{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T14:08:19Z","timestamp":1788962899346,"version":"build-2803163510"},"reference-count":33,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T00:00:00Z","timestamp":1788912000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Cardiovasc. Dev. Dis.","JCDD"],"abstract":"<jats:p>Chronic total coronary occlusion (CTO) occurs within advanced coronary artery disease (CAD), but its association with left ventricular (LV) deformation and pressure\u2013strain-loop-derived myocardial work beyond global LV ejection fraction (LVEF) is uncertain. We performed a retrospective cross-sectional analysis of 148 unique patients with multivessel or left-main CAD, including 70 with and 78 without CTO. Absolute global longitudinal strain (GLS) was the principal endpoint; global work index (GWI), constructive work (GCW), wasted work (GWW), and work efficiency (GWE) were secondary endpoints. Sequential CTO coefficients were estimated using HC3 heteroscedasticity-consistent linear models in a pool of patients with complete global mechanics and LVEF data. A history of myocardial infarction was more frequent with CTO (42.9% vs. 23.1%), with lower LVEF and larger LV volumes. In crude distributional comparisons among 136 patients with global mechanics data, median GLS was 14.0% versus 15.5% (p = 0.021), while median GCW was 1723 versus 1997 mmHg% (p = 0.026). In the multivariable regression analysis, the CTO-minus-non-CTO GLS coefficient was \u22121.40 percentage points (95% CI, \u22122.80 to 0.00) unadjusted, \u22121.10 (95% CI, \u22122.58 to 0.38) after clinical adjustment, and \u22120.16 (95% CI, \u22121.24 to 0.92) after adding LVEF. CTO status marked a modest adverse global LV mechanical phenotype, but clinically adjusted estimates were imprecise and markedly attenuated after accounting for LVEF. Prospective studies integrating ischemia, scar, viability, and longitudinal follow-up are needed.<\/jats:p>","DOI":"10.3390\/jcdd13090449","type":"journal-article","created":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T12:26:11Z","timestamp":1788956771000},"page":"449","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Left Ventricular Mechanics in Multivessel Coronary Artery Disease with Versus Without Chronic Total Occlusion"],"prefix":"10.3390","volume":"13","author":[{"given":"Stela","family":"Madunic","sequence":"first","affiliation":[{"name":"School of Medicine, University of Split, 21000 Split, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tina","family":"Volarevic","sequence":"additional","affiliation":[{"name":"School of Medicine, University of Split, 21000 Split, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mihajlo","family":"Kovacic","sequence":"additional","affiliation":[{"name":"Department of Interventional Cardiology, County Hospital Cakovec, 40000 Cakovec, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonia","family":"Melada","sequence":"additional","affiliation":[{"name":"Division of Clinical Cardiology, Department of Cardiovascular Diseases, University Hospital of Split (KBC Split), 21000 Split, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dino","family":"Miric","sequence":"additional","affiliation":[{"name":"School of Medicine, University of Split, 21000 Split, Croatia"},{"name":"Division of Ischemic Heart Disease, Department of Cardiovascular Diseases, University Hospital of Split (KBC Split), 21000 Split, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4878-8146","authenticated-orcid":false,"given":"Josip Andelo","family":"Borovac","sequence":"additional","affiliation":[{"name":"School of Medicine, University of Split, 21000 Split, Croatia"},{"name":"Division of Ischemic Heart Disease, Department of Cardiovascular Diseases, University Hospital of Split (KBC Split), 21000 Split, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"991","DOI":"10.1016\/j.jacc.2011.12.007","article-title":"Current Perspectives on Coronary Chronic Total Occlusions","volume":"59","author":"Fefer","year":"2012","journal-title":"JACC"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"479","DOI":"10.1161\/CIRCULATIONAHA.120.046754","article-title":"Definitions and Clinical Trial Design Principles for Coronary Artery Chronic Total Occlusion Therapies: CTO-ARC Consensus Recommendations","volume":"143","author":"Ybarra","year":"2021","journal-title":"Circulation"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"e174","DOI":"10.4244\/EIJ-D-23-00749","article-title":"Evaluation and management of patients with coronary chronic total occlusions considered for revascularisation. 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