Effects of Elective Percutaneous Coronary Intervention on Subtle Left Ventricular Systolic Dysfunction in Patients
Swargam Venu1, Ramnath Venkitasubramonia Iyer2, Prabath Kumar Dash2
1Cardiology, Dr. Pinnamaneni Siddhartha Institute of Medical Sciences and Research Foundation, Vijayawada, IND.
Insights
Subtle left ventricular (LV) systolic dysfunction in stable coronary artery disease (CAD) patients was detected using global longitudinal strain (GLS). Successful percutaneous coronary intervention (PCI) significantly improved GLS, especially in severe CAD cases.
Area of Science:
- Cardiology
- Echocardiography
- Cardiac Physiology
Background:
- Stable coronary artery disease (CAD) can present with subclinical left ventricular (LV) dysfunction.
- Global longitudinal strain (GLS) is a sensitive marker for LV systolic function.
- Conventional echocardiography may not detect early signs of LV dysfunction in CAD patients.
Purpose of the Study:
- To detect subtle LV systolic dysfunction in stable CAD patients using GLS.
- To assess GLS changes at 24 hours and six months post-percutaneous coronary intervention (PCI).
- To correlate baseline GLS with CAD severity.
Main Methods:
- 94 stable CAD patients undergoing elective PCI were evaluated.
- Conventional 2D echocardiography and GLS were performed pre-PCI.
- Follow-up assessments of GLS were conducted at 24 hours and six months post-PCI.
Main Results:
- Reduced baseline GLS (-16.72 ± 1.98) indicated subclinical LV dysfunction despite normal ejection fraction (59.21 ± 2%).
- Baseline GLS correlated significantly with CAD severity, worsening with more stenotic vessels.
- GLS significantly improved at six months post-PCI (-21.87 ± 1.70; p < 0.001), with improvements seen at 24 hours as well.
Conclusions:
- Subtle LV dysfunction, undetectable by conventional methods, exists in stable CAD patients with normal LVEF.
- GLS is a valuable tool for detecting and monitoring LV dysfunction in CAD.
- Successful PCI leads to significant improvement in GLS, particularly in patients with more severe CAD.
Abstract:
Aim The study aimed to detect subtle left ventricular (LV) systolic dysfunction, reflected by abnormal global longitudinal strain (GLS), in patients with stable coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI) and to evaluate any improvement in GLS at 24 hours and six months post-PCI. Methods A total of 94 patients with stable CAD scheduled for elective PCI at our hospital were evaluated using conventional 2D echocardiography and GLS prior to the procedure. Follow-up assessments were conducted at 24 hours and six months post-PCI. Results Our study revealed evidence of subclinical LV dysfunction in the form of reduced baseline GLS (-16.72 ± 1.98) despite a normal ejection fraction (59.21 ± 2%). Baseline GLS showed a significant correlation with the severity of CAD, declining progressively with an increasing number of stenotic coronary vessels. Notably, there was significant improvement in subclinical LV dysfunction following PCI, as evidenced by enhanced GLS values at the six-month follow-up (-21.87 ± 1.70; p < 0.001). Among patients stratified into single-vessel disease (SVD, 63.8%), double-vessel disease (29.8%), and triple-vessel disease (3VD, 6.4%), GLS improved significantly at both 24 hours and six months post-PCI compared to baseline. Conclusions Patients with stable CAD, normal LVEF, and no regional wall motion abnormalities on 2D echocardiography were found to exhibit subtle LV dysfunction as detected by GLS. GLS parameters showed significant improvement following successful PCI. The degree of GLS impairment progressively worsened with the severity of CAD, increasing from SVD to 3VD.
