Effect of elective percutaneous coronary intervention of left anterior descending coronary artery on regional myocardial function using strain imaging

Gehan Magdy; M Sadaka; Tarek Elzawawy; Abdallah Elmaghraby

doi:10.1016/j.ehj.2017.12.003

December 24, 2017The Egyptian Heart JournalOpen Access

Effect of elective percutaneous coronary intervention of left anterior descending coronary artery on regional myocardial function using strain imaging

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Why the study?

Does elective PCI of the LAD improve regional myocardial function assessed by strain imaging in patients with stable CAD?

Key Points

To evaluate the recovery of regional left ventricular systolic function after elective percutaneous coronary intervention of the left anterior descending artery using strain and strain rate imaging.
Enrolled 30 patients with stable coronary artery disease (mean age 56.8 ± 6.6 years; 66.7% male) on optimal medical therapy undergoing elective LAD PCI and 15 healthy controls, all exhibiting preserved baseline LV wall motion and systolic function.
Conducted tissue Doppler imaging before, immediately after, and three months post-PCI to quantify peak systolic longitudinal strain (PSLS) and peak systolic strain rate (PSSR) across six LAD-supplied myocardial segments.
Average PSLS and PSSR in ischemic segments were significantly lower in patients compared to controls at baseline and improved significantly at three months post-PCI, but showed no significant change immediately post-procedure.
Receiver operating characteristic analysis identified a PSLS cutoff of -13.69% for detecting regional myocardial ischemia with 93.3% sensitivity and 80.0% specificity.

Structured PICO

Does elective PCI of the LAD improve regional myocardial function assessed by strain imaging in patients with stable CAD?

P

Population

30 patients with stable CAD on optimal medical therapy recommended for elective PCI to LAD, with normal LV wall motions and normal LV systolic function (mean age 56.8 ± 6.6 years, 66.7% male), and 15 healthy control subjects.

I

Intervention

Elective percutaneous coronary intervention (PCI) of the left anterior descending artery (LAD)

C

Comparator

Healthy control subjects (for baseline comparison) and pre-PCI baseline (for longitudinal comparison)

O

Outcome

Peak systolic longitudinal strain (PSLS) and peak systolic strain rate (PSSR) measured by Tissue Doppler imaging (TDI) at baseline, immediately post-PCI, and 3 months post-PCIsurrogate

TDI-derived strain and strain rate imaging can detect resting regional myocardial dysfunction in stable CAD with preserved LVEF and demonstrate functional improvement 3 months after elective PCI.