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Improvement in left ventricular function following higher-risk percutaneous coronary intervention in patients with
Juan J Russo1,2, Megha Prasad1, Darshan Doshi3
1Columbia University Medical Center, New York, New York.
Insights
Hemodynamically-supported percutaneous coronary intervention (PCI) improved left ventricular ejection fraction (LVEF) in patients with ischemic cardiomyopathy. Factors like baseline LVEF and vessels treated predicted LVEF improvement after PCI.
Area of Science:
- Cardiology
- Cardiovascular Interventions
Background:
- Surgical revascularization improves outcomes in ischemic cardiomyopathy.
- Limited data exist on left ventricular ejection fraction (LVEF) changes after percutaneous coronary intervention (PCI) in this population.
Purpose of the Study:
- To assess LVEF changes after hemodynamically-supported PCI.
- To identify predictors of LVEF improvement in patients with ischemic cardiomyopathy.
Main Methods:
- Analysis of paired echocardiography data from the PROTECT II trial and cVAD registry.
- Assessed changes in LVEF (ΔLVEF) at baseline and ≥30 days post-PCI.
- Used multivariable models to identify independent correlates of ΔLVEF.
Main Results:
- Mean LVEF increased by 6.5% (from 24.8% to 31.4%) post-PCI (p < .001).
- 57% of patients achieved a ΔLVEF ≥5%.
- Increased number of vessels treated correlated with greater LVEF improvement.
Conclusions:
- Hemodynamically-supported PCI led to significant LVEF improvement in patients with severe left ventricular systolic dysfunction.
- Lower baseline LVEF and more vessels treated were associated with greater LVEF gains.
Background:
Surgical revascularization is associated with improved ventricular function and clinical outcomes among patients with ischemic cardiomyopathy. There are less extensive data on changes in ventricular function among patients with ischemic cardiomyopathy undergoing percutaneous coronary intervention (PCI). Accordingly, we sought to assess the extent and predictors of change in left ventricular ejection fraction (ΔLVEF) among patients undergoing hemodynamically-supported PCI.
Methods:
We assessed ΔLVEF following hemodynamically-supported PCI (with Impella or intra-aortic balloon counterpulsation) among patients enrolled in the PROTECT II trial and cVAD registry. The ΔLVEF was compared among patients with paired echocardiography at baseline and at least 30 days of follow-up. Independent correlates of ΔLVEF (modeled continuously and with an absolute ΔLVEF≥5%) were assessed using multivariable models.
Results:
Among the 689 patients with paired echocardiographic data included in the analysis, the mean LVEF improved from 24.8 ± 9.9% to 31.4 ± 13.3% after PCI, for a net increase of 6.5 ± 10.8% (p < .001). A total of 395 (57%) patients had ΔLVEF ≥ 5% following hemodynamically-supported PCI. The number of vessels treated was associated with ΔLVEF (ΔLVEF 5.5% with 1 vessel, 6.6% with 2 vessels, and 8.3% with 3 vessels, p for trend = .046). A lower baseline LVEF, absence of a history of congestive heart failure or aldosterone receptor antagonist use, and a greater number of vessels treated were independent correlates of LVEF improvement.
Conclusions:
Among patients with severe left ventricular systolic dysfunction and paired echocardiographic assessments, an improvement in LVEF was observed following hemodynamically-supported PCI.
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