Short Term Effect of Percutaneous Recanalization of Chronic Total Occlusions on QT Dispersion and Heart Rate Variability Parameters (original) (raw)
Related papers
Coronary artery disease, 2014
Coronary collaterals may be insufficient for restoring blood flow to normal levels in patients with chronic total occlusions (CTO), leading to myocardial ischemia and electrical inhomogeneity in the ventricles. We evaluated the effect of percutaneous CTO revascularization on parameters of ventricular repolarization, including the T wave peak-to-end interval (TpTe) interval, the TpTe/QT ratio, and QT dispersion. A total of 114 patients who underwent CTO percutaneous coronary intervention (PCI) of any major coronary artery were divided into two groups: the successful CTO PCI group (n=90) and the failed CTO PCI group (n=24). Patients' 12-lead ECGs were analyzed within 24 h before revascularization and 24-48 h after the procedure for the following parameters: corrected QT interval (QTc) dispersion, TpTe interval (V2 and V5), and TpTe/QT ratio (V2 and V5). Subsequently, the successful CTO PCI group was divided into subgroups according to the Rentrop class, number of diseased vessels,...
2020
Background: The experiments show that pre-ejection velocity analysis is particularly sensitive to blood flow. After reduced regional perfusion, tissue velocities drop, but they rise with reperfusion. Thus, following revascularization, cardiac function recovery may be predicted using tissue doppler imaging (TDI). Objective: The aim of the current work was to determine the effectiveness of tissue Doppler imaging echocardiography in predicting the restoration of myocardial function in patients with coronary artery disease (CAD) following percutaneous coronary revascularization. Patients and Methods: Our study prospectively enrolled 27 patients. Only 24 patients completed the study protocol while, unfortunately, three died during follow up. Included patients were diagnosed with CAD based on previous diagnostic coronary angiography (CA) done before. They have impaired systolic function and regional wall motion abnormality (RWMA) on transthoracic echocardiography (TTE) and were eligible for percutaneous coronary intervention (PCI). Results: From all Tissue Doppler Imaging-Pulsed wave (TDI-PW) derived parameters, only mean IVCPv and mean S wave velocity of dysfunctional segments at baseline correlate significantly with changes in LVEF (global functional recovery) with revascularization. The mean of both IVCPv and the S wave of defective segments varied significantly at baseline among patients who showed significant improvement in LVEF 6 months after revascularization versus those patients who didn't exhibit significant improvement (2.8±0.4 vs. 3.5±0.8 for IVCPv, and 4.5±0.9 vs 5.8±1.1 for S wave, p value <0.05 and <0.01 respectively). There was significant moderate positive correlation between mean IVCPv and mean S wave velocity at baseline and changes in LVEF (global functional recovery) with revascularization (p value<0.05 and <0.01 respectively). Conclusions: It could be concluded that in patients with CAD, the resting IVCPv & S wave by TDI pattern accurately predicts the recovery of global systolic function with high pulse pressure variation (PPV) but not the regional function.
Catheterization and Cardiovascular Interventions, 2020
Objectives: The aim of the present analysis is to evaluate the clinical impact of chronic total occlusions (CTOs) recanalization in patients with left ventricular (LV) systolic dysfunction. Background According to contemporary knowledge, patient selection for percutaneous CTO revascularization is not yet standardized. In particular, data on outcomes in patients with LV systolic dysfunction undergoing percutaneous coronary intervention (PCI) for CTO are scarce. Methods: From a total of 2,421 consecutive patients with at least one CTO, 436 patients with ejection fraction (EF) ≤45%, who were referred for coronary angiography between January 1998 and September 2014, were selected. Patients with successful recanalization of the target CTO were assigned to CTO-revascularized group and those with failed or not attempted recanalization to the CTO-not revascularized (CTO-NR) group. Study endpoints were all-cause death, cardiac death, and occurrence of myocardial infarction on follow-up. Results: Out of 436 CTO patients with reduced EF, 228 (52.3%) were successfully recanalized and 208 patients (47.7%) were not, either due to CTO-PCI failure (n = 106, 24.3%) or because CTO-PCI was not attempted (n = 102, 23.4%). At longterm follow-up, CTO-NR patients had significantly higher rate of overall (p = .021) and cardiac mortality (p = .035) compared to those successfully revascularized. Conclusion: In patients with systolic LV dysfunction (EF ≤ 45%), CTO revascularization was associated with significant lower rate of total and cardiac mortality compared to those with nonrevascularized CTO.
The Heart Surgery Forum, 2008
Background: Arrhythmias attributable to altered autonomic modulation of the heart, with elevated sympathetic and depressed vagal modulation, occur to a similar extent after surgery performed on beating or arrested hearts. Coronary artery bypass grafting (CABG) with cardiopulmonary bypass has been associated with more frequent occurrence of arrhythmic events than surgery performed without CABG, even with comparable levels of postoperative cardiac autonomic (dis) regulation after arrested-and beating-heart revascularization. We explored the effects of arrested-and beating-heart revascularization procedures on the dynamics of ventricular repolarization and on increased postoperative arrhythmic events. Methods: Study participants included 57 CABG patients; 28 underwent on-pump and 29 underwent off-pump procedures. The 2 groups were comparable regarding clinical and postoperative characteristics. With high-quality 15-minute digital electrocardiograms, we assessed ventricular repolarization dynamics using RR and QT intervals and analyzed QT variability (QTV) and QT-RR interdependence. RR and QT intervals were determined from stationary 5-minute segments. QT-interval variability was determined by a T-wave template-matching algorithm. We used linear regression to compute the slope/correlation of the QT/RR interval. The Fisher exact test, nonpaired t-test, and ANOVA were applied to test the results; P < .05 was considered significant. Results: Postoperative arrhythmic events were significantly more frequent in both groups. One week postoperatively these events were significantly more frequent in the on-pump group. In both groups, the RR interval was shorter after CABG (P < .001). The QT variability index increased from-1.2 ± 0.6 to-0.8 ± 0.4 after off-pump CABG and from-1.3 ± 0.5 to-0.5 ± 0.6 on day 4 after surgery (P < .05), further deteriorating to-0.2 ± 0.6 one week after CABG in the on-pump group only (P < .05). QT-RR correlations decreased from 0.39 to 0.24 in the off-pump vs 0.34 to 0.17 in the on-pump group (P < .05), and in both groups they remained significantly reduced for as long as 4 weeks after CABG. Conclusions: For both on-and off-pump CABG, beat-to-beat heart-rate changes and rate-dependent ventricular repolarization adaptation showed disparities that worsened after surgery. The observed repolarization lability after CABG procedures seems to be transient but more pronounced after on-pump CABG. The association of arrhythmic events with ventricular repolarization lability changes in the setting of faster heart rates offers novel insights into the mechanisms of perioperative proarrhythmia after beating-and arrested-heart revascularization.
Effect of coronary angioplasty on QT dispersion
American Heart Journal, 1997
Increased QT dispersion (QTma x-QTmi n [QTd]) reflects inhomogeneous ventricular repolarization that may provide a substrate for serious arrhythmias and is associated with adverse clinical outcomes in patients with heart disease. Effective treatment of acute myocardial infarction or ventricular arrhythmias may reduce QTd, but the effect of coronary revascularization on QTd in patients without these conditions is unknown. In this study, QTd was measured before and 4 and 24 hours after successful angioplasty in 94 patients without ongoing symptomatic myocardial ischemia or malignant arrhythmias. QTd decreased from 434 + 17 msec before angioplasty to 354 _+ 15 msec 4 hours (p < 0.05) and 33 + 14 msec 24 hours after angioplasty (p < 0.05). QTd was improved in 64% of patients, worse in 28%, and unchanged in 8%. Thus angioplasty significantly improves QTd. This may reflect increased myocardial perfusion and may be inherently beneficial by reducing the propensity for arrhythmias. (
International Journal of Cardiology, 2004
Objective: We sought to define the influence of revascularisation and contractile reserve on left ventricular (LV) remodelling in patients with LV dysfunction after myocardial infarction. Revascularisation of viable myocardium is associated with improved regional function, but the effect on remodelling is undefined. Methods: We studied 70 patients with coronary artery disease and LV dysfunction, 31 of whom underwent revascularisation. A standard dobutamine stress echocardiogram (DbE) was carried out. All patients underwent standard medical treatment; the decision to revascularise was made clinically, independent of this study. LV volumes and ejection fraction were measured by 3D echocardiography at baseline and after an average of 40 weeks. Results: There was no significant difference in baseline ejection fraction or volumes between patients who underwent revascularisation and the remainder. Compared to medically treated patients, revascularised patients had significant improvements in ejection fraction and end-systolic volume in follow-up. The impact of baseline variables on remodelling was assessed by dividing patients into tertiles of LV ejection fraction and volumes. Revascularised patients in the lowest tertile of ejection fraction at baseline ( < 38%) had a significant improvement in end-systolic volume and ejection fraction, larger than obtained in medically treated patients with low ejection fraction. Revascularised patients with an ejection fraction > 38% did not show significant improvement in volumes compared to baseline. Revascularised patients in the largest tertiles of end-systolic (>88 ml) or end-diastolic volume (>149 ml) at baseline had a significant improvement in end-systolic volume. Conclusion: Remodeling appears to occur independent of the presence of regional contractile reserve but does correlate with the volume response to low-dose dobutamine. D
The effect of recanalization of a chronic total coronary occlusion on P-wave dispersion
Journal of Cardiovascular and Thoracic Research
Introduction: P-wave dispersion (PWD) obtained from the standard 12-lead electrocardiography (ECG) is considered to reflect the homogeneity of the atrial electrical activity. The aim of this investigation was to evaluate the effect of percutaneous chronic total occlusion (CTO) revascularization on the parameters of P wave duration and PWD on ECG in cases before and after procedure at 12th months. Methods: We analyzed 90 consecutive CTO cases who were on sinus rhythm and underwent percutaneous coronary intervention (PCI). P-wave maximum (P-max) and P-wave minimum (P-min), P-wave time, and PWD were determined before and twelve months after the CTO intervention. The study population was categorized into two groups as successful and unsuccessful CTO PCI groups. Results: The CTO PCI was successful in 71% of cases (n=64) and it was unsuccessful in 29% of cases (n=26). Both groups, except for age and hypertension, were similar in terms of demographic and clinical aspects. CRP levels were s...
Effect of coronary angioplasty on precordial QT dispersion
American Journal of Cardiology, 1997
Increased QT dispersion (QTma x -QTmi n [QTd]) reflects inhomogeneous ventricular repolarization that may provide a substrate for serious arrhythmias and is associated with adverse clinical outcomes in patients with heart disease. Effective treatment of acute myocardial infarction or ventricular arrhythmias may reduce QTd, but the effect of coronary revascularization on QTd in patients without these conditions is unknown. In this study, QTd was measured before and 4 and 24 hours after successful angioplasty in 94 patients without ongoing symptomatic myocardial ischemia or malignant arrhythmias. QTd decreased from 434 + 17 msec before angioplasty to 354 _+ 15 msec 4 hours (p < 0.05) and 33 + 14 msec 24 hours after angioplasty (p < 0.05). QTd was improved in 64% of patients, worse in 28%, and unchanged in 8%. Thus angioplasty significantly improves QTd. This may reflect increased myocardial perfusion and may be inherently beneficial by reducing the propensity for arrhythmias. (Am Heart J 1997; 134:3 99-405.)
JACC: Cardiovascular Imaging, 2009
We sought to determine: 1) whether F-18-fluorodeoxyglucose (FDG) positron emission tomography (PET) parameters identify high-risk patients who gain benefit from revascularization; 2) whether there is a cut point for such benefit; and 3) predictors of outcome in patients with severe left ventricular (LV) dysfunction due to coronary artery disease. B A C K G R O U N D Patients with ischemic LV dysfunction might benefit from revascularization but not without risk. The FDG PET imaging can detect viable myocardium that recovers after revascularization. In the PARR-2 (PET and Recovery Following Revascularization-2) trial, FDG PET imaging showed a nonsignificant trend for improved outcome compared with standard care. Understanding the predictors of outcome from this prospective trial should help better identify patients at risk and which patients most benefit from revascularization. M E T H O D S This post hoc analysis included 182 patients with left ventricular ejection fraction (LVEF) Ͻ35% and coronary artery disease, being considered for revascularization work-up, and randomized to the PET arm of PARR-2. The primary outcome was a composite of cardiac death, myocardial infarction, or cardiac repeat hospital stay at 1 year. R E S U L T S There is an interaction between PET mismatch and protocol revascularization such that higher mismatch, when combined with revascularization, yields fewer primary outcome events (p ϭ 0.02). On the basis of adjusted Cox modeling, with reduced mismatch (Ͻ7%), the risk is not significantly different with or without revascularization. As mismatch increases above this mark, risk is reduced with revascularization. Increasing creatinine (for a 10-mol/l increase: hazard ratio: 1.03, 95% confidence interval: 1.01 to 1.06, p ϭ 0.010) is also associated with increased risk, whereas decreasing LVEF (for a 2% decrease: hazard ratio: 1.08, 95% confidence interval: 0.99 to 1.18, p ϭ 0.087) trends toward an association with increased risk. C O N C L U S I O N S In this post hoc analysis, patients with ischemic cardiomyopathy with larger amounts of mismatch have improved outcome with revascularization. Renal function was also an independent predictor of outcome. The FDG PET seems to define high-risk patients that gain benefit from revascularization. (PET and Recovery Following Revascularization [PARR 2]; NCT00385242) (