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Published on: April 17, 2021
[Effects of percutaneous coronary intervention on cardiac function in ischemic cardiomyopathy patients with different
X F Zheng1, L M Wu2, L L Chen2
1Department of Cardiology, the third Affiliated Hospital of Fujian Medical University, Fuzhou 350108, China.
Insights
Percutaneous coronary intervention (PCI) improves outcomes for ischemic cardiomyopathy patients with left ventricular ejection fraction >35%, but not those with LVEF ≤35%. Lower preoperative LVEF independently predicts acute left ventricular failure post-PCI.
Area of Science:
- Cardiology
- Interventional Cardiology
- Heart Failure Research
Background:
- Ischemic cardiomyopathy (ICM) significantly impacts left ventricular (LV) function and remodeling.
- Percutaneous coronary intervention (PCI) is a key revascularization strategy for ICM patients.
- The clinical impact of PCI on LV remodeling and major adverse cardiovascular and cerebrovascular events (MACE) in ICM patients with varying LVEF and low SYNTAX scores requires further evaluation.
Purpose of the Study:
- To assess the clinical impact of PCI on LV myocardial remodeling and MACE in ICM patients with SYNTAX score ≤22.
- To analyze outcomes based on preoperative left ventricular ejection fraction (LVEF) categories: ≥50%, 36%-49%, and ≤35%.
Main Methods:
- A cohort of 191 ICM patients undergoing PCI were categorized by preoperative LVEF.
- Clinical outcomes, including MACE and LV remodeling parameters (LVEF, LV end-diastolic volume), were assessed at 12-month follow-up.
- Multivariate analysis was used to identify predictors of adverse events.
Main Results:
- While MACE incidence was similar across groups (P=0.231), acute left ventricular failure was significantly higher in the LVEF ≤35% group (22.9%, P=0.01).
- Preoperative LVEF ≤35% was an independent predictor of acute left ventricular failure (OR=2.696, P=0.030).
- PCI significantly improved LV ejection fraction and reduced LV end-diastolic volume and left atrium size at 1 year, with significant differences in remodeling parameters across LVEF groups.
Conclusions:
- PCI improves prognosis in ICM patients with LVEF >35% (SYNTAX score ≤22) but offers limited benefit for those with LVEF ≤35%.
- Preoperative LVEF is a crucial predictor of acute left ventricular failure post-PCI in this population.
- Postoperative LV remodeling and systolic function are closely correlated with preoperative LVEF.
Abstract:
Objective: To evaluate the clinical impact of percutaneous coronary intervention (PCI) on left ventricular myocardial remodeling and main adverse cardiovascular and cerebrovascular events (MACE) in ischemic cardiomyopathy patients with different left ventricular ejection fraction and SYNTAX score≤22. Methods: A total of 191 ischemic cardiomyopathy patients who underwent PCI in Department of Cardiology from May 2017 to October 2018 were enrolled in this study, and they were divided into three groups according to preoperative left ventricular ejection fraction (≥50% group, 36%~49% group and ≤35% group). The main outcomes and left ventricular ejection fraction, left ventricular end-diastolic volume were analyzed at 12 months follow-up. The main outcomes were the recurrence of acute left ventricular failure, recurrent angina, restenosis, revascularization, non-fatal myocardial infarction, cardiovascular death and non-cardiovascular death. Results: The incidence of MACE was 32.6% (15 cases) in ≥50% group, 32.0% (31 cases) in 36%-49% group, 45.8% (22 cases) in ≤35% group, respectively, which was lower in the first two groups than in ≤35% group, but there was no statistically significant difference among the 3 groups (P=0.231). The incidence of acute left ventricular failure in the three groups was 2.2%, 12.4% and 22.9%, respectively, and there was statistically significant difference among the 3 groups (P= 0.01). Multivariate analysis indicated that preoperative left ventricular ejection fraction ≤35% was an independent predictor of acute left ventricular failure (OR=2.696, 95%CI: 1.099-6.612, P=0.030). Compared with baseline data, left ventricular end-diastolic volume ((62±4) mm vs (56±5) mm, P<0.001), left atrium ((42±6) mm vs (40±6) mm, P<0.001) decreased significantly 1 year after PCI. However, left ventricular ejection fraction ((43±10)% vs (51±13)%, P<0.001) increased significantly. At 1 year, left ventricular remodeling related parameters were detected in 3 groups, and there was statistically significant difference in left ventricular end-diastolic volume ((53.1±0.6) mm vs (55.1±0.5) mm vs (59.1±0.7) mm, P<0.001), left ventricular ejection fraction ((62.1±1.1)% vs (51.4±1.0)% vs (37.0±1.5)%, P<0.001) among the 3 groups. Conclusions: Coronary vascular reopening with PCI in patients with ischaemic cardiomyopathy and SYNTAX score≤22, can improve prognosis of patients with preoperative left ventricular ejection fraction>35% significantly, but not in those with preoperative left ventricular ejection fraction≤35%. Preoperative left ventricular ejection fraction may be an independent predictor of acute left ventricular failure in patients with ischemic cardiomyopathy and SYNTAX score≤22, postoperative left ventricular remodeling and left ventricular systolic function correlate with preoperative left ventricular ejection fraction.
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