Hemamalini Padma Kavirayani1 , Jenny Madhuri Gudivada2
BACKGROUND Although percutaneous coronary intervention (PCI) is an excellent therapy for coronary artery disease, the effects of PCI on left ventricular diastolic function have not been systematically investigated in patients of Acute ST Elevation Myocardial Infarction (STEMI) in our population. The aim of this study was to investigate the reversibility of these diastolic abnormalities and improvement in left ventricular diastolic function by using echocardiographic diastolic parameters in patients with Acute STEMI in the setting of PCI and thus determine the effects of improved myocardial perfusion on impaired left ventricular diastolic abnormalities. METHODS A total of 100 consecutive patients admitted to Intensive Coronary Care Unit (ICCU), was included in the study. Echocardiography was done before PCI and 48 hours after PCI, to evaluate the indices of LV diastolic function in these patients. RESULTS The mean age of the patients was 52.04 ± 9.49 years, and majority of patients were males (84%). All had mild to moderate degree of left ventricular diastolic dysfunction. Mitral E wave velocity (63.41 cm/s ± 19.93 before treatment versus 71.51 cm/s ± 9.56, 48 hours after treatment), the peak velocity of late filling due to atrial contraction (mitral A wave velocity) (75.93 cm/s ± 20.3 before treatment vs. 78.96 cm/s ± 24.18, 48 hours after treatment), E/A ratio (1.03 ± 0.3 before treatment vs. 0.98 ± 0.24, 48 hours after treatment) showed improvement after PCI. After PCI deceleration time (DT) decreased (210.15 msec ± 47.43 before treatment versus 201.64 msec ± 28.15, 48 hours after treatment), and the difference was statistically significant (p<0.001). It is notable that early diastolic mitral annular velocity (E’) improved significantly 48 hours after PCI (5.81 cm/s ± 1.65 before treatment vs. 7.96 cm/s ± 1.95, 48 hours after treatment, p < 0.001). E/ E2 ratio showed significant change 48 hours after PCI; it was statistically significant (10.17 ± 2.26 before treatment vs. 8.83 ± 1.7, 48 hours after treatment p<0.001). CONCLUSIONS Improvement in some indices of left ventricular diastolic function after PCI suggests that PCI can be an effective modality of treatment for diastolic dysfunction caused by myocardial ischemia and revascularization can restore diastolic properties of the heart after the insult in STEMI patients and thus prevent their progression to HFPEF.
