Percutaneous coronary intervention in patients with impaired left ventricular function

2018 ◽  
pp. 273-284
Author(s):  
Divaka Perera ◽  
Natalia Briceno
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Myocardial Dysfunction ◽  
Coronary Intervention ◽  
Left Ventricular ◽  
Circulatory Support ◽  
Lv Function ◽  
Percutaneous Coronary ◽  
Clinical Consequences ◽  
Intra Aortic Balloon Counterpulsation ◽  
Ischaemic Cascade

Changes in left ventricular (LV) function are an early manifestation of the ischaemic cascade, and often precede well-recognized markers of ischaemia. Prolonged post-ischaemic myocardial dysfunction can persist for hours or days after bloodflow is restored. Patients with impaired LV function at the outset face potentially hazardous clinical consequences from percutaneous coronary intervention (PCI). This chapter explores the options for optimizing PCI when LV function is impaired, different uses of percutaneous mechanical circulatory support (including intra-aortic balloon counterpulsation and LV assist devices) with the aim of preventing the development of cardiogenic shock, and the impact of revascularization in ischaemic cardiomyopathy and the role of viability testing.

Percutaneous coronary intervention in patients with impaired left ventricular function

2010 ◽  
pp. 277-289 ◽  
Author(s):  
Divaka Perera ◽  
Simon Redwood
Keyword(s):  
Blood Flow ◽  
Percutaneous Coronary Intervention ◽  
Ventricular Function ◽  
Myocardial Dysfunction ◽  
Coronary Intervention ◽  
Left Ventricular ◽  
Balloon Occlusion ◽  
Lv Function ◽  
Clinical Consequence ◽  
Percutaneous Coronary

Changes in left ventricular (LV) function are an early manifestation of the ischaemic cascade and often precede the well-recognized markers of ischaemia, such as ST segment changes or chest pain. Decreased ventricular compliance, diminished regional and global contractility, and elevated end-diastolic pressure occur within a few seconds of interruption of coronary blood flow by balloon occlusion, whereas recovery of these parameters can lag several minutes behind balloon deflation, restoration of blood flow, and resolution of electrocardiogram (ECG) changes. Prolonged postischaemic myocardial dysfunction, or stunning, can occur following recurrent ischaemia, which may persist for several hours or days even when blood flow is restored. The impact of transient or repetitive coronary occlusion on LV function is rarely of clinical consequence when percutaneous coronary intervention (PCI) is performed in patients with preserved ventricular function, but is potentially hazardous in those who have LV impairment at the outset, particularly when there is a large amount of myocardium at risk. These patients have attenuated haemodynamic reserve and may recover incompletely from post-ischaemic stunning, which increases the risk of entering a deteriorating spiral of decreasing cardiac output and worsening ischaemia that could culminate in cardiogenic shock or ventricular arrhythmias. Furthermore, patients with impaired LV function tend to be older and have more advanced comorbidities, which are independently associated with an adverse outcome following any form of revascularization.

scholarly journals Echocardiographic Evaluation of left Ventricular Function Following Late Percutaneous Coronary Intervention after Acute Anterior Myocardial Infarction with Left Ventricular Systolic Dysfunction

2018 ◽  
Vol 33 (2) ◽  
pp. 90-93
Author(s):  
Md Tufazzal Hossen ◽  
Sayed Ali Ahsan ◽  
Md Abu Salim ◽  
Khurshed Ahmed ◽  
Md Mukhlesur Rahman ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
Left Ventricular ◽  
Coronary Stenting ◽  
Lv Function ◽  
P Value ◽  
Anterior Myocardial Infarction ◽  
Late Intervention ◽  
Percutaneous Coronary

Background: The effect of late percutaneous coronary intervention on left ventricular function is incompletely understood. Objectives: To evaluate the effect of late Percutaneous Coronary Intervention on LV systolic function following coronary stenting after acute anterior myocardial infarction. Methods: A total of 60 patients, > 24 hours to 6 weeks after anterior AMI who attended in UCC, BSMMU between July 2014 to June 2015 were included in this study. They underwent coronary stenting. After coronary stenting all patients were in TIMI flow-3. Serial echocardiographic assessment of LV function before and after late intervention with modified Simpson’s rule in apical 4 chamber view as well as comparison between baseline result with that of after intervention were done. The patients were on standard medical therapy in post intervention period. Result: Mean age was 54.3±8.91 years with minimum 30 years and maximum 75 years. Most of the patients were male (67%). LVESV was 60.0±14.4 ml before PCI and 58.3±15.3 ml at discharge (p value 0.091) & 44.1±17.6 ml after 3 months (p value <0.001). LVEF was 40.2±3.1% before PCI, 40.2±3.3% at discharge (p value 0.509) & 47.6±5.9% after 3 months (p value <0.001). There was no significant improvement of LV function from baseline till discharge but significant improvement occurred after 3months. Conclusion: Using echocardiographic techniques, our results showed that left ventricular volume decreased and the left ventricular ejection fraction increased significantly after three months of late intervention. Bangladesh Heart Journal 2018; 33(2) : 90-93

scholarly journals Left brachial artery: one more way to percutaneous insertion of IMPELLA 2.5L circulatory support for high-risk percutaneous coronary intervention – a case report

2020 ◽  
Author(s):  
Paolo Sganzerla ◽  
Francesco Cinelli ◽  
Andrea Capoferri ◽  
Mauro Rondi
Keyword(s):  
Percutaneous Coronary Intervention ◽  
High Risk ◽  
Circulatory System ◽  
Common Femoral Artery ◽  
Coronary Intervention ◽  
Left Ventricular ◽  
Circulatory Support ◽  
Coronary Syndrome ◽  
Percutaneous Coronary ◽  
Artery Disease

Abstract Background Percutaneous circulatory support allows the performance of coronary interventions in ever more complex anatomic and clinical situations. The large-bore systems currently available need a suitable vascular calibre to be inserted restricting percutaneous access mainly to the common femoral artery. Case summary We present the case of a 64-year-old man, admitted with an acute coronary syndrome and congestive heart failure, due to triple-vessel coronary artery disease with left main involvement and left ventricular dysfunction. He was successfully treated with percutaneous coronary intervention (PCI) supported through an IMPELLA 2.5L circulatory system. Concomitant severe and diffuse peripheral vascular disease did not allow femoral insertion of the circulatory support which was therefore successfully introduced through a left brachial percutaneous approach. Discussion To the best of our knowledge, this is the first report of a brachial, percutaneous placement of the IMPELLA 2.5L system to support a high-risk PCI procedure. In appropriately selected patients, this approach could be an option when common vascular accesses are not available.

Viability and functional recovery after chronic total occlusion percutaneous coronary intervention

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
R De Winter ◽  
S.P Schumacher ◽  
H Everaars ◽  
W.J Stuijfzand ◽  
P.A Van Diemen ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Functional Recovery ◽  
Coronary Intervention ◽  
Left Ventricular ◽  
Lv Function ◽  
Wall Thickening ◽  
Total Occlusion ◽  
Systolic Volume ◽  
End Diastolic Volume ◽  
Percutaneous Coronary

Abstract Background Current guidelines advocate viability assessment to guide percutaneous coronary intervention (PCI) of chronic coronary total occlusions (CTO). Purpose Aim of the present study was to evaluate viability as well as global and regional functional recovery after successful CTO PCI using quantitative cardiac magnetic resonance (CMR) imaging. Methods 132 patients with sequential CMR at baseline and 3-months after successful CTO PCI were prospectively recruited between 2013 and 2018. Segmental wall thickening (SWT) and percentage late gadolinium enhancement (LGE) were quantitatively measured per segment. Viability was defined as dysfunctional myocardium (&lt;2.84mm SWT) with no or limited scar (≤50% LGE). Results Significant improvements in left ventricular (LV) ejection fraction (from 48.1±11.8 to 49.5±12.1%, p&lt;0.01), LV end-diastolic volume (from 99.1±31.8 to 95.7±30.2ml, p&lt;0.01), and LV end-systolic volume (from 54.4±30.5 to 51.2±29.3ml, p&lt;0.01) were observed after CTO PCI. CTO segments with viability (N=216, (31%)) demonstrated a significantly higher increase in SWT (0.80±1.39mm) compared to CTO segments with pre-procedural preserved function (N=456 (65%), 0.07±1.43mm, p&lt;0.01) or extensive scar (LGE &gt;50%, N=26 (4%), −0.08±1.09mm, p&lt;0.01). Improvement in SWT was comparable between segments with viability if further stratified to 0, &gt;0–25, and &gt;25–50% hyperenhancement (p=0.94). Patients with ≥2 CTO segments viability showed more SWT increase in the CTO territory compared to patients with 0–1 segment viability (0.49±0.93 vs. 0.12±0.98mm, p=0.03). Conclusions Improvements in LV function and volumes were significant but modest following CTO PCI. Detection of dysfunctional myocardial segments without extensive scar (≤50% LGE) as a marker for viability may aid in identifying subjects with significant regional functional recovery after CTO PCI. Funding Acknowledgement Type of funding source: None

Abstract 2664: Clinical Outcome and Left Ventricular Contractile Function After Distal Protection in Primary Percutaneous Coronary Intervention The Drug Elution and Distal Protection in ST-Elevation Myocardial Infarction (DEDICATION) Trial

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Klaus F Kofoed ◽  
Henning Kelbæk ◽  
Leif Thuesen ◽  
Steen H Poulsen ◽  
Christian Hassager ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Clinical Outcome ◽  
Wall Motion ◽  
Contractile Function ◽  
Coronary Intervention ◽  
Left Ventricular ◽  
Lv Function ◽  
Percutaneous Coronary ◽  
Distal Protection

Objective Embolization of material from an infarct-related lesion during percutaneous coronary intervention (PCI) may result in an increased infarct size. We evaluated the effect of distal protection during PCI for ST-segment elevation myocardial infarction (STEMI) on clinical outcome and myocardial function. Methods and results Patients with STEMI were randomly referred within 12 hours for PCI with (n = 312) or without distal protection (n = 314). Left ventricular (LV) contractile function was assessed with echocardiography 8 month after PCI. Global LV myocardial wall motion index (WMI) was calculated as the average wall motion score of all myocardial segments. Major adverse cardiac and cerebral events (MACCE) 8 months after PCI was 7.1 % after distal protection and 5.7 % after conventional treatment (p = 0.17). WMI improved by 4.1% at 8 months in patients treated with distal protection compared to patients receiving conventional PCI (p<0.01). In myocardium subtended by culprit coronary vessels treated with distal protection regional LV function was 9 –11% higher than myocardial regions treated conventionally (p<0.02). Conclusion Routine use of distal protection during primary PCI is associated with a significant improvement in LV contractile function, with no detectable impact on intermediate term clinical outcome.

scholarly journals Evaluation of patients with myocardial infarction undergoing percutaneous coronary intervention (PCI) using low dose dobutamine stress echocardiography

2019 ◽  
Vol 10 (2) ◽  
pp. 1516-1522
Author(s):  
Reem Jamal Jabir ◽  
Affan Ezzat Hasan ◽  
Qasim Mohammed Jumaah ◽  
Layth Rafea Taqa
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Low Dose ◽  
Heart Diseases ◽  
Coronary Intervention ◽  
Left Ventricular ◽  
Ischemic Myocardium ◽  
Lv Function ◽  
P Value ◽  
Percutaneous Coronary

Coronary artery disease (CAD) is a spectrum of heart diseases which has the highest mortality in the world. Systolic left ventricular (LV) function is an important predictor of outcome, and its precise assessment remains of great importance for the choice of treatment in populations with myocardial infarction (MI). This study was aimed to assess the function and viability of ischemic myocardium of LV before and after the percutaneous coronary intervention (PCI) by using 2dimentional (2D) STE with LDDSE and to know the usefulness of low dose dobutamine (LDD) test in detecting the viable ischemic LV area. The results of the current study revealed there was a significant decrease (improvement) in GLS before dobutamine from (-10.49±3.4) to (-12.87±3.44) after dobutamine. Then there was a significant increase (deterioration) in GLS from (-12.87±3.44) after giving 5 mg/kg/min dobutamine to (-11.56±3.29) after giving 10 mg/kg/min dobutamine (P value < 0.001). While there were no significant differences in GLS after low dose dobutamine (-12.87±3.44) with the same parameters 3-6 months after PCI (-13.48±3.7). Left anterior descending artery (LAD) is the most common affected artery in our study. The study concluded that GLS provides a sensitive measure of LV function and appears reduced despite preserved LVEF also GLS can detect the viability of ischemic myocardium of LV with using LDD test which then assessed by PCI.

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