الفهرس 
Introduction and Aim of the WorkOnly 14 pages are availabe for public view
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Abstract
Background : Percutaneous coronary intervention (PCI) is an established procedure for the treatment of coronary artery disease. Its usefulness in symptom relief is well established. However, the effect of PCI on systolic and diastolic function in patients with preserved baseline left ventricular systolic function is unknown. Tissue Doppler echocardiography is emerged as a sensitive and quantitative measure of both systolic and diastolic longitudinal myocardial function. Furthermore, it has been reported that impaired left ventricular longitudinal function may precede circumferential ventricular dysfunction in patients with coronary artery disease. We hypothesized that although not evident on standard 2-dimensional echocardiography or contrast ventriculography, reduced regional contractile function distal to coronary artery stenosis may be present in patients with chronic stable angina and that PCI would have the potential to improve ventricular systolic and diastolic function after successful angioplasty.
Aim of the work: The aim of the study is to assess the effect of percutaneous coronary intervention (PCI) on regional left ventricular systolic and diastolic functions using tissue Doppler (TDI), in patients with chronic stable angina with no visible regional wall motion abnormalities, and to compare these changes between the longitudinal and short axial functions of the left ventricle.
Patients & Methods: The study was carried out in cardiology departments in Zagazig university hospitals, in the period between June 2012 and May 2013, the study included 60 patients with chronic stable angina, who were on standard anti-ischemic medications according to the guidelines on the management of stable angina pectoris of the European Society of Cardiology. Different parameters were compared in the same sample of patients before and after intervention, percentage of change in different variables was compared in different areas of the myocardium with and without relating it to the vessels revascularized. All patients were subjected to all of the following: Complete history taking, Full general and local examination, Conventional Echocardiographic evaluation, Tissue Doppler evaluation of systolic & diastolic function 1 day before and 1 day after PCI, including systolic and diastolic velocities in longitudinal axis at the Septal, lateral, Posterior, and Anterior angles of the mitral annular ring, and on the lateral angle of the tricuspid valve to assess the right ventricular function. Radial LV function was evaluated in the anterior and posterior LV regions, in the epicardial and subendocardial areas, Coronary Angiography, Calculation of Gensini score, PCI and Revaluation of the LV and RV function by conventional and TDI after 24 hours of intervention as before.
Results: There was a global improvement of both systolic and diastolic TDI irrespective to the artery revascularized as the myocardium act as a single unite showing improvement in remote areas to some extent even if the opened artery was not supplying that area directly. There was a good agreement that areas supplied directly by the vessel revascularized show the greatest improvement which could be detected by TDI measurements with high reproducibility and accuracy. When we assessed radial functions in areas corresponding to the revascularized vessel there was significant improvement especially in the subendocardial regions when compared to epicardial regions showed that the subendcardial regions was the most affected by myocardial ischemia and the best to improve with revascularization when compared to epicardial region. The results of our study were the first to show that although the amplitude of TDI signal in the longitudinal axis is more than radial axis, the percentage of improvement in radial axis is significantly more than the percentage of improvement in longitudinal axis after revascularization in chronic stable angina patients. Our study revealed that older diabetic females with higher angina class showed the best benefit from revascularization as assessed by the percentage of improvement in systolic and diastolic functions in the endocardial radial axis. Conclusion: The effect of PCI in patients with chronic stable angina goes beyond pain relief, as it rejuvenates the apparently normal myocardium, at the level of both systolic and diastolic functions in the longitudinal and radial axis. Elderly diabetic women are a high-risk group of patients that deserve aggressive intervention as they show the best pay off.
Key words: PCI (Percutaneous coronary intervention), TDI (Tissue Doppler Imaging), LV (left ventricle), RV (right ventricle). *Corresponding author. E-mail address: dr.alaarmy@yahoo.com . (Alaa Ramadan). Cardiology Department, Faculty of Medicine, Zagazig University<br.