Assessment of left ventricular systolic function in patients with chronic coronary syndrome and heart failure with reduced ejection fraction after percutaneous coronary intervention
DOI:
https://doi.org/10.58354/jvc.107E.2023.705Từ khóa:
Heart failure with reduced ejection fraction (HFrEF), Global longitudinal strain (GLS), Chronic coronary syndrome (CCS), Percutaneous coronary intervention (PCI)Tóm tắt
Objective: Describe the characteristic and change of left ventricular systolic function after percutaneous coronary intervention in patients with chronic coronary syndrome and heart failure with reduced ejection fraction after percutaneous coronary intervention.
Methods: This prospective study involved the monitoring of 40 patients who had an ejection fraction of 40% or less and were diagnosed with chronic coronary artery disease. These patients underwent a successful percutaneous coronary intervention at the Vietnam National Heart Institute and Hanoi Medical University Hospital between September 2022 and August 2023. The main objective is to evaluate the left ventricular systolic function following the intervention using 2D echocardiography.
Results: A total of 40 patients (34 male and 6 females) with a mean age of 68.3 ± 10.2, were assessed for left ventricular systolic function using 2D echocardiography before and after the intervention. In paired assessment at 90-day follow-up, baseline LVEF improved significantly (before intervention: 32.8 ± 7.2% and after: 38,7 ± 7,3%, p < 0.01). Left ventricular longitudinal strain improved significantly on all cross-sections such as: 4-chamber GLS (before: -10.4 ± 3.97%, after: -13.6 ± 4.3%, p < 0.01), 2-chamber GLS (before: -10.6 ± 3.8%, after: -13.1 ± 4.2%, p < 0.01), 3-chamber GLS (before: -9.8 ± 3.7%, after: -12.3 ± 4.6%, p < 0.01), GLS Avg (before: -10.3 ± 3.6%, after: -13 ± 4.1%, p< 0.01), basal GLS (before: -11.2 ± 3.8%, after: -14 ± 4.5%, p < 0.01), middle GLS (before: -9.3 ± 4.4%, after: -11.8 ± 3.9%, p < 0.01), apical GLS (before: -11.5 ± 5.1%, after: -14.3 ± 5.9%, p < 0.01). In comparison with the incomplete-revascularization group, there was a significant improvement in left ventricular systolic function in the complete-revascularization group (OR= 22.17, p < 0.01).
Conclusions: In patients with chronic coronary syndrome and a reduced left ventricular ejection fraction, the systolic function of the left ventricle was enhanced following percutaneous coronary intervention, particularly in the group that underwent complete revascularization.
Tài liệu tham khảo
Vedin O, Lam CSP, Koh AS, et al. Significance of Ischemic Heart Disease in Patients With Heart Failure and Preserved, Midrange, and Reduced Ejection Fraction: A Nationwide Cohort Study. Circ: Heart Failure. 2017;10(6):e003875. doi: 10.1161/CIRCHEARTFAILURE.117.003875
Perera D, Clayton T, O’Kane PD, et al. Percutaneous Revascularization for Ischemic Left Ventricular Dysfunction. N Engl J Med. 2022;387(15):1351-1360. doi: 10.1056/NEJMoa2206606
Velazquez EJ, Lee KL, Jones RH, et al. Coronary-Artery Bypass Surgery in Patients with Ischemic Cardiomyopathy. N Engl J Med. 2016;374(16):1511-1520. doi: 10.1056/NEJMoa1602001
DeVore AD, Yow E, Krucoff MW, et al. Percutaneous coronary intervention outcomes in patients with stable coronary disease and left ventricular systolic dysfunction. ESC Heart Failure. 2019;6(6):1233-1242. doi: 10.1002/ehf2.12510
Wolff G, Dimitroulis D, Andreotti F, et al. Survival Benefits of Invasive Versus Conservative Strategies in Heart Failure in Patients With Reduced Ejection Fraction and Coronary Artery Disease: A Meta-Analysis. Circ: Heart Failure. 2017;10(1):e003255. doi: 10.1161/CIRCHEARTFAILURE.116.003255
Pathak S, Lai FY, Miksza J, et al. Surgical or percutaneous coronary revascularization for heart failure: an in silico model using routinely collected health data to emulate a clinical trial. European Heart Journal. 2023;44(5):351-364. doi: 10.1093/eurheartj/ehac670
Velazquez EJ, Lee KL, Deja MA, et al. Coronary-Artery Bypass Surgery in Patients with Left Ventricular Dysfunction. N Engl J Med. 2011;364(17):1607-1616. doi: 10.1056/NEJMoa1100356
Smiseth OA, Torp H, Opdahl A, et al. Myocardial strain imaging: how useful is it in clinical decision making? Eur Heart J. 2016;37(15):1196-1207. doi: 10.1093/eurheartj/ehv529
Blessberger H, Binder T. Two dimensional speckle tracking echocardiography: clinical applications. Heart. 2010;96(24):2032-2040. doi: 10.1136/hrt.2010.199885
Lobo AS, Cantu SM, Sharkey SW, et al. Revascularization in Patients With Spontaneous Coronary Artery Dissection and ST-Segment Elevation Myocardial Infarction. Journal of the American College of Cardiology. 2019;74(10):1290-1300. doi: 10.1016/j.jacc.2019.06.065
Bangalore S, Guo Y, Samadashvili Z, et al. Outcomes With Complete Versus Incomplete Revascularization in Patients With Multivessel Coronary Disease Undergoing Percutaneous Coronary Intervention With Everolimus Eluting Stents. The American Journal of Cardiology. 2020;125(3):362-369. doi: 10.1016/j.amjcard.2019.10.022
Kramer DG, Trikalinos TA, Kent DM, et al. Quantitative Evaluation of Drug or Device Effects on Ventricular Remodeling as Predictors of Therapeutic Effects on Mortality in Patients With Heart Failure and Reduced Ejection Fraction. Journal of the American College of Cardiology. 2010;56(5):392-406. doi: 10.1016/j.jacc.2010.05.011
Adachi Y, Sakakura K, Wada H, et al. Determinants of Left Ventricular Systolic Function Improvement Following Coronary Artery Revascularization in Heart Failure Patients With Reduced Ejection Fraction (HFrEF). Int Heart J. 2016;57(5):565-572. doi: 10.1536/ihj.16-087
Russo JJ, Prasad M, Doshi D, et al. Improvement in left ventricular function following higher‐risk percutaneous coronary intervention in patients with ischemic cardiomyopathy. Cathet Cardio Intervent. 2020;96(4):764-770. doi: 10.1002/ccd.28557
