Benefits of CTO-PCI in Selected Cases With HFrEF (CTOHFrEF)

Inclusion Criteria: * At least one chronic total coronary occlusion * LVEF ≤40% by CMR * Evidence of myocardial viability and/or ischemia in at least two contiguous segments subtended by the occluded vessel. Exclusion Criteria: * Women of childbearing age or pregnant * Claustrophobia * Admission to hospital within the previous 90 days due to decompensated heart failure, myocardial infarction or unstable angina. * Severe valvulopathy * Pacemaker or implantable cardioverter defibrillator * Indication for coronary artery bypass surgery * Heart transplantation waiting list * Follow-up not feasible * Life expectancy shorter than 12 months. * Iodine contrast or gadolinium allergy * Aspirin or clopidogrel allergy * Asthma * NYHA IV class * Liver cirrosis * Noncompliance with medical treatment * Chronic kidney disease with serum creatinine levels ≥ 2.5 mg/dl or glomerular filtration rate ≤30 ml/min/1.73m2 * Evidence of active bleeding * High risk of bleeding * CTO distal vessel not visible through collateral circulation * CTO distal vessel diameter \<2mm * Absence of acceptable vascular access