The impact of percutaneous coronary intervention (PCI) on diastolic dysfunction in coronary artery disease

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Date
2014
Authors
Umar, Bello Tambuwal
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Publisher
Universiti Sains Malaysia
Abstract
Coronary artery disease is an important and major cardiovascular cause of morbidity and mortality worldwide. There has been much progress made in the management of coronary disease especially in revascularisation of the occluded coronary blood vessel. Abnormal diastolic function is increasingly recognised as a significant contributor to cardiac morbidity and mortality in the setting of ischemic heart disease; because of this, the role of percutaneous coronary intervention (PCI) as a therapy for coronary artery disease (CAD) should be evaluated in improving diastolic dysfunction. The objective of this study is to evaluate the impact of PCI on diastolic dysfunction in CAD patients by Doppler Echocardiographic parameters. Forty two patients with coronary artery disease who fulfilled the inclusion criteria were enrolled in this study. All the patients had PCI and all patients underwent Doppler Echocardiographic examination within 48 hours before PCI, within 48 hours after PCI and at three months of PCI for evaluation LV function. The mean age of the study patients was 59.3 + 8.1 years. Thirty six patients were male with 6 female patients. Almost all patients (40 patients) had mild to moderate degree of left ventricular diastolic dysfunction before PCI. All the study patients had severe coronary artery disease with more than 70% occlusion of the involved coronary artery. The E/A ratio before PCI (0.99+0.43) compared with post PCI within 48 hours (1.12+0.46) showed significant improvement but no progressive improvement at three months of PCI (1.10+0.31). Isovolumic relaxation time (IVRT) of 106.8+24.5 before PCI versus 89.0+23.8 at 48 hours versus 89.9+19.5 at 3 months after PCI also showed remarkable improvement. Improvement was also noted in deceleration time DT, 224.0+49.5 versus 211+45.6 versus 201+37.3. The E'/A' obtained from Tissue Doppler imaging also showed improvement noticeable within 48 hours 0.65+ 0.33 versus 1.06 + 0.52 versus 1.05+0.35. It was statistically significant (P=0.006) that diastolic dysfunction improved within 48 hours of PCI. There was no significantsustained/progressive improvement after 48 hours of PCI to three months of PCI (P=0.965). There was association found between the severity of coronary artery disease and severity of diastolic dysfunction. Left anterior descending artery (LAD) disease patients were found to have more heart failure as complication following MI. Improvement of diastolic dysfunction after PCI as demonstrated in this study showed that PCI is an effective mode of treatment for diastolic dysfunction in patients with significant coronary artery disease. This can significantly reduce morbidity and mortality in these patients.
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Keywords
Coronary artery disease,
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