Abstract
Objective: to compare the left ventricle (LV) functional parameters and the results of stress echocardiography in patients with and without adverse cardiovascular events (ACE) after percutaneous coronary interventions (PCI) and to identify predictors of ACE.
Material and methods. Research included 112 patients with ischemic heart disease, the mean age was 67.2 ± 2.0 years. There were 24 patients with ACE in group I and 88 patients in group II without ACE after PCI. The study design was based on the comparative principle between the groups. Echocardiographic parameters at rest, stress echocardiography data with a high load was carried out in research patients. Evaluation points were preoperative period, 1 year after PCI, long-term period (6.3 ± 0.3 years).
Results. It was found that at rest echocardiography in patients who subsequently developed ACE, LV end-systolic volume (ESV) was slightly higher (p = 0.05). LV end-diastolic volume (EDV) and LV ejection fraction (EF) (p > 0.05) did not differ between the groups. The number of asynergic segments detected at rest and their localization were relatively similar in both groups (p > 0.05). One year after PCI, the average LV ESV, LV EDV, LV EF, the number of asynergic segments did not differ significantly between the groups (p > 0.05). In the long-term follow-up in group I, there was decreased average LV EF (p = 0.04) and increased number of asynergic segments at rest (p > 0.05), then in group II.
According to stress echocardiography, before endovascular intervention, the tolerance threshold was significantly lower in patients of group I (p = 0.001). In 1 year after PCI, the average tolerance threshold according to the Bruce protocol was 2.1 ± 0.27 steps in group I, 2.9 ± 0.11 steps in group II (p = 0.002),
the average duration was 6.33 ± 0.73 and 8.1 ± 0.13 min in groups I and II, respectively (p = 0.02). When examined in the long term after PCI, the average tolerance threshold according to the Bruce protocol in group I was significantly lower than in group II (p = 0.001). The Duke index in patients of groups I and II also differed significantly (p = 0.0001).
The predictors of adverse cardiovascular events within the univariate model were the Duke index (p = 0.001), the new segments of asynergy (p = 0.012), low exercise tolerance (p = 0.031), and LV EF less than 35% at rest (p = 0.024). According to the multivariate model, only the Duke index preserved predictive value.
Conclusion. The predictors of ACE were the Duke index, the appearence of new asynergy segments, low exercise tolerance and LV EF less than 35% at rest.
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About the authors
- Elena Z. Golukhova, Professor, Academician of the Russian Academy of Sciences, Director of Center; ORCID
- Leo A. Bockeria, Academician of the Russian Academy of Sciences, President of Center; ORCID
- Inga V. Tetvadze, Cand. Med. Sci., Chief Physician of V.I. Burakovsky Institute of Cardiac Surgery; ORCID
- Aleksey A. Kupryashov, Cand. Med. Sci., Head of Department, Transfuziologist; ORCID
- Anton I. Skopin, Cand. Med. Sci., Cardiovascular Surgeon; ORCID
- Sevindzh K. Mamedova, Cand. Med. Sci., Junior Researcher; ORCID
- Lana N. Kirtbaya, Cand. Med. Sci., Cardiologist; ORCID
- Nargiz M. Magomedova, Cand. Med. Sci., Researcher, Cardiologist; ORCID
