Impact of elective PCI on left intraventricular mechanical dyssynchrony in patients with chronic stable angina (tissue Doppler study)

Abstract

Aim: To detect the impact of elective PCI on left intraventricular mechanical dyssynchrony in patients with chronic stable angina. Methods: 100 patients with chronic stable angina were included and divided into two groups according to LV systolic and diastolic mechanical dyssynchrony measured by TSI 12-segments SD and Te-SD. 24 h then 1 month after PCI, patients with dyssynchrony were reclassified into improved vs persistent LV mechanical dyssynchrony. Results: At baseline 72% had LV systolic mechanical dyssynchrony. Patients with LV systolic mechanical dyssynchrony were significantly older (58.42 ± 4.617 vs. 54.64 ± 3.456, respectively, p < 0.001), diabetic (36.11% vs. 14.3% p value < 0.05), higher prevalence of pseudo-normal and restrictive filling patterns (p value < 0.05), significantly larger LVESV (39.88 ± 13.67 vs. 32.93 ± 9.79 ml, p < 0.05), lower EF% (54.13 ± 6.69% vs. 58.54 ± 6.4%, p value < 0.05) and greater WMSI (1.3 ± 0.25 vs. 1.15 ± 0.13, p value < 0.05). 24 h after PCI, 16 (22.22%) improved. 1 m after PCI 61 (84.72%) improved from baseline. Latest activated segment improved in 21.02% after 24 h and 41.69% improved after 1 m. Age was only variable independently associated with non-improvement of LV systolic mechanical dyssynchrony on multivariate analysis. Of the 23 patients with normal EF and WMSI, 13 had systolic dyssynchrony at baseline, 6 improved after 24 h and all improved at 1 m. Diastolic dysfunction improved in 18 (28.125%) 24 h after PCI. After 1 m improved in 50 (78.125%) and remained unchanged in 14 (21.875%), and was closely correlated to the grades of LV diastolic dysfunction. Conclusion: PCI had significant effect on LV systolic and diastolic mechanical intraventricular dyssynchrony.

Keywords

• PCI
• Systolic
• Diastolic
• Dyssynchrony