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Effect of revascularizing viable myocardium on left ventricular diastolic function in patients with ischaemic
Erberto Carluccio1, Paolo Biagioli, Gianfranco Alunni
1Division of Cardiology, University of Perugia, Ospedale Silvestrini, S. Andrea delle Fratte, Perugia, Italy.
Insights
Revascularization significantly improves diastolic function in patients with ischaemic cardiomyopathy. This improvement in diastolic filling is linked to the amount of viable heart tissue and reverse remodeling, offering an additional benefit of this procedure.
Area of Science:
- Cardiology
- Cardiovascular Medicine
- Heart Failure Research
Background:
- Ischaemic left ventricular (LV) dysfunction with viable myocardium typically improves systolic function after revascularization.
- Diastolic dysfunction is common in these patients, but its response to revascularization remains unclear.
Purpose of the Study:
- To investigate the impact of revascularization on diastolic function in patients with chronic ischaemic cardiomyopathy and viable myocardium.
- To determine factors associated with improvements in diastolic function post-revascularization.
Main Methods:
- Echocardiography was used to assess systolic function (ejection fraction, wall motion score index) and diastolic function (transmitral Doppler, tissue Doppler imaging) in 26 patients.
- Patients were evaluated at baseline and at least 4 months after revascularization.
Main Results:
- Revascularization led to significant improvements in systolic function (EF increased, WMSI decreased).
- Diastolic filling patterns improved, with a reduction in restrictive filling and improved E' velocity and E/E' ratio.
- Decreased LV filling pressure was observed post-revascularization.
Conclusions:
- Revascularization can substantially improve LV diastolic filling in patients with ischaemic cardiomyopathy.
- The degree of diastolic function improvement correlates with myocardial viability and LV reverse remodeling, highlighting an added benefit of revascularization for viable but dysfunctional myocardium.
Aims:
In patients with ischaemic left ventricular (LV) dysfunction and viable myocardium, revascularization improves systolic function. Diastolic dysfunction is also present in such patients; however, whether revascularization improves diastolic function also is largely unknown.
Methods:
Twenty-six patients with chronic ischaemic cardiomyopathy [ejection fraction (EF) 32 +/- 6%, wall motion score index (WMSI) 2.45 +/- 0.33] and viable myocardium (low-dose dobutamine echocardiography) were examined at baseline and > or =4 months after revascularization. Diastolic function was assessed by transmitral pulsed-wave Doppler and tissue Doppler imaging (TDI) at the mitral annulus.
Results:
At baseline, 62% of patients showed non-restrictive filling (non-RF) pattern, and 38% restrictive filling (RF) pattern. After revascularization, along with improvement in systolic function (EF 43 +/- 10%, WMSI 1.78 +/- 0.47, P = 0.0002 for both), diastolic filling improved in most patients, with only three patients still exhibiting RF pattern (P = 0.016); furthermore, E' velocity increased (32 +/- 42%, P = 0.0028) and E/E' decreased (-19 +/- 31%, P = 0.0378) compared with baseline. Left ventricular filling pressure also decreased, from 17.5 +/- 6.8 to 13.1 +/- 6.5 mmHg (P = 0.005). Improvement of diastolic function by TDI was related to the extent of viability at baseline (P = 0.0098) and to LV reverse remodelling after revascularization (P = 0.0092).
Conclusion:
In patients with ischaemic cardiomyopathy, LV diastolic filling may largely improve after revascularization. Improvement of diastolic dysfunction is related to the amount of viable tissue and it may represent an additional advantage of revascularizing dyssinergic but viable myocardium.
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