Results of percutaneous coronary interventions in patients with dysfunctional myocardium.

Abstract

Aim: to evaluate immediate and long-term results of endovascular treatment of patients with dysfunctional viable myocardium. Material and methods. 220 patients were included in the study and were divided into 2 groups. The main group (n=138) included patients with proven ischemia and the presence of viable myocardium in the post-MI zone, on account of which they performed endovascular intervention on the arteries that supply the viable myocardium. The control group (n=82) was formed retrospectively and included patients who were on optimal medical therapy, with invasive diagnostics and endovascular treatment not performed by such patients. The viability of the myocardium was determined by the methods ofMRI of the heart with delayed contrast and the method of stress echocardiography with dobutamine. Inclusion criteria: angina pectoris II-IV functional class (CCS); the presence of proven myocardial ischemia according to stress tests; occlusion or subtotal stenosis of one or more coronary arteries according to digital angiography (SYNTAX score <32); presence of segments with disturbed local contractility of left ventricular myocardium; presence of a viable myocardium in the zone of the occluded / stenotic artery; circulatory failure of I-III functional class (NYHA); left ventricular ejection fraction (LVEF) less than 50%. Results. The magnetic resonance imaging (RMI) with delayed contrasting at the preoperative stage allows to reliably estimate the existing violations of local contractility in the zone of the hibernated myocardium, in comparison with the method of stress echocardiography with dobutamine. After 12 and 18 months of follow-up, there was a significant increase in the incidence of non-fatal MI in the control group. In all patients in the long-term period after PCI completion, a significant increase in the left ventricular ejection fraction and an improvement in the local contractility of the myocardium are noted. Among patients who underwent MRI of the heart, it was possible to detect a significant decrease in the mass fraction of ischemic myocardium in the post-MI zone. There was a strong positive correlation (r = 0.54, p<0.05) between the duration of myocardial hibernation and the timing of restoration of its function after PCI. Conclusion. PCI performance in patients with dysfunctional viable myocardium is highly effective, compared with patients receiving only medication. The method of MRI of the heart with delayed contrast allows judging more objectively the dynamics Оригинальные исследования of the restoration of the function of the hibernated viable myocardium and remodeling of the heart after the revascularization, in comparison with stress echocardiography with dobutamine.