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[Clinical predictors of left ventricular function improvement after percutaneous coronary interventions in patients
D Dudek1, Ł Rzeszutko, P Turek
1II Klinika Kardiologii Instytutu Kardiologii Collegium Medicum Uniwersytetu Jagiellońskiego w Krakowie. mcdudek@cyf-kr.edu.pl
Insights
Mild heart failure symptoms and lack of angina predict left ventricle function recovery after percutaneous coronary intervention (PCI) in patients with reduced ejection fraction. These factors are key for improving outcomes post-PCI.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Function Assessment
Context:
- While predictors for left ventricle function recovery after surgical revascularization are known, factors influencing recovery post-percutaneous coronary intervention (PCI) in patients with coronary artery disease and low ejection fraction (LVEF) remain understudied.
- Percutaneous coronary intervention (PCI) is a common treatment for coronary artery disease, but its impact on left ventricle function recovery in patients with impaired ejection fraction requires further investigation.
Purpose:
- To identify clinical prognostic factors associated with left ventricle function improvement following PCI in patients diagnosed with coronary artery disease and impaired LVEF.
- To analyze the influence of baseline clinical characteristics, including heart failure symptoms and angina class, on LVEF recovery after PCI.
Summary:
- A study of 29 patients with LVEF < 45% undergoing PCI revealed a significant increase in ejection fraction (EF) from 38.4% to 50.4% after 6 months.
- Patients with milder heart failure symptoms (NYHA class I/II) and severe angina (CCS III/IV) showed significant LVEF improvement post-PCI.
- Multivariate analysis indicated that NYHA class was an independent predictor of LVEF recovery, with a lack of angina symptoms negatively impacting recovery.
Impact:
- Identifies mild heart failure symptoms as a positive predictor and lack of angina as a negative predictor for LVEF recovery after PCI.
- Provides valuable clinical insights for stratifying patients undergoing PCI who are likely to experience improved left ventricle function.
- Highlights the importance of symptom assessment in predicting cardiac function recovery in patients with coronary artery disease and reduced ejection fraction.
Background:
The value of clinical predictors of left ventricle function recovery after surgical revascularization in patients with decreased ejection fraction is well documented. However, there are no clinical studies assessing factors which can influence left ventricle function in patients with coronary disease and low ejection fraction (LVEF) undergoing percutaneous coronary interventions (PCI).
Objective:
We tried to assess clinical prognostic factors of left ventricle function improvement after PCI in patients with coronary artery disease and impaired LVEF.
Patients And Methods:
We studied patients with LVEF < 45% undergoing PCI. We assessed duration and grade of symptoms of heart failure, angina class and echocardiographic parameters of LV systolic function. After 6 months follow-up LVEF was obtained again. We analyzed influence of baseline clinical factors on LVEF recovery after PCI.
Results:
We studied 29 patients (mean age 54.4 +/- 11 years) before and after PCI. In the whole group of patients we found significant increase in EF (38.4 +/- 6% vs 50.4 +/- 15%, p = 0.005) at follow up examination. There was significant improvement of EF in patients with NYHA class I or II (from 40.4 +/- 5% to 58.1 +/- 9%, p < 0.0001) as compared to NYHA class III or IV (from 31.4% +/- 9% to 31.8 +/- 11, p = NS). In multivariate regression analysis correlation between NYHA class and LVEF at control examination (beta = -0.54, p = 0.03) was independent from epidemiological variables and baseline LVEF. There was significant increase in LVEF in patients with severe angina (CCS III or IV) as compared to patients without angina (DEF 21.3 +/- 5% vs 7.9 +/- 10%, p = 0.009). There was also higher increase in LVEF in patients with chest pain during balloon inflation (delta EF 17.4 +/- 9% vs 5.7 +/- 9%, p = 0.01).
Conclusions:
Mild symptoms of heart failure and independent predictors of left ventricle function recovery after PCI in patients with impaired LVEF. The lack of angina symptoms negatively influence LVEF recovery after PCI.