Evaluation of the impact of percutaneous coronary intervention of chronic total occlusion on regional myocardial function using strain echocardiography (original) (raw)
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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.
University Heart Journal, 2015
The basis of pathophysiologic benefit of revascularization is improving the function of viable myocardium 37. Early coronary re-canalization helps to survive the viable myocardium and improve global LV function and survival 46. According to the studies in patients with CAD and LV dysfunction, the disease outcome can be improved with surgical revascularization (CABG) or PCI 37. PCI in patients with preserved LV function and optimal medical therapy doesn't reduce the cardiac death and MI, but it decreases the need for other procedure and the risk of angina. Its effect on LV systolic or diastolic function is not clear 31. PCI has been used increasingly for revascularization in ischemic heart disease (IHD) patients. In most of the studies, the primary PCI, criterion such as ejection fraction (EF), diastolic function and the wall motion or chamber sizes has been investigated. But result of previous studies in related area, about elective PCI, has shown unequal viewpoints 1,6,13,27,30,32,39,41. Intervals between MI and PCI, basic left ventricular ejection fraction (LVEF) before PCI and global condition of the patients affect the result of PCI. Angina occurs when there is regional myocardial ischemia caused by inadequate coronary perfusion and is usually but not always induced by
European Radiology
Objectives Global left ventricular (LV) function is routinely used to assess cardiac function; however, myocardial strain is able to identify more subtle dysfunction. We aimed to determine the recovery and prognostic value of featuring tracking (FT) cardiovascular magnetic resonance (CMR) strain in ST-segment elevation myocardial infarction (STEMI) patients with a concurrent chronic total occlusion (CTO). Methods In the randomized EXPLORE trial, there was no significant difference in global LV function after percutaneous coronary intervention (PCI) of the CTO, compared with no-CTO PCI, post-STEMI. In the current study, we included 200 of the 302 EXPLORE patients with a baseline CMR, of which 180 also had 4-month follow-up (serial) CMR. Global longitudinal strain (GLS) was calculated from 3 long-axis views. Global circumferential strain (GCS) and segmental strain were calculated from 3 short-axis views (basal, mid, and apical). Results Global strain significantly improved at 4 months (GLS Δ − 1.8 ± 4.3%, p < 0.001; GCS Δ − 1.7 ± 4.7%, p < 0.001); however, there was no treatment effect of CTO-PCI on strain recovery. GLS was a significant predictor for 4 months of LVejection fraction (p = 0.006), incremental to other CMR parameters including infarct size. For mortality, infarct size remained the strongest predictor. On regional level, segmental strain independently predicted recovery in the dysfunctional segments (p < 0.001). Conclusions Global and segmental myocardial strains significantly improved over time, with no effect of CTO-PCI. Global strain was associated with outcome and segmental strain was an independent predictor for regional LV recovery in the dysfunctional CTO territory. Further research is needed to determine the additional prognostic value of strain beyond routine CMR parameters. Key Points • In STEMI patients with a concurrent CTO, strain significantly improves over time, regardless of CTO-PCI. • Global strain is an independent predictor for functional recovery, incremental to infarct size, LVEF, and clinical parameters. • Segmental strain was able to predict the recovery of wall thickening, incremental to transmural extent of infarction.
World Journal of Cardiovascular Diseases, 2014
Introduction: Coronary artery disease (CAD) is the most common cause for left ventricular dysfunction. Unfortunately, the treatment strategies of regional myocardial diastolic dysfunction in patients with CAD have not been well characterized and benefit of percutaneous coronary intervention (PCI) as a treatment strategy is not clear. So the present study aimed to assess the effects of PCI on regional and global left ventricular diastolic dysfunction in patients with CAD assessed by strain rate (SR) imaging. Methods: Thirty adult symptomatic patients with coronary artery disease that underwent coronary angiography and candidate for PCI on left anterior descending artery were enrolled to our study. Echocardiographic findings and early diastolic SR were measured before and 48 hours after PCI. Results: Mean age of the patients was 59.9 ± 8.3 years. Most of the left ventricular diastolic parameters showed significant difference before and after elective PCI; while mitral E velocity, DT, E/A and pulmonary vein flow before and after PCI did not show significant difference assessed by statically test. Also before PCI, mean (SD) of peak early diastolic SR in ischemic regions (1.89 ± 0.22) was smaller than of non-ischemic regions (2.53 ± 0.26) while after PCI this parameter became similar in ischemic regions (2.55 ± 0.27) and non-ischemic regions (2.55 ± 0.26). Conclusion: Most of the left ventricular diastolic parameters improved after PCI in CAD patients. Also regional myocardial relaxation as measured by peak early diastolic SR (ESR) in the ischemic segments improved significantly compared with that in non-ischemic segments.
Clinics, 2013
OBJECTIVE: Successful revascularization of chronic total occlusions has been associated with improved left ventricular systolic function, reduced anginal symptoms, increased exercise capacity, and increased survival. This study was conducted to determine the impact of revascularization in chronic total occlusion on left ventricular function using novel echocardiographic techniques. METHODS: A total of 129 patients with chronic total occlusion who underwent revascularization between April 2011 and November 2012 were included in this study. Echocardiographic assessments with two-dimensional speckle tracking echocardiography and real-time three-dimensional echocardiography were performed before the procedure and one month after the procedure. The left ventricular ejection fraction, left ventricular volumes, and three-dimensional systolic dyssynchrony index were quantified. RESULTS: An immediate procedural success was obtained in 118 patients (91.5%). There were no acute or subacute stent thromboses during follow-up. The mean left ventricular ejection fraction significantly increased (p,0.001), while the left ventricular end-diastolic and end-systolic volumes significantly decreased (p = 0.001 and p,0.001, respectively). The three-dimensional systolic dyssynchrony index also decreased significantly (p,0.001). The global longitudinal strain showed a significant increase after successful revascularization (p,0.001). An increase in the global longitudinal strain was correlated with an increase in the left ventricular ejection fraction (r = 0.27, p = 0.02). The patients with a left ventricular ejection fraction $50% displayed a greater improvement in the global longitudinal strain, and the patients with diabetes showed less improvement. CONCLUSIONS: Using novel echocardiographic techniques, our results showed that restoring the coronary blood flow in chronic total occlusion patients reduces the left ventricular volumes and improves the left ventricular ejection fraction and the global longitudinal strain of hibernating myocardium.
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.
Biomedical Research-tokyo, 2017
Background: Recovering blood flow to a coronary stenosis may improve left ventricular (LV) function in patients with coronary artery disease (CAD). However, the reported data about evaluation of LV function post-percutaneous coronary intervention (PCI) in CAD was limited. Purpose of this study was to compare the LV function measured by ejection fraction (EF) and global longitudinal strain in patients with CAD underwent PCI, and to identify factors affecting the change of LV function. Methods: Patients with CAD who underwent elective PCI were enrolled. Echocardiographic measurements of LV function by EF as well as by 2D speckle tracking to assess global longitudinal strain were performed in all patients within 24 hours pre- and post-PCI procedure. The LV global longitudinal peak strain average (GLPS-Avg) was calculated from 18 segments measurement. Results: A total of 40 patients (55.9 ± 7.5 y.o.) were enrolled. Means of GLPS-Avg pre- and post-PCI were -12.41 ± 4.82% and -13.41 ± 4.9...
World Journal of Cardiovascular Diseases, 2020
Background: This study aimed to determine the impact of the percutaneous coronary intervention (PCI) on myocardial function assessed by tissue Doppler echocardiography. Methods: Conventional two-dimensional echocardiography and Myocardial tissue peak velocities were recorded at the lateral, ant.septal, post.septal, posterior, ant. and inferior angles of the mitral annulus as well as at the lateral tricuspid annulus by pulsed-wave tissue Doppler echocardiography before PCI, as well as 1 day and 6 weeks after intervention. Results: Fifty consecutive patients with chronic stable angina and preserved systolic left ventricular function (mean age, 58.3 ± 6.594 years; 32 men) undergoing PCI were studied. Conventional echocardiographic revealed no statistically significant difference between pre-and post-PCI (1 day after PCI and 6 weeks after PCI) as regarding trans-mitral and trans-tricuspid flow velocities except as regarding LVEDD, LVESD and LVEF which showed a significant improvement post-PCI. Compared with pre-interventional values, systolic peak velocity and early diastolic velocities improved at all sites (P ≤ 0.05 for each). The most pronounced improvement occurred in the septal area. Similarly, late diastolic velocities improved at all sites
2019
Objectives: this study aimed to assess the effects of percutaneous coronary intervention (PCI) on regional and global left ventricular (LV) functions (systolic and diastolic) in patients with coronary artery disease (CAD) using tissue Doppler strain rate (SR) imaging. Patients and Methods: in this study, we randomly assigned 100 Egyptian adult symptomatic patients with CAD that underwent coronary angiography and candidate for PCI on the left anterior descending artery. LV early diastolic and systolic SR were measured 24 h before and 48 h after PCI. Results: Most of the LV diastolic and systolic parameters (A, E', E/A, E/E', and isovolumic relaxation time [IVRT]) showed significant difference before and after elective PCI, while mitral E velocity, DT, and pulmonary vein flow before and after PCI did not show significant difference. SR imaging findings showed high significant difference mean peak systolic and mean early diastolic SR of ischemic regions after PCI; mean early di...