Echocardiographic assessment of revascularization completeness impact on diastolic dysfunction in ischemic heart
Tomislav Sipić1, Kresimir Stambuk2, Aleksandar Trbović2
1Clinic for Cardiovascular diseases Magdalena, Department of Cardiology, Krapinske toplice, Croatia. tomislav.sipic@magdalena.hr
Insights
Complete revascularization in ischemic heart disease may not be essential for diastolic function recovery. Echocardiography showed similar diastolic function recovery in patients with complete versus incomplete revascularization, suggesting correct indication is key.
Area of Science:
- Cardiology
- Medical Imaging
Background:
- Diastolic dysfunction, a progressive condition affecting left ventricular (LV) relaxation and filling, significantly increases morbidity and mortality.
- Ischemic heart disease is a primary cause of diastolic dysfunction, often requiring revascularization.
- The impact of complete versus incomplete revascularization on diastolic function recovery remains an area of investigation.
Purpose of the Study:
- To assess the impact of complete versus incomplete revascularization on diastolic dysfunction in patients with ischemic heart disease using echocardiography.
- To evaluate echocardiographic parameters for assessing diastolic function recovery post-revascularization.
Main Methods:
- Echocardiography was used to evaluate diastolic function in 65 patients with pre-existing diastolic dysfunction undergoing PCI revascularization.
- Patients were divided into complete and incomplete revascularization groups.
- Key echocardiographic parameters, including E/A ratio and E/E' lat ratio, were analyzed.
Main Results:
- Diastolic function recovery was statistically significant in both complete and incomplete revascularization groups (p < 0.001).
- No significant difference in diastolic function recovery was observed between the two groups.
- Tissue Doppler imaging (E/E' lat) emerged as the best parameter for assessing recovery.
Conclusions:
- Echocardiographic assessment of diastolic function recovery is a safe and effective method.
- Incomplete revascularization may yield comparable diastolic function recovery to complete revascularization when indications are appropriate.
- Factors like diabetes and patient age may influence recovery, but correct revascularization strategy is paramount.
Abstract:
Diastolic dysfunction indicates a functional abnormality of diastolic relaxation, filling, or distensibility of the left ventricle (LV), regardless of whether the LVEF is normal or abnormal. Diastolic dysfunction is practically always progressive and connected with higher morbidity and mortality rates, and, if not treated may lead to a diastolic heart failure. The golden standard for evaluation of diastolic function is echocardiography. One of the most important causes of diastolic dysfunction is ischemic heart disease. The revascularization of chronic myocardial ischemia can be partial (incomplete) or complete. Previous data have shown that the completeness of revascularization could have influence on clinical outcomes. The aim of this study was to asses, by means of echocardiography, the impact of completeness of revascularization on diastolic dysfunction in ischemic heart disease. This study included 65 consecutive patients with previously recognized diastolic dysfunction that met criteria for PCI revascularization. Two groups of patients were identified; one with complete revascularization achieved and another one with incomplete one. There were no statistical differences between two groups considering gender age, arterial hypertension, hyperlipoproteinaemia, previous CABG and left ventricle systolic function. In the incomplete revascularization group, the proportion of patients that had diabetes mellitus, previous myocardial infarction and previous PCI procedure were statistically higher (p < 0.05). The diastolic function recovery was statistically significant in both groups (p < 0.001), and there was no statistically significant difference in recovery between the two groups. Lack of recovery was registered in 18.2% patients with incomplete revascularization achieved, and 15.6% in the complete group, which was not significant, but shows a trend. The causes of somewhat worse recovery in the incomplete revascularization group could be attributed to the higher proportion of diabetics, to the somewhat older population and ultimately to the incomplete revascularization. The E/A ratio on diastolic transmitral flow as well as the E/E lat ratio on tissue doppler were found as the best echocardiographic parameters in diastolic function evaluation. In follow up recovery after complete or incomplete revascularization the tissue doppler (E/E lat) was recognized as the best parameter. In conclusion, we found that echocardiographic assessment of diastolic function recovery was a safe method, and our results showed that even in incomplete revascularization group of patients the recovery of diastolic function could be as good as in the complete one, if the indication for revascularization was correct.
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