Revascularization of patients with chronic total occlusion and left ventricular systolic dysfunction

2026-03-22

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Giuseppe Vadalà

Kambis Mashayekhi

Cristina Madaudo

Michael Behnes

Giuseppe Panuccio

Alice Moroni

Davide Tomasello

Gianluca Campo

Emmanouil Brilakis

Alfredo Ruggero Galassi *

DOI：10.1016/j.pcad.2026.03.006

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• CTO occurs in 20–30% of patients with LVSD and is associated with a worse prognosis. • Randomized trials largely exclude patients with LVEF ≤35% and complex CAD/CTOs, limiting high-quality evidence for CTO-PCI in this population. • Viability testing (CMR-LGE, PET, dobutamine echocardiography) guides patient selection but does not reliably predict hard clinical benefit after CTO-PCI. • Prophylactic mechanical circulatory support (Impella, VA-ECMO) may improve hemodynamics during high-risk CTO-PCI in LVSD but increases bleeding and access complications and lacks definitive outcome data. • Dedicated RCTs (e.g., CTO-HF) and multidisciplinary, viability/ischemia-guided approaches at high-volume centers are needed to define the prognostic impact of CTO-PCI in LVSD.

Keywords:

chronic total occlusion

left ventricular systolic dysfunction

revascularization

viability testing

high-risk PCI

Revascularization of patients with chronic total occlusion and left ventricular systolic dysfunction

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