CARDIOVASCULAR JOURNAL OF AFRICA • Vol 22, No 4, July/August 2011
182
AFRICA
Colour M-mode superiority in evaluation of improvement
in myocardial performance indices following successful
percutaneous coronary intervention (PCI)
R SATTARZADEH, M MALEKI, A JAMALIAN, A AMIRPOUR, A FIRUZI, N SAMIEI, M ESMAEILZADEH,
A GHORBANI, A TAVOOSI
Abstract
Aim:
This study aimed at evaluating the early effects of
successful elective percutaneous coronary intervention (PCI)
on systolic and diastolic function.
Methods:
We consecutively studied the systolic and diastolic
function in 21 patients with stable coronary artery disease
(CAD) and left ventricular ejection fraction (LVEF)
>
40%
before and 48 hours after successful elective PCI.
Results:
Tei index and systolic indices (LVEF, regional wall
motion abnormality score, tricuspid annular plane systolic
excursion and peak systolic velocity of mitral and tricuspid
annulus) did not change significantly. Among the diastolic
indices, only velocity propagation (Vp) improved significant-
ly (from 42.9
±
10.8 to 51.8
±
10.7,
p
-value
=
0.008) following
PCI. Diastolic velocities, E/A ratio, deceleration time (DT),
early and late diastolic velocities of mitral annulus in TDI,
pulmonary vein systolic (PVs) and diastolic flow velocity
(PVd) did not show significant improvement.
Conclusion:
Propagation velocity of mitral inflow was the
earliest index to recover following successful PCI in patients
with stable CAD.
Keywords:
percutaneous coronary intervention, echocardiogra-
phy, coronary artery disease, systolic function, diastolic function
Submitted 7/5/10, accepted 2/8/10
Cardiovasc J Afr
2010;
22
: 182–185
DOI: 10.5830/CVJA–2010–061
Percutaneous coronary intervention (PCI) is a very common
revascularisation procedure performed in patients with stable
coronary artery disease (CAD).
1
PCI has shown promise in terms
of reduction of symptoms and improvement in quality of life.
2,3
However, physiological cardiac changes following improvement
of anatomical blood flow after PCI are still unclear.
Echocardiography provides a feasible and non-invasive tech-
nique for assessment of global and regional myocardial func-
tion.
4
Results of echocardiographic assessment of systolic and
diastolic ventricular function following successful elective PCI
have been contradictory and confusing.
5-9
However, the tech-
niques used in previous studies were mainly based on qualitative
and semi-quantitative assessment of myocardial function, and
information on quantification of regional and global myocardial
function with the recently introduced technique, tissue Doppler
imaging (TDI),
10-12
following PCI is limited.
The present study was designed to evaluate the early effects
of successful elective PCI on systolic and diastolic function glob-
ally and regionally through thorough echocardiographic exami-
nations, including two-dimensional (2-D), M-mode, colour
Doppler and TDI.
Methods
Our study participants were recruited from 31 consecutive
patients with stable CAD who were scheduled for elective PCI
in Rajaie Heart Centre. Patients were considered for inclusion if
they had angiographically documented coronary artery stenosis
>
70% in diameter in the culprit lesion by visual assessment, and
documented ischaemia. Ischaemia was documented using stress
testing in patients with typical stable angina, according to the
Canadian Cardiovascular Society (class I or II).
Exclusion criteria were bundle branch block, pacemaker
implantation, left ventricular ejection fraction (LVEF)
<
40%,
valvular heart disease, cardiomyopathy, history of coronary
artery bypass grafting (CABG), refractory angina or acute
myocardial infarction (MI) requiring emergency revascularisa-
tion, and left main stem disease.
All patients were evaluated by an experienced echocardiolo-
gist, using conventional (2-D, M-mode and colour Doppler) and
tissue Doppler echocardiography examinations one day before
and 48 hours after successful PCI, in order to assess cardiac
systolic and diastolic function. Successful revascularisation was
defined as a residual stenosis of
<
30% in luminal diameter with
TIMI flow grade 3. Patients with unsuccessful PCI (10 people)
were excluded.
All patients were on an optimal medical regimen consisting
of nitrates, aspirin,
β
-blockers, angiotensin converting enzyme
inhibitors and lipid-lowering agents (statins) along with a low-fat
diet on an individual basis.
Department of Cardiology, Tehran University of Medical
Sciences, Imam Khomeini Hospital, Tehran, Iran
R SATTARZADEH, MD
Department of Cardiology, Shaheed Rajaie Cardiovascular
Medical and Research Centre, Iran Medical University,
Tehran, Iran
M MALEKI, MD, FACC
A JAMALIAN, MD
A AMIRPOUR, MD
A FIRUZI, MD
N SAMIEI, MD
M ESMAEILZADEH, MD, FCAPSC
Digestive Diseases Research Centre, Tehran University of
Medical Sciences, Shariati Hospital, Tehran, Iran
A GHORBANI, MD
Department of Cardiology, Tehran University of Medical
Sciences, Imam Khomeini Hospital, Tehran, Iran
A TAVOOSI, MD,
