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Mehmood, Zia, Suresh, Preethi, Li, Rui, Assadi, Hosamadin, Kasmai, Bahman, Thampi, Kurian, Maart, Clint, Gilbert, Timothy, Eccleshall, Simon, Sawh, Chris, Nair, Sunil, van der Geest, Rob J., Vassiliou, Vassilios S. 
ORCID: https://orcid.org/0000-0002-4005-7752, Ryding, Alisdair, Matthews, Gareth ORCID: https://orcid.org/0000-0001-8353-4806 and Garg, Pankaj ORCID: https://orcid.org/0000-0002-5483-169X
(2026)
Myocardial Viability and Ischaemia in Chronic Total Occlusion.
Medicina (Lithuania), 62 (3).
ISSN 1010-660X
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Abstract
Background and Objectives: Chronic total occlusion (CTO) affects 30% of patients undergoing coronary angiography rendering poorer outcomes. While percutaneous coronary intervention (PCI) can be technically successful, RCTs show no survival benefit. Cardiovascular Magnetic Resonance (CMR) provides comprehensive myocardial phenotyping, offering prognostic insights in this high-risk cohort. Materials and Methods: Fifty-six patients with angiographically confirmed CTO underwent stress perfusion CMR with late gadolinium enhancement. Myocardial function, ischaemia and scar burden were quantified and compared across CTO territory and viability subgroups. Results: In patients with CTO, 27% of patients (15/56) had no viability. In patients with viable myocardium, 66% (27/41) demonstrated reversible ischaemia. Viable myocardium was associated with significantly higher LV stroke volumes (93.6 ± 20.1 mL vs. 80.9 ± 18.4 mL, p = 0.039), along with lower LV scar mass (18.7 ± 13.5g vs. 32.3 ± 12.8g; p = 0.002) and scar percentage (14.9 ± 8.3% vs. 25.9 ± 7.5%; p = 0.001). Viable myocardium showed more ischaemia both globally (11.6 ± 14.3g vs. 0.2 ± 9.3g; p = 0.005) and within the CTO territory (10.3 ± 10.3% vs. 2.3 ± 2.7%; p = 0.01). Non-viable myocardium was associated with significantly higher CTO-territory scar mass (9.4 ± 6.5 g vs. 5.1 ± 6.9 g; p = 0.046) and scar percentage (21.8 ± 13.3% vs. 11.7 ± 12.8%; p = 0.01), indicating extensive fibrosis. A scar burden threshold of 11.18% in CTO territory predicted non-viability with 80% sensitivity and 65.85% specificity (AUC = 0.701 [95% CI 0.54–0.87], p = 0.019). Conclusions: Among CTO patients, 27% harbour no viability, while patients with viable myocardium typically exhibit reversible ischaemia—representing a phenotype with preserved viability and inducible ischaemia. These findings support the use of multiparametric CMR to phenotype CTO territories prior to considering CTO-PCI.
| Item Type: | Article |
|---|---|
| Additional Information: | Publisher Copyright: © 2026 by the authors. |
| Uncontrolled Keywords: | cardiac magnetic resonance imaging,chronic total occlusion,late gadolinium enhancement,myocardial ischaemia,myocardial viability,general medicine ,/dk/atira/pure/subjectarea/asjc/2700/2700 |
| Faculty \ School: | Faculty of Medicine and Health Sciences > Norwich Medical School |
| UEA Research Groups: | Faculty of Medicine and Health Sciences > Research Centres > Metabolic Health Faculty of Science > Research Groups > Norwich Epidemiology Centre Faculty of Medicine and Health Sciences > Research Groups > Norwich Epidemiology Centre Faculty of Medicine and Health Sciences > Research Groups > Cardiovascular and Metabolic Health |
| Related URLs: | |
| Depositing User: | LivePure Connector |
| Date Deposited: | 08 Jul 2026 14:17 |
| Last Modified: | 08 Jul 2026 23:52 |
| URI: | https://ueaeprints.uea.ac.uk/id/eprint/103789 |
| DOI: | 10.3390/medicina62030540 |
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