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Post PCI Systolic Evaluation In Patients With Coronary Artery Disease Using Tissue Doppler Echocardiography

Background: Patients with stable coronary artery disease may have subtle derangements in their cardiac function before evident changes in conventional echocardiographyderived ejection fraction (EF). These derangements manifest firstly in the longitudinal before circumferential LV function. The effect of PCI on longitudinal and circumferential systolic and diastolic function of the ventricle in patients with chronic stable angina has shown controversial results. In the current study, we tried to evaluate the impact of percutaneous coronary intervention (PCI) on myocardial systolic and diastolic function assessed by different non-invasive indices as EF, Myocardial Performance Index (MPI) and longitudinal myocardial function assessed by Tissue Doppler imaging (TDI) in patients with stable coronary artery disease. Method: A total of 50 patients scheduled for elective PCI were enrolled in this study. All had chronic stable angina and a left ventricular ejection fraction >55% with no obvious segmental wall motion abnormality. All underwent conventional echocardiographic evaluation of indices of left ventricular systolic function including EF and MPI, in addition to pulsed-wave tissue Doppler imaging at the mitral and lateral tricuspid annulus. All indices were measured one day before and 5 days after PCI. Results: 44% of the patients were males and 56% were females. The mean age was 55.5± 9.1 years. Compared to preinterventional values, there was a significant improvement of the mean systolic myocardial velocity S′ wave in the LV as a whole (noticed mainly at the anterior wall) and the lateral RV annulus 5 days after intervention irrespective of the lesion site. Regarding segmental improvement in areas supplied by the lesion targeted by intervention, there was also a highly significant improvement in anterior S′ wave velocities 5 days after intervention. Conclusion: Pulsed wave tissue Doppler is more sensitive in post-PCI monitoring and follow up of patients with chronic stable angina and seemingly normal baseline cardiac function.