ISSN 2415-3060 (print), ISSN 2522-4972 (online)
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JMBS 2022, 7(5): 119–123
https://doi.org/10.26693/jmbs07.05.119
Clinical Medicine

Assessment of Mechanical Myocardial Dyssynchrony in Patients with Different Forms of Coronary Heart Disease Undergoing Revascularization

Mehtieva F. B., Bilchenko O. V.
Abstract

The purpose of the study was to determine the presence of mechanical dyssynchrony of the myocardium in patients with various clinical variants of coronary heart disease undergoing revascularization. Materials and methods. 137 patients (106 men and 31 women, aged from 31 to 81 years) took part in the study, including 121 patients with coronary heart disease who underwent a revascularization procedure. Results and discussion. The frequency of detection of mechanical dyssynchrony of the myocardium is significantly higher in patients with coronary heart disease compared to patients without coronary heart disease who underwent revascularization (41.3% vs. 6.2%, respectively). Aortic transit time was significantly and significantly greater in the group of patients with coronary heart disease compared to patients without coronary heart disease, while pulmonary transit time was the same in the comparison groups. Accordingly, this caused a significant difference in interventricular mechanical delay. Left ventricular filling time was significantly shorter in the group of patients with coronary heart disease and, conversely, left ventricular ejection time was shorter in the group of patients without coronary heart disease. The study showed a significant increase in the frequency of myocardial dyssynchrony in patients with coronary heart disease who underwent revascularization, which creates conditions for studying the prognostic value in relation to the clinical results of revascularization. The time of advancement to the aorta was significantly and reliably longer in the group of patients with coronary heart disease compared to patients without coronary heart disease, while the time of advancement to the pulmonary artery was the same in the comparison groups, which caused a significant difference in the interventricular mechanical delay and confirms dependence of the development of myocardial dyssynchrony on the localization of the coronary artery lesion. Conclusion. Indicators of diastolic dysfunction of the left ventricular myocardium, although there was a tendency for a difference between the group of patients with coronary heart disease and the comparison group, this tendency was unreliable, which demonstrated their later change in relation to the indicators of myocardial dyssynchrony. The data obtained by us confirm the greater informativeness of mechanical dyssynchrony of the left ventricle indicators in comparison with indicators that characterize diastolic function and their earlier changes in patients with coronary heart disease. In turn, early detection and treatment of mechanical dyssynchrony of the left ventricle can delay the onset of left ventricular dysfunction in patients with coronary heart disease

Keywords: chronic coronary syndrome, acute coronary syndrome, left ventricular remodeling, diastolic function, percutaneous coronary interventions

Full text: PDF (Ukr) 251K

References
  1. Aktaa S, Gencer B, Arbelo E, Davos CH, Désormais I, Hollander M, et al. European Society of Cardiology Quality Indicators for Cardiovascular Disease Prevention: developed by the Working Group for Cardiovascular Disease Prevention Quality Indicators in collaboration with the European Association for Preventive Cardiology of the European Society of Cardiology. Eur J Prev Cardiol. 2022 May 25;29(7):1060-1071. PMID: 34687540. https://doi.org/10.1093/eurjpc/zwab160
  2. Neumann FJ, Sousa-Uva M, Ahlsson A, Alfonso F, Banning AP, Benedetto U, et al. 2018 ESC/EACTS Guidelines on myocardial revascularization. Eur Heart J. 2019 Jan 7;40(2):79-80. PMID: 30615155. https://doi.org/10.1093/eurheartj/ehy855
  3. Towashiraporn K. Current recommendations for revascularization of non-infarct-related artery in patients presenting with ST-segment elevation myocardial infarction and multivessel disease. Front Cardiovasc Med [Internet]. Front Cardiovasc Med. 2022 Aug 11;9:969060. PMID: 36035910. PMCID: PMC9402999. https://doi.org/10.3389/fcvm.2022.969060
  4. Fudim M, Dalgaard F, Fathallah M, Iskandrian AE, Borges-Neto S. Mechanical dyssynchrony: How do we measure it, what it means, and what we can do about it. J Nucl Cardiol. 2021 Oct;28(5):2174-2184.
  5. PMID: 31144228. https://doi.org/10.1007/s12350-019-01758-0
  6. Fudim M, Fathallah M, Shaw LK, Liu PR, James O, Samad Z, et al. The Prognostic Value of Diastolic and Systolic Mechanical Left Ventricular Dyssynchrony Among Patients With Coronary Heart Disease. JACC Cardiovasc Imaging. 2019 Jul;12(7 Pt 1):1215-1226. PMID: 30031704. https://doi.org/10.1016/j.jcmg.2018.05.018
  7. Garcia MJ, Kwong RY, Scherrer-Crosbie M, Taub CC, Blankstein R, Lima J, et al. State of the Art: Imaging for Myocardial Viability: A Scientific Statement from the American Heart Association. Circ Cardiovasc Imaging. 2020 Jul;13(7):e000053. PMID: 32833510. https://doi.org/10.1161/HCI.0000000000000053
  8. Panza JA, Ellis AM, Al-Khalidi HR, Holly TA, Berman DS, Oh JK, et al. Myocardial Viability and Long-Term Outcomes in Ischemic Cardiomyopathy. N Engl J Med. 2019 Aug 22;381(8):739-748. PMID: 31433921. PMCID: PMC6814246. https://doi.org/10.1056/NEJMoa1807365
  9. Gimelli A, Liga R, Giorgetti A, Favilli B, Pasanisi EM, Marzullo P. Determinants of left ventricular mechanical dyssynchrony in patients submitted to myocardial perfusion imaging: A cardiac CZT study. J Nucl Cardiol. 2016 Aug;23(4):728-36. PMID: 26338425. https://doi.org/10.1007/s12350-015-0247-8
  10. Park S, Cheon GJ, Paeng JC, Won KS, Kang KW, Kim KB, et al. Phase analysis of gated myocardial perfusion single-photon emission computed tomography after coronary artery bypass graft surgery: Reflection of late reverse remodeling in patients with patent grafts after coronary artery bypass graft surgery. Nucl Med Commun. 2016;37(11):1139-47. PMID: 27341412. https://doi.org/10.1097/MNM.0000000000000565
  11. Hess PL, Shaw LK, Fudim M, Iskandrian AE, Borges-Neto S. The prognostic value of mechanical left ventricular dyssynchrony defined by phase analysis from gated single-photon emission computed tomography myocardial perfusion imaging among patients with coronary heart disease. J Nucl Cardiol. 2017;24(2):482-490. PMID: 26809439. https://doi.org/10.1007/s12350-015-0388-9
  12. Thygesen K, Alpert JS, Jaffe AS, Chaitman BR, Bax JJ, Morrow DA, et al. Fourth Universal Definition of Myocardial Infarction (2018). Circulation. 2018 Nov 13;138(20):e618-51.
  13. Collet JP, Thiele H, Barbato E, Bauersachs J, Dendale P, Edvardsen T, et al. 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J. 2021 May 21;42(20):2020-2021. PMID: 33186459. https://doi.org/10.1093/eurheartj/ehaa909
  14. Ibanez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Kardiol Pol. 2018;76(2):229-313. PMID: 29457615. https://doi.org/10.5603/KP.2018.0041
  15. Knuuti J, Wijns W, Saraste A, Capodanno D, Barbato E, Funck-Brentano C, et al. 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes. Eur Heart J. 2020 Jan 14;41(3):407-477. PMID: 31504439. https://doi.org/10.1093/eurheartj/ehz425
  16. 7.3.5. Do two arbitrary processes have the same central tendency? Available from: https://www.itl.nist.gov/div898/handbook/prc/section3/prc35.htm
  17. Karacalioglu AO, Balta Ş, Emer O, Demirkol S, Celik T, Ozguven M. Phase analysis in patients with reversible perfusion defects and normal coronary arteries at angiography. Ann Nucl Med. 2013;27(5):416-422. PMID: 23436215. https://doi.org/10.1007/s12149-013-0700-1
  18. Sharma RK, Donekal S, Rosen BD, Tattersall MC, Volpe GJ, Ambale-Venkatesh B, et al. Association of subclinical atherosclerosis using carotid intima-media thickness, carotid plaque, and coronary calcium score with left ventricular dyssynchrony: The multi-ethnic Study of Atherosclerosis. Atherosclerosis. 2015;239(2):412-8. PMID: 25682041. PMCID: PMC4361257. https://doi.org/10.1016/j.atherosclerosis.2015.01.041
  19. Zheng D, Liu Y, Zhang L, Hu F, Tan X, Jiang D, et al. Incremental Value of Left Ventricular Mechanical Dyssynchrony Assessment by Nitrogen-13 Ammonia ECG-Gated PET in Patients With Coronary Artery Disease. Front Cardiovasc Med. 2021;8:719565. PMID: 34722656. PMCID: PMC8555411. https://doi.org/10.3389/fcvm.2021.719565
  20. Zhang F, Yang W, Wang Y, Tang H, Wang J, Shao X, et al. Is there an association between hibernating myocardium and left ventricular mechanical dyssynchrony in patients with myocardial infarction? Hell J Nucl Med. 2018;21(1):28-34. PMID: 29550844. https://doi.org/10.1967/s002449910704