open access

Ahead of print
Original Article
Published online: 2019-06-27
Get Citation

Improvement of left ventricular function after percutaneous coronary intervention in patients with stable coronary artery disease and preserved ejection fraction: Impact of diabetes mellitus

Malgorzata Sikora-Frac, Beata Zaborska, Pawel Maciejewski, Andrzej Budaj, Bronislaw Bednarz
DOI: 10.5603/CJ.a2019.0066
·
Pubmed: 31257568

open access

Ahead of print
Original articles
Published online: 2019-06-27

Abstract

Background: Many patients with stable coronary artery disease (CAD) have no visual segmental wall motion abnormalities and a left ventricular (LV) ejection fraction (LVEF) ≥ 50% at rest despite significant coronary artery stenosis. Here, the aim was to determine the impact of percutaneous coronary intervention (PCI) on LV function assessed by enhanced echocardiography in patients with stable CAD with or without diabetes mellitus type 2 and a preserved LVEF.

Methods: Sixty-six consecutive patients with CAD and LVEF ≥ 50%, admitted to the hospital for planned coronary angiography, were prospectively assessed. PCI was performed for coronary artery stenosis > 70%. CAD extent was assessed using SYNTAX and EXTENT scores. To assess LV function, LVEF, global longitudinal strain (GLS), and LV peak systolic myocardial velocity (S’) were measured and Tei index was calculated before and 3 months after PCI.

Results: Before PCI, LVEF, GLS, and Tei index were significantly worse in diabetic patients. LV functional indices improved significantly after PCI in all patients (p < 0.001). Multivariate linear regression analyses were performed to evaluate the impact of selected factors on LV function after PCI expressed as changes (Δ) of LVEF, GLS, S’, and Tei index. LV function improvement expressed as ΔGLS was associated only with SYNTAX score. Higher SYNTAX scores were related to greater GLS improvement (β = 0.003, 95% confidence interval: 0.0004–0.005; p = 0.02).

Conclusions: Percutaneous coronary intervention significantly improved LV function in diabetic and non-diabetic CAD patients with preserved LVEF. Enhanced echocardiography allowed an assessment of subtle changes in LV function.

Abstract

Background: Many patients with stable coronary artery disease (CAD) have no visual segmental wall motion abnormalities and a left ventricular (LV) ejection fraction (LVEF) ≥ 50% at rest despite significant coronary artery stenosis. Here, the aim was to determine the impact of percutaneous coronary intervention (PCI) on LV function assessed by enhanced echocardiography in patients with stable CAD with or without diabetes mellitus type 2 and a preserved LVEF.

Methods: Sixty-six consecutive patients with CAD and LVEF ≥ 50%, admitted to the hospital for planned coronary angiography, were prospectively assessed. PCI was performed for coronary artery stenosis > 70%. CAD extent was assessed using SYNTAX and EXTENT scores. To assess LV function, LVEF, global longitudinal strain (GLS), and LV peak systolic myocardial velocity (S’) were measured and Tei index was calculated before and 3 months after PCI.

Results: Before PCI, LVEF, GLS, and Tei index were significantly worse in diabetic patients. LV functional indices improved significantly after PCI in all patients (p < 0.001). Multivariate linear regression analyses were performed to evaluate the impact of selected factors on LV function after PCI expressed as changes (Δ) of LVEF, GLS, S’, and Tei index. LV function improvement expressed as ΔGLS was associated only with SYNTAX score. Higher SYNTAX scores were related to greater GLS improvement (β = 0.003, 95% confidence interval: 0.0004–0.005; p = 0.02).

Conclusions: Percutaneous coronary intervention significantly improved LV function in diabetic and non-diabetic CAD patients with preserved LVEF. Enhanced echocardiography allowed an assessment of subtle changes in LV function.

Get Citation

Keywords

coronary artery disease, left ventricular function, percutaneous coronary intervention, echocardiography, diabetes mellitus

About this article
Title

Improvement of left ventricular function after percutaneous coronary intervention in patients with stable coronary artery disease and preserved ejection fraction: Impact of diabetes mellitus

Journal

Cardiology Journal

Issue

Ahead of print

Article type

Original Article

Published online

2019-06-27

DOI

10.5603/CJ.a2019.0066

Pubmed

31257568

Keywords

coronary artery disease
left ventricular function
percutaneous coronary intervention
echocardiography
diabetes mellitus

Authors

Malgorzata Sikora-Frac
Beata Zaborska
Pawel Maciejewski
Andrzej Budaj
Bronislaw Bednarz

References (30)
  1. Gheorghiade M, Sopko G, De Luca L, et al. Navigating the crossroads of coronary artery disease and heart failure. Circulation. 2006; 114(11): 1202–1213.
  2. Montalescot G, Sechtem U, Achenbach S, et al. 2013 ESC guidelines on the management of stable coronary artery disease: the Task Force on the management of stable coronary artery disease of the European Society of Cardiology. Eur Heart J. 2013; 34(38): 2949–3003.
  3. Windecker S, Stortecky S, Stefanini GG, et al. Revascularisation versus medical treatment in patients with stable coronary artery disease: network meta-analysis. BMJ. 2014; 348: g3859.
  4. Li X, Kong M, Jiang D, et al. Comparing coronary artery bypass grafting with drug-eluting stenting in patients with diabetes mellitus and multivessel coronary artery disease: a meta-analysis. Interact Cardiovasc Thorac Surg. 2014; 18(3): 347–354.
  5. Dai X, Luo ZC, Zhai Lu, et al. Reassessing Coronary Artery Bypass Surgery Versus Percutaneous Coronary Intervention in Patients with Type 2 Diabetes Mellitus: A Brief Updated Analytical Report (2015-2017). Diabetes Ther. 2018; 9(5): 2163–2171.
  6. Strotmann JM, Richter A, Kukulski T, et al. Doppler myocardial imaging in the assessment of regional myocardial function in longitudinal direction pre- and post-PTCA. Eur J Echocardiogr. 2001; 2(3): 178–186.
  7. Labovitz AJ, Lewen M, Kern MJ, et al. The effects of successful PTCA on left ventricular function: assessment by exercise echocardiography. Am Heart J. 1989; 117(5): 1003–1008.
  8. Diller GP, Wasan BS, Thom SA, et al. Evidence of improved regional myocardial function in patients with chronic stable angina and apparent normal ventricular function--a tissue Doppler study before and after percutaneous coronary intervention. J Am Soc Echocardiogr. 2009; 22(2): 177–182.
  9. Gasior Z, Drzewiecki J, Wita K, et al. [Left ventricular systolic function after PTCA--recent and late assessment by exercise echocardiography]. Pol Arch Med Wewn. 1994; 92(4): 307–312.
  10. Smith SC, Feldman TE, Hirshfeld JW, et al. ACC/AHA/SCAI 2005 guideline update for percutaneous coronary intervention. A report of the American College of Cardiology/American Heart Association Task Force on practice guidelines (ACC/AHA/SCAI Writing Committee to Update the 2001 Guidelines for Percutaneous Coronary Intervention). Circulation. 2006; 113(7): e166–286.
  11. Sianos G, Morel MA, Kappetein AP, et al. The SYNTAX Score: an angiographic tool grading the complexity of coronary artery disease. EuroIntervention. 2005; 1(2): 219–227.
  12. Sullivan DR, Marwick TH, Freedman SB. A new method of scoring coronary angiograms to reflect extent of coronary atherosclerosis and improve correlation with major risk factors. Am Heart J. 1990; 119(6): 1262–1267.
  13. Tei C. New non-invasive index for combined systolic and diastolic ventricular function. J Cardiol. 1995; 26(2): 135–136.
  14. Schiller NB, Shah PM, Crawford M, et al. Recommendations for quantitation of the left ventricle by two-dimensional echocardiography. American Society of Echocardiography Committee on Standards, Subcommittee on Quantitation of Two-Dimensional Echocardiograms. J Am Soc Echocardiogr. 1989; 2(5): 358–367.
  15. Lang RM, Badano LP, Mor-Avi V, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2015; 28(1): 1–39.e14.
  16. Nakai H, Takeuchi M, Nishikage T, et al. Subclinical left ventricular dysfunction in asymptomatic diabetic patients assessed by two-dimensional speckle tracking echocardiography: correlation with diabetic duration. Eur J Echocardiogr. 2009; 10(8): 926–932.
  17. Antoni ML, Mollema SA, Atary JZ, et al. Time course of global left ventricular strain after acute myocardial infarction. Eur Heart J. 2010; 31(16): 2006–2013.
  18. Bache RJ, McHale PA, Greenfield JC. Transmural myocardial perfusion during restricted coronary inflow in the awake dog. Am J Physiol. 1977; 232(6): H645–H651.
  19. Yao GH, Zhang C, Sun FR, et al. Quantification of transmural gradient of blood flow in myocardial ischemia with real-time myocardial contrast echocardiography and dipyridamole stress test. Ultrasound Med Biol. 2008; 34(1): 22–30.
  20. Choi JO, Cho SW, Song YB, et al. Longitudinal 2D strain at rest predicts the presence of left main and three vessel coronary artery disease in patients without regional wall motion abnormality. Eur J Echocardiogr. 2009; 10(5): 695–701.
  21. Biering-Sørensen T, Hoffmann S, Mogelvang R, et al. Myocardial strain analysis by 2-dimensional speckle tracking echocardiography improves diagnostics of coronary artery stenosis in stable angina pectoris. Circ Cardiovasc Imaging. 2014; 7(1): 58–65.
  22. Agarwal R, Gosain P, Kirkpatrick JN, et al. Tissue Doppler imaging for diagnosis of coronary artery disease: a systematic review and meta-analysis. Cardiovasc Ultrasound. 2012; 10: 47.
  23. Tomai F, Crea F, Chiariello L, et al. Ischemic preconditioning in humans: models, mediators, and clinical relevance. Circulation. 1999; 100(5): 559–563.
  24. Klisiewicz A, Michałek P, Szymański P, et al. Changes in the response of hibernated myocardium to inotropic stimulation after angioplasty: a Doppler myocardial imaging study. Clin Cardiol. 2003; 26(11): 503–507.
  25. Parisi AF, Folland ED, Hartigan P. A comparison of angioplasty with medical therapy in the treatment of single-vessel coronary artery disease. Veterans Affairs ACME Investigators. N Engl J Med. 1992; 326(1): 10–16.
  26. Ryo K, Tanaka H, Kaneko A, et al. Efficacy of longitudinal speckle tracking strain in conjunction with isometric handgrip stress test for detection of ischemic myocardial segments. Echocardiography. 2012; 29(4): 411–418.
  27. Sürücü H, Tatli E, Okudan S, et al. Evaluation of subendocardial and subepicardial left ventricular functions using tissue Doppler imaging after complete revascularization. Echocardiography. 2009; 26(2): 203–210.
  28. Aneja A, Tang WH, Bansilal S, et al. Diabetic cardiomyopathy: insights into pathogenesis, diagnostic challenges, and therapeutic options. Am J Med. 2008; 121(9): 748–757.
  29. Stuart HJ, Farooq V, Serruys PW, et al. The SYNTAX score and its clinical implications. Heart. 2014; 100(2): 169–177.
  30. Généreux P, Palmerini T, Caixeta A, et al. SYNTAX score reproducibility and variability between interventional cardiologists, core laboratory technicians, and quantitative coronary measurements. Circ Cardiovasc Interv. 2011; 4(6): 553–561.

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

By "Via Medica sp. z o.o." sp.k., ul. Świętokrzyska 73, 80–180 Gdańsk, Poland
tel.:+48 58 320 94 94, fax:+48 58 320 94 60, e-mail: viamedica@viamedica.pl