Global Longitudinal Strain Improves After Revascularization of Chronic Total Occlusion: A Systematic Review and Meta-Analysis

Background: The clinical benefit of percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) remains controversial, particularly regarding left ventricular (LV) functional recovery. Global longitudinal strain (GLS) has emerged as a more sensitive marker of myocardial function than left ventricular ejection fraction (LVEF). This study aimed to evaluate the effect of CTO revascularization on LV function using GLS. Methods: This systematic review and meta-analysis were conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020) guidelines. A comprehensive literature search was performed in the PubMed/MEDLINE database from inception through March 2026 using predefined search terms and Boolean operators. Reference lists of relevant articles were also screened to ensure completeness. Studies evaluating GLS before and after PCI for CTO and reporting quantitative strain data were included. Pooled effect estimates were calculated as mean differences (MDs) with 95% confidence intervals (CIs) using a random-effects model. Subgroup and sensitivity analyses were performed to explore heterogeneity and assess the robustness of the findings. Results: Six studies involving 376 patients were included. Successful CTO-PCI may be associated with an improvement in GLS (MD = 1.69; 95% CI: 1.09–2.29; p < 0.001), with substantial heterogeneity (I2 = 81%). Subgroup analysis demonstrated greater GLS improvement in studies with longer follow-up durations. Sensitivity analyses confirmed the robustness of the results. Conclusions: CTO revascularization may be associated with an improvement in LV myocardial function as assessed by GLS, even in the absence of marked changes in conventional parameters such as LVEF. These findings support the clinical utility of GLS as a sensitive imaging biomarker for detecting early myocardial recovery and for guiding risk stratification in patients undergoing CTO-PCI.