Early Recovery of Left Ventricular Function After Revascularization in Acute Coronary Syndrome

Abstract

The aim of this study was to assess the accuracy of echocardiographic techniques in detecting the early recovery of left ventricular (LV) function after revascularization in acute coronary syndrome (ACS). In 80 consecutive patients with ACS (age 55.7 ± 9.4 years, 77% male, 15% with CCS Angina III), an echocardiographic examination of left ventricle regional wall motion abnormalities (LV RWMA), peak systolic strain rate (PSSR), peak systolic strain (PSS) and end systolic strain (ESS) was performed before and after percutaneous intervention (PCI). Of the 80 patients, one vessel stenosis (>70%) was present in 53 (66%), two vessel disease in 12 (15%) and multivessel disease in 15 patients (19%). In total, 51% of patients had hypertension, 40% diabetes and 23% dyslipidemia. After PCI, regional PSS, ESS and PSSR of their segments subtended by the culprit vessel improved; left anterior descending-LAD, circumflex-LCx and right coronary-RCA (p<0.05 for all) as well as global S and SR (p < 0.05 for all). In univariate analysis, hypertension (HTN) (β = −0.294 (−0.313-0.047), p = 0.009, smoking β = −0.244 (−0.289-0.015) =0.03, WMA β = −0.317 (−0.284-0.014), p = 0.004 and the number of diseased vessels β = −0.256 (−0.188-0.054) p=0.03 were predictors of delta global SR. In multivariate analysis, only HTN β = 0.263 (0.005-3.159) and the number of diseased vessels β =0.263 (0.005 -3.159), p=0.04) predicted delta global SR. In ACS, the echocardiographic regional myocardial deformation is accurate in detecting early recovery of LV myocardial function after culprit lesion revascularization. Also, the findings of this study support the current practice regarding the crucial importance of proximal epicardial vessel PCI treatment on LV function compared to more distal lesions.

Strain Rate Changes during Stress Echocardiography Are the Most Accurate Predictors of Significant Coronary Artery Disease in Patients with Previously Treated Acute Coronary Syndrome

“…Data interpretation: Although the wall motion score index is currently used as the conventional echocardiographic parameter for diagnosing ischemic dysfunction [25] and for diagnosing significant coronary artery stenosis (>70%) according to guidelines [26], it proved less accurate in the subset of patients we studied compared to myocardial deformation measurements. All our patients had symptoms suggestive of ischemia, probably stable angina, but we used stress echocardiography on them in order to identify the most accurate echocardiographic parameter for predicting the culprit lesion and whether they are the same as we previously found in patients with acute coronary syndrome (STEMI and NSTEMI) [27,28]. This objective was also strengthened by the underlying ischemic myocardial disease our patients had, as manifested by a reduced resting LV EF.…”

Myocardial recovery after percutaneous coronary intervention in coronary artery disease patients with impaired systolic function- predictive utility of global longitudinal strain

“…This finding is dis concordant with other studies. 7 , 24 , 25 This might be explained by relative angle dependency and the frame-rate limitations of TDI, different ACS presentations selected in each study, and variable degrees of LV systolic impairment.…”