engleski

The association of CABG vs. PCI on echocardiographic indices of global longitudinal strain and myocardial work in patients with HFrEF and ischemic cardiomyopathy: a pilot study

Background: It is unknown if the mode of coronary revascularization among patients with heart failure with reduced ejection fraction (HFrEF) of ischemic etiology may differentially impact on advanced echocardiographic indices of myocardial function, independently of traditional parameters such as left ventricular ejection fraction (LVEF). Purpose: To determine whether the mode of coronary revascularization is associated with the difference in advanced echocardiographic parameters reflecting myocardial function among patients with HFrEF and ischemic cardiomyopathy. Methods: Forty consecutive HFrEF (LVEF <40%) patients with ischemic cardiomyopathy that were revascularized with coronary artery bypass surgery (CABG) or percutaneous coronary intervention (PCI) were included in the analysis. Patients were matched in a 1:1 fashion concerning the baseline LVEF while the transthoracic echocardiographic examination was performed by a single sonographer with high expertise in advanced echocardiographic studies. Myocardial functional parameters such as global longitudinal strain (GLS) and global work index (GWI) were compared between the two groups of interest (CABG versus PCI). Echocardiographic examination was performed by using a commercially available ultrasound system. The student t-test was used to examine potential differences between the two groups. Results: The mean age of the whole HFrEF cohort was 70.3 ± 9.7 years, 90% were male (N=36) while the average LVEF was 28.5 ± 7.4 %. Both groups of interest did not significantly differ in age (p=0.655), LVEF (p=0.983), diastolic function (p=0.830), arterial systolic, and diastolic blood pressure (p=0.195 and p=0.918, respectively). Furthermore, both groups were similar concerning hemoglobin (p=0.565), serum creatinine (p=0.376), high-sensitivity cardiac troponin I (p=0.553) and NT- proBNP (p=0.710) values (Table 1). Patients that were revascularized with CABG demonstrated significantly higher GLS (-7.8 ± 3.0 vs. -5.9 ± 2.2 %, p=0.028 ; Figure 1A) and GWI (752 ± 401 vs. 492 ± 255 mm Hg%, p=0.019 ; Figure 1B) values when compared to those revascularized with PCI. Conclusions: Among patients with HFrEF and ischemic cardiomyopathy, those revascularized with CABG demonstrated better myocardial function parameters than those that received PCI. Both groups had a similar systolic and diastolic function, anthropometric parameters, renal function, and similar levels of circulating biomarkers reflecting myocardial injury and stretch. These results suggest a more complete functional revascularization of the myocardium with CABG surgery as opposed to PCI in this population. Finally, our results show that novel and advanced echocardiographic modalities might aid in the identification of residual functional impairment of the myocardium, irrespective of traditional and conventional parameters of systolic and diastolic function.

ischemic cardiomyopathy ; heart failure ; percutaneous coronary intervention ; PCI ; coronary artery bypass grafting ; CABG ; revascularization ; advanced echocardiography ; myocardial work

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