P670Impact of embolic particles during coronary interventional procedures on regional myocardial wall motion in patients with stable angina pectoris


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Abstract

Purpose: Embolic particles liberated from plaque during percutaneous coronary intervention (PCI) causes myocardial injury. A Doppler guide wire (DGW) can detect embolic particles as high-intensity transient signals (HITS). We investigated the impact of peri-procedural microembolization on regional wall motion after PCI using 2-dimensional (2D)-speckle tracking method.Methods: We performed PCI to left anterior descending coronary arteries in 25 patients (18 men and 7 women, 68±8 years old) with stable angina pectoris. Inclusion criteria were 1) no apparent abnormalities in myocardial wall motion on echocardiography, 2) a single de novo lesion, and 3) successful PCI with residual stenosis less than 25%. We analyzed coronary flow spectrum with DGW to count the number of HITS during PCI procedures. In the days before and after PCI, we recorded echocardiography to analyze longitudinal peak strain (Ss), strain rate (SRs), and early diastolic strain rate (SRe) within at-risk area. In the day after PCI, cardiac troponin T (cTnT) was measured to evaluate myocardial injury.Results: Echo study showed no apparent abnormalities in wall motion after PCI as well as before. Average total number of HITS was 10±6 (ranged from 0 to 22, median was 9) throughout PCI procedures. Nineteen patients showed no elevation of cTnT in the day after PCI, while 6 patients showed positive value of cTnT. The total number of HITS was significantly higher in patients with cTnT elevation than in those without cTnT elevation (18±4 vs. 7±5, p<0.001). We compared echo parameters in between the days before and after PCI, and analyzed the correlation to the number of HITS. Ss and SRe significantly improved in case with the total number of HITS <10 (n=14, p<0.01). Ss, SRs, and SRe significantly worsened in case with the total number of HITS ≥10 (n=11, p<0.01). Improvements of Ss and SRe, which were respectively defined as the difference and the ratio between before and after PCI, had significant negative correlations to the total number of HITS (r=-0.65 and -0.68, respectively and p<0.001, both).Conclusions: Peri-procedural microembolization during PCI has a significant impact on regional systolic and diastolic function early after PCI. Strain analysis using 2D-speckle tracking is a useful method to assess PCI-induced subclinical change in regional cardiac function.

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