Effect of elective percutaneous coronary intervention of left anterior descending coronary artery on regional myocardial function using strain imaging

Background

Percutaneous coronary intervention (PCI) is a commonly used procedure for revascularization, however the impairment of regional myocardial function in patients with stable coronary artery disease (CAD) has not been well characterized, our study aimed to assess the improvement of left ventricular (LV) systolic function after elective PCI of the left anterior descending artery (LAD) using strain and strain rate imaging techniques.

Materials and methods

The study included 30 patients (aged 56.8 ± 6.6 years, 66.7% males) presented with stable CAD on optimal medical therapy, and recommended for elective PCI to LAD, all patients included in the study had a normal LV wall motions, and normal LV systolic function. Tissue Doppler imaging (TDI) was done before PCI, immediately, and three months post PCI. The peak systolic longitudinal strain (PSLS), and peak systolic strain rate (PSSR) were measured and averaged for the 6 LAD segments (the basal, mid, and apical segments of the anterior wall, the basal, mid anteroseptal, and the apicoseptal segments), 15 healthy control subjects were included as a control group.

Results

The average PSLS and PSSR of the ischemic segments were significantly lower in patients compared to control in the ischemic segments, and significantly increased 3 months post PCI but not immediately post PCI. Using the ROC curve a cutoff value of −13.69% for PSLS can detect regional ischemia with a sensitivity 93.3% and a specificity of 80%.

Conclusions

TDI derived strain and strain rate can detect resting regional myocardial dysfunction in presence of preserved LV systolic function, and can assess the improvement of regional myocardial function after successful elective PCI in patients with stable CAD.