Left Ventricular Function after Revascularization in Patients with Chronical Coronary Syndromes

Abstract

Background: The purpose of this study was to determine the dynamics of morpho-functional and myocardial deformation characteristics of the left ventricle after revascularization in patients with chronic coronary syndromes (CCS). Methods and Results: The study included 136 CCS patients of both sexes with stable anginal symptoms [(i) clinical scenario] and asymptomatic coronary artery disease (CAD) at screening [(vi) clinical scenario]. Diagnosis of CCS was performed according to the 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes. All patients underwent the following examinations: assessment of traditional risk factors, physical examination, general clinical and laboratory blood tests, 12-lead ECG, transthoracic echocardiography, two-dimensional speckle tracking echocardiography (STE), and coronary angiography (CAG). The SYNTAX score was calculated retrospectively according to the SYNTAX score algorithm. A total of 100 patients with CCS were enrolled in the main group (MG) and underwent revascularization by PCI with intracoronary stenting using drug-eluting stents. Among the main-group patients, one-vessel, two-vessel, and three-vessel CAD were detected in 36(26.5%), 34(25%), and 30(22.0%) cases, respectively. The comparison group (CG) included 36 CCS patients with hemodynamically non-significant coronary lesions (<50% stenosis). LVEF values were within the normal range in all groups, with the highest value in the CG, followed by the one-, two- and three-vessel lesion groups. LVEF obtained by the area-length method and modified biplane Simpson's method did not differ. The assessment of the contractile function of the LV myocardium was also obtained by assessing the global longitudinal strain (GLS) and global longitudinal strain rate (GLSR). The comparative analysis of the LV myocardial deformation properties in the studied groups showed that less negative GLS and GLSR were found in the three-vessel CAD, followed by the two-vessel and one-vessel CAD groups, and CG. CG demonstrated more negative GLS and GLSR than all MG subgroups. We analyzed the effect of revascularization on the GLS and found no statistically significant differences before and 48 hours after revascularization in all studied MG subgroups and CG. Thirty days after revascularization, GLS significantly showed more negative values in all MG subgroups: -18.12±0.63 versus -17.9±0.4 in one-vessel CAD, -16.13±0.71 versus -15.9±0.4 in two-vessel CAD and -13.91±1.25 versus -13.1±1.1 in three-vessel CAD. In CG with medical treatment only, GLS did not change statistically significantly but had more negative values than in the studied MG subgroups. Analysis of changes in LVEF after revascularization in the MG of patients with one-, two- and three-vessel CAD and in the CG after medical treatment did not reveal statistically significant dynamics. Conclusion: the results indicate the absence of statistically significant changes in myocardial deformation indicators and morpho-functional parameters of the left ventricle in CCS patients 48 hours after revascularization. Thirty days after revascularization, GLS significantly improves, while LVEF remains unchanged. GLS is superior to LVEF in visualizing improvement in LV function after revascularization in patients with CCS.

Keywords

• coronary artery disease
• left ventricular ejection fraction
• speckle tracking echocardiography
• global longitudinal strain