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Choosing an effective methods for assessing the results of percutaneous coronary interventions in post-myocardial infarction patients

Session Poster Session 3

Speaker Associate Professor Daniil Maximkin

Event : Heart Failure 2019

  • Topic : heart failure
  • Sub-topic : Chronic Heart Failure – Diagnostic Methods: Imaging
  • Session type : Poster Session

Authors : Y Rustamova (Baku,AZ), V Azizov (Baku,AZ), G Imanov (Baku,AZ), D A Maximkin (Moscow,RU), A Faibushevich (Moscow,RU)

Y Rustamova1 , V Azizov1 , G Imanov1 , D A Maximkin2 , A Faibushevich2 , 1Azerbaijan Medical University, Internal Medicine - Baku - Azerbaijan , 2RUDN University - Moscow - Russian Federation ,

Chronic Heart Failure – Diagnostic Methods: Imaging

Aim: to evaluate the effectiveness of cardiac magnetic resonance (CMR) and stress-echocardiography in the assessment of long-term results of percutaneous coronary interventions (PCI) in post-MI patients with  dysfunctional myocardium.

Methods: 112 patients were participated in the study. Inclusion criteria: myocardial infarction in previously; angina II-III functional class (CCS); multivessel coronary disease (SYNTAXscore I <32); the presence of segments with abnormality left ventricular local contractility; chronic heart failure I-III functional class (NYHA); left ventricular ejection fraction (LVEF) is less than 45%. All patients underwent stenting of the coronary arteries in the zone of viable myocardium. Only drug-eluting stents were implanted in coronary arteries. Long-term results were followed up 18 months after PCI in all patients. All patients underwent stress-echocardiography and CMR for visualization of myocardium after PCI.

Results: on average, initially accounted for 2.12 ± 0.74 segments with abnormality kinetic per patient according CMR, whereas, according to stress echocardiography, the average number of segments was 1.96±0.42. The average difference was 0.16 segment [0.11-0.18; 95% CI, p=0.003]. In the postoperative period, after 18 months, there was a significant decrease a segments with abnormality kinetics in the zone of hibernated myocardium, from 2.12 to 1.08, according to CMR (the average difference was 1.04 segment) [0.98-1.1; 95% CI, p <0.01], and from 1.96 to 0.98 according to stress-echocardiography (the average difference was 0.98 segments) [0.94–0.99; 95% CI, p = 0.023]. There is a significant discrepancy between the number of identified segments with abnormality kinetics using CMR and stress- echocardiography. There was a significant decrease in the transmurality index from 0.42 to 0.31 (according to CMR). The difference was 0.11 [0.09-0.14; 95% CI, p <0.05]. At the same time, recovery of myocardial function was clearly manifested in patients with a trasmurality index of 0.3–0.5, whereas with a transmurality index of more than 0.5, reliable recovery of myocardial function was not observed.

Conclusion: CMR allows a more objective analysis of the results of PCI in patients with dysfunctional myocardium, as compared with the stress-echocardiography method.

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