ASSESSMENT OF CHANGES IN LEFT VENTRICULAR FUNCTIONS AFTER PERCUTANEOUS CORONARY INTERVENTION OF CHRONIC TOTAL OCCLUSION OF LEFT ANTERIOR DESCENDING ARTERY; ECHOCARDIOGRAPHY AND TISSUE DOPPLER STUDY

Mohamed Mahmoud*, Mahmoud Ahmed A. Elbaset and Waleed Yousof

ABSTRACT

Chronic totally occluded lesions (CTO) are common, and over the past 20 years, CTO lesions have represented the most difficult anatomy for treatment with lower success rates and higher complication rates, CTO continue to represent one of the greatest challenges to interventional cardiologists. Although data are limited, successful percutaneous coronary intervention (PCI) may improve ventricular relaxation and regional wall motion, global ejection fraction improved in some studies, but not in another, among patients with successfully recanalized occlusions, those with persistent patency and normal flow had better global function and less ventricular dilatation than patients without patent vessels. Aim of the work: The purpose of this study is to assess change in left ventricular functions using conventional echocardiography and tissue Doppler study in patients with chronic total occlusion of Left Anterior Descending (LAD) after Percutineous Coronary Intervention (PCI). Subjects and methods: The study was conducted through the period from April 2011 to April 2014 and included 30 patients, 22 (73.3%) males and 8 (26.7%) females, with age from 40 to 67 years old with mean age 55.92. They were selected from patients admitted to Cardiology department in Al-Azhar University Hospitals. Inclusion criteria: Patients with Chronically Occluded Left Anterior Descending Artery. Exclusion criteria: Patients with rheumatic heart disease, Patients with end stage renal disease, Patients with end stage liver disease, Heamodynamicaly unstable patients, Patients with acute coronary syndrome and patients with decompensated heart failure. The following was done for all patients. a. Full history taking, b. Complete clinical examination, c. Resting surface 12 leads electrocardiography (ECG), d. Coronary angiography and PCI to the CTO LAD artery, and e.Transthorasic echocardiography with TDI before PCI and within 3 month after PCI. Results: Using M mode there was improvement in LVEF in 18 (60%) patients, unchanged in 4 (13.3%) patients, and decreased in 8 (26.6%) patients. With Mean ± SD = 64.5±8.5 pre PCI and 65.7±6.1 post PCI, with P value = 0.09. Using 2D to assess LVEF there was improvement in LVEF in 18 (60%) patients, unchanged in 5 (16.6%) patients, and decreased in 7 (23.3%) patients. With Mean ± SD = 58.48±5.1 pre PCI and 60.6±4.2 post PCI, with P value = 0.005. Using TDI to assess Left ventricular systolic function there was improvement in LV systolic function in 18 (60%) patients, unchanged in 5 (16.6%) patients, and decreased in 7 (23.3%) patients with Mean ± SD = 11.7±2.7pre PCI and 12.05±2.3 post PCI, with P value = 0.07. Regarding LV diastolic function using pulsed Doppler over mitral flow there was improvement in LV diastolic function by measuring E/A ratio which was Pre PCI:- normal or pseudonormal (E/A ratio 1- 2) in 5 (16.7 %) patients, and Impaired relaxation (E/A ratio < 1) in 25 (83.3 %) patients and post PCI become normal or pseudonormal (E/A ratio 1- 2) in 8 (26.7 %) patients, and impaired relaxation (E/A ratio < 1) in 22 (73.3 %) patients. Mean ± SD = 0.64±0.39 pre PCI and 0.90±0.24 post PCI, with P value = 0.001. And using TDI in patients pre and post PCI there was improvement in LV diastolic function as pre PCI:- normal or pseudonormal (E/A ratio 1- 2) in 3 (10 %) patients, and impaied Impaired relaxation (E/A ratio < 1) in in 27 (90 %) patients. Post PCI become normal or pseudonormal (E/A ratio 1- 2) in 7 (23.3 %) patients, and impaied Impaired relaxation (E/A ratio < 1) in 23 (76.7 %) patients. Mean ± SD = 0.64±0.39 pre PCI and 0.90±0.24 post PCI, with P value = 0.009 Conclusion: PCI for a CTO LAD has a beneficial effect and improvement in global LV functions that can be predicted by conventional echocardiography and tissue Doppler.

Keywords: CTO= coronary totally occluded, CAD= coronary artery disease, echocardiography, tissue Doppler imaiging, and left ventricular function.