function and changes in LV GLS.