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      Early assessment of percutaneous coronary interventions for chronic total occlusions analyzed by novel echocardiographic techniques

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          Abstract

          OBJECTIVE:

          Successful revascularization of chronic total occlusions has been associated with improved left ventricular systolic function, reduced anginal symptoms, increased exercise capacity, and increased survival. This study was conducted to determine the impact of revascularization in chronic total occlusion on left ventricular function using novel echocardiographic techniques.

          METHODS:

          A total of 129 patients with chronic total occlusion who underwent revascularization between April 2011 and November 2012 were included in this study. Echocardiographic assessments with two-dimensional speckle tracking echocardiography and real-time three-dimensional echocardiography were performed before the procedure and one month after the procedure. The left ventricular ejection fraction, left ventricular volumes, and three-dimensional systolic dyssynchrony index were quantified.

          RESULTS:

          An immediate procedural success was obtained in 118 patients (91.5%). There were no acute or subacute stent thromboses during follow-up. The mean left ventricular ejection fraction significantly increased ( p<0.001), while the left ventricular end-diastolic and end-systolic volumes significantly decreased ( p = 0.001 and p<0.001, respectively). The three-dimensional systolic dyssynchrony index also decreased significantly ( p<0.001). The global longitudinal strain showed a significant increase after successful revascularization ( p<0.001). An increase in the global longitudinal strain was correlated with an increase in the left ventricular ejection fraction (r = 0.27, p = 0.02). The patients with a left ventricular ejection fraction ≥50% displayed a greater improvement in the global longitudinal strain, and the patients with diabetes showed less improvement.

          CONCLUSIONS:

          Using novel echocardiographic techniques, our results showed that restoring the coronary blood flow in chronic total occlusion patients reduces the left ventricular volumes and improves the left ventricular ejection fraction and the global longitudinal strain of hibernating myocardium.

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          Two-dimensional strain-a novel software for real-time quantitative echocardiographic assessment of myocardial function.

          Marina Leitman, Peter Lysyansky, Stanislav Sidenko … (2004)
          We sought to assess the feasibility of 2-dimensional strain, a novel software for real-time quantitative echocardiographic assessment of myocardial function. Conventional and a novel non-Doppler-based echocardiography technique for advanced wall-motion analysis were performed in 20 patients with myocardial infarction and 10 healthy volunteers from the apical views. Two-dimensional strain is on the basis of the estimation that a discrete set of tissue velocities are present per each of many small elements on the ultrasound image. This software permits real-time assessment of myocardial velocities, strain, and strain rate. These parameters were also compared with Doppler tissue imaging measurements in 10 additional patients. In all, 80.3% of infarct and 97.8% of normal segments could be adequately tracked by the software. Peak systolic strain, strain rate, and peak systolic myocardial velocities, calculated from the software, were significantly higher in the normal than in the infarct segments. In the 10 additional patients, velocities, strain, and strain rate obtained with the novel software were not significantly different from those obtained with Doppler tissue imaging. Two-dimensional strain can accomplish real-time wall-motion analysis, and has the potential to become a standard for real-time automatic echocardiographic assessment of cardiac function.
          Article 0 comments Cited 192 times – based on 0 reviews     Review now
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            Global longitudinal strain: a novel index of left ventricular systolic function.

            Z Friedman, Yoram Agmon, Peter Lysyansky … (2004)
            Echocardiographic estimation of global left ventricular (LV) function is subjective and time consuming. Our aim was to develop a novel approach for assessment of global LV function from 2-dimensional echocardiographic images Novel computer software for tissue tracking was developed and applied as follows: digital loops were acquired from apical 2-, 3-, and 4-chamber views and a line was loosely traced along the LV endocardium at the frame wherein it was best defined. Around this line, the software selected natural acoustic markers moving with the tissue. Automatic frame-by-frame tracking of these markers during the heart cycle yielded a measure of contractility along the selected region of interest. Global longitudinal strain (GLS) and GLS rate (GLSR) were calculated for the entire U-shaped length of LV myocardium (basal, mid, and apical segments of 2 opposite walls in each view). To test this software, computer-derived GLS and GLSR were analyzed by a nonechocardiographer, blinded to the echocardiographic interpretation, in 27 consecutive patients after myocardial infarction (MI) (age 64.4 +/- 12.9 years; 19 men; mean wall-motion score index of 1.79 +/- 0.44) and compared with those obtained in 12 consecutive control patients (age 59.0 +/- 9.7 years; 8 women), with a normal echocardiographic study. GLS and GLSR, averaged from the 3 apical views, differed significantly in patients post-MI compared with control patients (GLS -14.7 +/- 5.1% vs -24.1 +/- 2.9% and GLSR -0.57 +/- 0.21/s vs -1.02 +/- 0.09/s for patients post-MI vs control patients, respectively; both P <.0001). There was a good linear correlation between the wall-motion score index and the GLS and GLSR (R = 0.68 and R = 0.67, respectively; both P <.0001). A cut-off value for GLS of -21% had 92% sensitivity and 89% specificity and a cut-off value for GLSR -0.9/s had 92% sensitivity and 96% specificity for the detection of patients post-MI. GLS and GLSR are novel indices for assessment of global LV function from 2-dimensional echocardiographic images. Early validation studies with the method are suggestive of high sensitivity and specificity in the detection of LV systolic dysfunction in patients post-MI.
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              Impact of diabetes on long-term prognosis in patients with unstable angina and non-Q-wave myocardial infarction: results of the OASIS (Organization to Assess Strategies for Ischemic Syndromes) Registry.

              J. Calvin Kouokam, Andrzej Budaj, L Piegas … (2000)
              Although unstable coronary artery disease is the most common reason for admission to a coronary care unit, the long-term prognosis of patients with this diagnosis is unknown. This is particularly true for patients with diabetes mellitus, who are known to have a high morbidity and mortality after an acute myocardial infarction. Prospectively collected data from 6 different countries in the Organization to Assess Strategies for Ischemic Syndromes (OASIS) registry were analyzed to determine the 2-year prognosis of diabetic and nondiabetic patients who were hospitalized with unstable angina or non-Q-wave myocardial infarction. Overall, 1718 of 8013 registry patients (21%) had diabetes. Diabetic patients had a higher rate of coronary bypass surgery than nondiabetic patients (23% versus 20%, P:<0.001) but had similar rates of catheterization and angioplasty. Diabetes independently predicted mortality (relative risk [RR], 1.57; 95% CI, 1.38 to 1.81; P:<0.001), as well as cardiovascular death, new myocardial infarction, stroke, and new congestive heart failure. Moreover, compared with their nondiabetic counterparts, women had a significantly higher risk than men (RR, 1.98; 95% CI, 1.60 to 2.44; and RR, 1.28; 95% CI, 1.06 to 1.56, respectively). Interestingly, diabetic patients without prior cardiovascular disease had the same event rates for all outcomes as nondiabetic patients with previous vascular disease. Hospitalization for unstable angina or non-Q-wave myocardial infarction predicts a high 2-year morbidity and mortality; this is especially evident for patients with diabetes. Diabetic patients with no previous cardiovascular disease have the same long-term morbidity and mortality as nondiabetic patients with established cardiovascular disease after hospitalization for unstable coronary artery disease.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Clinics (Sao Paulo)
                Journal ID (iso-abbrev): Clinics (Sao Paulo)
                Title: Clinics
                Publisher: Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo
                ISSN (Print): 1807-5932
                ISSN (Electronic): 1980-5322
                Publication date (Print): October 2013
                Volume: 68
                Issue: 10
                Pages: 1333-1337
                Affiliations
                [I ]Bezmialem Foundation University, Faculty of Medicine, Department of Cardiology, Istanbul/Turkey.
                [II ]Dicle University, School of Medicine, Department of Cardiology, Diyarbakır/Turkey.
                Author notes

                Erdogan E contributed to the study design, data collection and interpretation, statistical analysis, manuscript preparation, and literature search. Akkaya M contributed to the study design, data collection and interpretation, and literature search. Bacaksiz A contributed to the data interpretation, manuscript preparation, and literature search. Tasal A, Sönmez O, Elbey MA, Kul S, Turfan M, Vatankulu MA, and Göktekin O contributed to the data collection and interpretation and statistical analysis.

                E-mail: drercanerdogan@ 123456gmail.com Tel.: + 90 212 453 17 00
                Article
                Publisher ID: cln_68p1333
                DOI: 10.6061/clinics/2013(10)07
                PMC ID: 3798672
                PubMed ID: 24212840
                SO-VID: fcd0a8d1-8b7a-45c6-84fb-81e77497b900
                Copyright © Copyright © 2013 Hospital das Clínicas da FMUSP
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 14 June 2013
                Date revision received : 22 July 2013
                Date accepted : 27 July 2013
                Page count
                Pages: 5
                Categories
                Subject: Clinical Science

                ScienceOpen disciplines: Medicine
                Keywords: chronic total occlusions,left ventricular function,percutaneous coronary intervention
                Data availability:
                ScienceOpen disciplines: Medicine
                Keywords: chronic total occlusions, left ventricular function, percutaneous coronary intervention

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