Echocardiographic assessment of revascularization completeness impact on diastolic dysfunction in ischemic heart disease
Diastolic dysfunction indicates a functional abnormality of diastolic relaxation, filling, or distensibility of the left ventricle (LV), regardless of whether the LVEF is normal or abnormal. Diastolic dysfunction is practically always progressive and connected with higher morbidity and mortality rates, and, if not treated may lead to a diastolic heart failure. The golden standard for evaluation of diastolic function is echocardiography. One of the most important causes of diastolic dysfunction is ischemic heart disease. The revascularization of chronic myocardial ischemia can be partial (incomplete) or complete. Previous data have shown that the completeness of revascularization could have influence on clinical outcomes. The aim of this study was to asses, by means of echocardiography, the impact of completeness of revascularization on diastolic dysfunction in ischemic heart disease.
This study included 65 consecutive patients with previously recognized diastolic dysfunction that met criteria for PCI revascularization. Two groups of patients were identified; one with complete revascularization achieved and another one with incomplete one. There were no statistical differences between two groups considering gender, age, arterial hypertension, hyperlipoproteinaemia, previous CABG and left ventricle systolic function. In the incomplete revascularization group, the proportion of patients that had diabetes mellitus, previous myocardial infarction and previous PCI procedure were statistically higher (P<0.05).
The diastolic function recovery was statistically significant in both groups (P<0.001), and there was no statistically significant difference in recovery between the two groups. Lack of recovery was registered in 18.2% patients with incomplete revascularization achieved, and 15.6% in the complete group, which was not significant, but shows a trend. The causes of somewhat worse recovery in the incomplete revascularization group could be attributed to the higher proportion of diabetics, to the somewhat older population and ultimately to the incomplete revascularization.
The E/A ratio on diastolic transmitral flow as well as the E/E lat ratio on tissue doppler were found as the best echocardiographic parameters in diastolic function evaluation. In follow up recovery after complete or incomplete revascularization the tissue doppler (E/E lat) was recognized as the best parameter.
In conclusion, we found that echocardiographic assessment of diastolic function recovery was a safe method, and our results showed that even in incomplete revascularization group of patients the recovery of diastolic function could be as good as in the complete one, if the indication for revascularization was correct.
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