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Complete percutaneous revascularization for multivessel disease in patients with impaired left ventricular function:

Sharon W Kirschbaum1, Tirza Springeling, Eric Boersma

  • 1Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands.

JACC. Cardiovascular Interventions
|April 20, 2010
PubMed

Insights

Complete revascularization significantly improves left ventricular ejection fraction (EF) in patients with multivessel coronary artery disease. Cardiac MRI accurately predicts EF recovery after percutaneous coronary intervention (PCI).

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiac Imaging

Background:

  • The long-term impact of percutaneous coronary intervention (PCI) on myocardial function in multivessel coronary artery disease (CAD) remains incompletely understood.
  • The predictive value of cardiac magnetic resonance imaging (MRI) for global cardiac function recovery after PCI requires further investigation.

Purpose of the Study:

  • To evaluate the effect of complete, incomplete, and unsuccessful PCI on left ventricular ejection fraction (EF) in patients with multivessel CAD and impaired left ventricular function.
  • To assess the diagnostic accuracy of cardiac MRI in predicting EF improvement post-PCI.

Main Methods:

  • Cardiac MRI was performed before and 6 months after PCI in patients with multivessel CAD undergoing complete (n=34), incomplete (n=22), or unsuccessful (n=15) revascularization.
  • Left ventricular EF, wall thickening (assessed with dobutamine stress), and transmural extent of infarction (using delayed enhancement MRI) were quantified.

Main Results:

  • Complete revascularization led to a significant improvement in EF (46% to 51%, p < 0.0001).
  • No significant EF changes were observed after incomplete (49% to 49%, p = 0.88) or unsuccessful revascularization (49% to 47%, p = 0.11).
  • Dobutamine stress cardiac MRI demonstrated high sensitivity (100%) and specificity (75%) for predicting EF improvement >4% after PCI.

Conclusions:

  • Complete revascularization in multivessel CAD significantly improves left ventricular EF.
  • Incomplete or unsuccessful revascularization does not lead to EF improvement.
  • Cardiac MRI is a valuable tool for predicting EF recovery before PCI, guiding treatment decisions.
Abstract

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