Left ventricular mechanical dyssnchrony: A potential new marker for 3-vessel CAD
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Cited by 3 publications
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Effect of revascularization of coronary arteries on mechanical dyssynchrony of left ventricular myocardium in patients with coronary heart disease
Introduction. Defining a treatment strategy for patients with stable coronary heart disease will require the development of personalized criteria, among which the assessment of myocardial dyssynchrony is considered promising. The aim of the study was to evaluate the effect of revascularization of coronary arteries on indicators of mechanical myocardial dyssynchrony in patients with stable coronary heart disease. Materials and methods. The study included 121 patients with coronary heart disease, who were assessed for mechanical myocardial dyssynchrony before and 2 weeks after revascularization. The main group included 48 patients with myocardial dyssynchrony, and the comparison group included 73 patients without myocardial dyssynchrony. Complete occlusion and lesions of 3 coronary arteries were found more often in the group with myocardial dyssynchrony, and the main group also had a higher SYNTAX SCORE. The results. Mechanical dyssynchrony of the myocardium was found in 39% of patients with coronary heart disease. Before revascularization, a signifiant increase in SPWMD, APEI, IVMD, and a decrease in LVFT and LVET were found in the group of patients with myocardial dyssynchrony. After revascularization in the main group, in 9 patients out of 48 (18.7%), indicators of myocardial dyssynchrony returned to normal values. LVFT in the group of patients with myocardial dyssynchrony significantly increased, as well as left ventricular ejection time (LVET) (from 318.5±9.6 ms to 344.9±23.2 ms, p<0.01). Conclusions. After revascularization, the number of patients with myocardial dyssynchrony significantly decreased due to the improvement of interventricular and intraventricular dyssynchrony indicators. Key words: myocardial dyssynchrony, coronary heart disease, revascularization, coronary angiography, SYNTAX SCORE.
Effect of revascularization of coronary arteries on mechanical dyssynchrony of left ventricular myocardium in patients with coronary heart disease
Introduction. Defining a treatment strategy for patients with stable coronary heart disease will require the development of personalized criteria, among which the assessment of myocardial dyssynchrony is considered promising. The aim of the study was to evaluate the effect of revascularization of coronary arteries on indicators of mechanical myocardial dyssynchrony in patients with stable coronary heart disease. Materials and methods. The study included 121 patients with coronary heart disease, who were assessed for mechanical myocardial dyssynchrony before and 2 weeks after revascularization. The main group included 48 patients with myocardial dyssynchrony, and the comparison group included 73 patients without myocardial dyssynchrony. Complete occlusion and lesions of 3 coronary arteries were found more often in the group with myocardial dyssynchrony, and the main group also had a higher SYNTAX SCORE. The results. Mechanical dyssynchrony of the myocardium was found in 39% of patients with coronary heart disease. Before revascularization, a signifiant increase in SPWMD, APEI, IVMD, and a decrease in LVFT and LVET were found in the group of patients with myocardial dyssynchrony. After revascularization in the main group, in 9 patients out of 48 (18.7%), indicators of myocardial dyssynchrony returned to normal values. LVFT in the group of patients with myocardial dyssynchrony significantly increased, as well as left ventricular ejection time (LVET) (from 318.5±9.6 ms to 344.9±23.2 ms, p<0.01). Conclusions. After revascularization, the number of patients with myocardial dyssynchrony significantly decreased due to the improvement of interventricular and intraventricular dyssynchrony indicators. Key words: myocardial dyssynchrony, coronary heart disease, revascularization, coronary angiography, SYNTAX SCORE.
The relationship between mechanical dyssynchrony of the left ventricular myocardium and the degree of coronary artery occlusion in patients with coronary artery disease
Background. The prevalence of chronic heart failure in the world is increasing; however, it is stabilizing in developed countries. One of the reasons for this stabilization is an improvement of acute coronary syndrome treatment and revascularization. Revascularization in patients with chronic coronary syndromes without signs of the left ventricular dysfunction is less effective. One of the promising methods for assessing left ventricular dysfunction is the detection of electrical and mechanical dyssynchrony of the myocardium (DM). However, mechanical dyssynchrony of the myocardium has not been sufficiently studied in patients with coronary artery (CA) disease. The purpose was to assess the relationship between mechanical myocardial dyssynchrony and the degree of coronary artery occlusion in patients with coronary artery disease who underwent revascularization. Materials and methods. One hundred and thirty-four patients with coronary artery disease (35 with myocardial infarction and 99 with chronic coronary syndromes) who underwent coronary angiography and revascularization of coronary arteries were included in the study. According to the results of coronary angiography, patients were divided into 3 groups: 12 had unchanged CA (group 1), 17 had atherosclerotic lesions of CA without signs of occlusion (group 2), and 105 patients were with CA occlusion. Among those with CA occlusion, 10 people had an occlusion of less than 50 %, 26 patients had occlusion from 50 to 80 %, 36 had more than 80 %, and 33 patients had complete occlusion of at least one coronary artery. In all patients, parameters of mechanical DM were determined by ultrasound method. Results. In the first group, 3 patients (25 %) had mechanical DM, in the second — 4 patients (23.5 %), in the group with coronary artery occlusion, 42 patients (40 %) had mechanical DM. In the group with complete CA occlusion, mechanical DM was detected in 18 (53 %) cases. Septal to posterior wall motion delay (SPWMD) did not differ significantly in the comparison groups; however, it increased significantly to 64.8 ± 43.2 ms in patients with complete CA occlusion compared with 40.8 ± 13.1 ms in the group with unchanged CA (p < 0.05). SPWMD had a significant correlation with the degree of CA occlusion (r = 0.254, p = 0.009). The interventricular mechanical delay increased significantly, to 61.3 ± 40.5 ms compared with 33.4 ± 3.4 ms in patients with unchanged CA (p < 0.05). Left ventricular filling time was significantly shorter in the group with complete CA occlusion compared to the patients with incomplete CA occlusion and those with unchanged CA (47.3 ± 10.4 ms vs. 54.2 ± 5.7 ms, respectively; p < 0.05). Left ventricular ejection time was not significantly different between comparison groups, but correlated significantly with the degree of CA occlusion (r = 0.241, p = 0.013). The early ventricular time deceleration, the time from the beginning of the QRS complex to the beginning of the peak systolic velocity did not differ significantly. The time to the peak systolic velocity was significantly longer in the group with complete CA occlusion (32.6 ± 8.5 ms), and had a significant correlation with the degree of CA occlusion (r = 0.26, p = 0.007). Conclusions. A third of patients with chronic coronary syndrome included in the study had DM. In the group with complete CA occlusion, the frequency of DM detection increased significantly and was diagnosed in half of cases. In patients with complete CA occlusion, DM manifested itself in a significant SPWMD, an increase in the period of pre-ejection into the aorta and, as a result, a significant increase in the interventricular mechanical delay. An increase in the time to peak systolic velocity was also found in the group of patients with complete CA occlusion. DM associated with left ventricular diastolic dysfunction was detected in a group of patients with complete CA occlusion and manifested itself in a reduced left ventricular filling time.
The relationship between mechanical dyssynchrony of the left ventricular myocardium and the number of affected coronary arteries in patients with coronary heart disease who underwent revascularization
Background. A promising method for early detection of myocardial dysfunction is the evaluation of mechanical dyssynchrony of the left ventricular myocardium, the prognostic value of which in the diagnosis of 3-vessel lesions was shown only in a single study and requires further confirmation. Purpose – to assess the relationship between the number of affected coronary arteries and the presence of mechanical dyssynchrony of the myocardium, and its significance in predicting 3-vessel lesions in patients with coronary heart disease. Materials and Methods. 134 patients who underwent coronary angiography with revascularization of coronary arteries were included in the study. Patients were divided into comparison groups depending on the number of affected coronary arteries (without lesions, one, two and three coronary arteries). Variables of mechanical myocardial dyssynchrony were determined for all patients by ultrasound examination of the heart using Doppler examination and synchronization with the ECG. Results. The largest relative number of patients with myocardial dyssynchrony was observed in the group with lesions of 3 coronary arteries – 23 (52%). The presence of myocardial dyssynchrony had a significant correlation with SYNTAX SCORE (r=0.18, p=0.035). The aortic pre-ejection interval in the group of patients with lesions of 3 coronary arteries was significantly longer compared to the group of patients without lesions of the coronary arteries, however, the pulmonary pre-ejection interval was the same in the comparison groups. As a result of this difference, interventricular mechanical delay was significantly greater in the group of patients with occlusion of 3 coronary arteries (54,8±36,6 ms; р=0,043). The time to peak systolic velocity in the group of patients with lesions of 3 coronary arteries was significantly longer (32,1±8,0 ms; р=0,021) compared to the group of patients without atherosclerotic lesions, which was confirmed by a positive correlation (r=0.190, p=0.003). The ROC analysis of the predictive capabilities of the combination of the factors of the presence of myocardial dyssynchrony, left ventricular ejection fraction, interventricular mechanical delay, root mean square deviation of the time to the peak of systolic velocity, and the E/A ratio in relation to lesions of 3 coronary arteries showed sufficient sensitivity (0.89) and specificity (0.87). Conclusions. Patients with lesions to 3 coronary arteries have a significantly higher relative frequency of mechanical myocardial dyssynchrony compared to patients without and lesions of 1 or 2 coronary arteries; correlation of myocardial dyssynchrony with 3-vessel lesions and SYNTAX SCORE was also found. The combination of variables of myocardial dyssynchrony in terms of predicting 3-vessel occlusion of coronary arteries has sufficient sensitivity and specificity.
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