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Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
10:28

Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function

Published on: March 15, 2022

Effect of embolic particles during coronary interventional procedures on regional wall motion in patients with stable

Yoshiharu Higuchi1, Katsuomi Iwakura, Atsunori Okamura

  • 1Division of Cardiology, Sakurabashi Watanabe Hospital, Osaka, Japan. yhiguchi-ja@umin.net

The American Journal of Cardiology
|January 17, 2012
PubMed

Insights

Microembolization during percutaneous coronary intervention (PCI) causes subclinical cardiac dysfunction. A Doppler guidewire detected high-intensity transient signals (HITS), correlating with reduced myocardial strain after PCI in stable angina patients.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiac Imaging

Background:

  • Percutaneous coronary intervention (PCI) can lead to microembolization, causing minor myocardial injury.
  • High-intensity transient signals (HITS) detected by Doppler guidewires indicate embolic particles during PCI.
  • Assessing subclinical cardiac function changes post-PCI is crucial for patient outcomes.

Purpose of the Study:

  • To investigate the impact of periprocedural microembolization during PCI on regional myocardial function.
  • To correlate the number of high-intensity transient signals (HITS) with changes in myocardial strain.
  • To evaluate the utility of Doppler guidewire and strain analysis in detecting subclinical cardiac injury post-PCI.

Main Methods:

  • 25 patients with stable angina underwent PCI to the left anterior descending coronary artery.
  • Doppler guidewire was used to count HITS during PCI.
  • Echocardiography with 2D speckle tracking assessed longitudinal peak systolic strain, peak strain rate, and early diastolic strain rate before and after PCI.

Main Results:

  • PCI was successful with an average of 10 ± 6 HITS detected.
  • No visible wall motion abnormalities were observed post-PCI.
  • Patients with ≥10 HITS showed significant worsening of peak systolic strain, peak strain rate, and early diastolic strain rate post-PCI (p <0.01).
  • Strong inverse correlations were found between HITS count and changes in peak systolic strain (R(2) = 0.35) and early diastolic strain rate (R(2) = 0.46).

Conclusions:

  • Periprocedural microembolization during PCI negatively affects subclinical cardiac function in stable angina patients.
  • Doppler-detected HITS can quantify embolic burden and predict myocardial functional impairment.
  • Strain analysis is a sensitive tool for detecting microvascular dysfunction following PCI.

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