Evaluation the Rate of Reverse Remodeling After Elective PCI in Patients with Ventricular Dysfunction

Abstract

Introduction: Therapies that showed the pathology of left ventricular remodeling are often associated with improved outcomes. The incidence and impact of reverse left ventricular (LV) remodeling after percutaneous coronary intervention (PCI) is still unknown. Reverse remodeling is associated with improved long-term prognosis in patients with acute myocardial infarction. However, its determinants are still not fully understood. On the other hand, due to the increasing use of PCI in the treatment of coronary artery disease, its complications are significant, so this study was conducted with the aim of investigating the rate of reverse remodeling after elective PCI in patients with ventricular dysfunction.

Method and material: This study was a cohort study. The invited cases were examined by trained people after providing explanations and completing the informed consent form. According to the vascular involvement in angiography, PCI patients were performed by a specialist on the involved vessel. For candidate patients, PCI was performed on the day of admission in the hospital, and echocardiography was performed. These patients had received the same drug intervention, including aspirin and Plavix, beta-blocker and ACE-inhibitor. The patients were hospitalized for one day and after the visit due to the absence of angiography complications such as re-bleeding at the angiography site and hematoma and bruising at the site, they were discharged with medication instructions. Also, 6 months after PCI, the patients underwent the evaluation of the above indicators by echocardiography again. The demographic characteristics of the patients were investigated. Also, hemoglobin, cardiac output and mitral valve insufficiency were evaluated before and after PCI.

Results: The present study was conducted on 100 referring patients who were candidates for PCI. Our results showed that 62 of the patients were men and 38 were women. The average age was 62.79 for men and 62.71 for women. Patients had underlying disease of diabetes, kidney problem (ESRD), ischemic heart disease (IHN) and high blood pressure (HTN). The highest rate of vascular involvement among patients was related to the RCA vein. With the increase in the number of underlying diseases, the number of involved vessels also increased, heart rate and diastolic failure showed improvement 6 months after the intervention, and the MR rate decreased significantly after the intervention. The findings show that PCI has been able to increase the percentage of cardiac efficiency. It should be noted that this increase of 6.5% (EF>5%) is completely significant (P<0.0001). In our study, the number of people with normal left ventricular size increased after the intervention.

Conclusion: PCI with hemodynamic support may be a potential therapeutic strategy to select patients with underlying cardiac and renal disease and reduced EF. Also, PCI is effective in improving mitral valve failure, diastolic failure and improving heart rate and reverse remodeling of the left ventricle.