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

Giuseppe Vadalà

doi:10.1016/j.pcad.2026.03.006

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

2026-03-22

0

PRE

AI

G

Giuseppe Vadalà

K

Kambis Mashayekhi

C

Cristina Madaudo

M

Michael Behnes

G

Giuseppe Panuccio

A

Alice Moroni

D

Davide Tomasello

G

Gianluca Campo

E

Emmanouil Brilakis

A

Alfredo Ruggero Galassi *

DOI：10.1016/j.pcad.2026.03.006

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Abstract

En 中文

• 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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