[The use of tissue Doppler imaging for the diagnosis of restenosis after percutaneous coronary revascularisation].
OBJECTIVE AND AIM OF THE STUDY: Diagnosis of restenosis after percutaneous transluminal coronary angioplasty (PTCA) is difficult due to low sensitivity and specificity of widely used methods. The aim of the study was to evaluate the usefulness of tissue Doppler Imaging (TDI) in the diagnosis of restenosis in comparison with the results of clinical examination, electrocardiographic exercise test (ETT) and wall motion score index (WMSI) analysis.


METHODS
22 patients (18 males, 4 females) aged 46-69 with coronary artery disease who underwent PTCA, with restenosis of widen artery found during one-year follow-up. The angioplasty of anterior descending artery was made in 16 patients, circumflex artery was widened in 2 patients, right coronary artery in 4 patients. Clinical and echocardiographic examinations, ETT and TDI were made in all the patients before PTCA, one month after PTCA and during restenosis before control coronary angiography. In TDI examination maximal systolic and maximal early diastolic velocities of myocardium were determined in 18 left ventricle segments.


RESULTS
After the procedure significant decrease of clinical symptoms and ST depression during ETT were found. Restenosis resulted in recurrence of clinical symptoms and ETT parameter worsening. No significant changes in the mean values of left ventricle ejection fraction was observed after PTCA or during restenosis. Mitral inflow E/A ratio was decreased before PTCA, after PTCA and during restenosis. In 12 (55%) patients despite significant coronary artery stenosis, WMSI was normal (1.0) both before PTCA, after PTCA and during restenosis. In 10 (45%) patients with anterior descending artery stenosis regional contractility disturbances were found before PTCA. After revascularisation WMSI decreased in only 4 patients. During TDI examination in patients with contractility disturbances before PTCA, revascularisation resulted in significant systolic myocardial velocity increase, and restenosis was manifested by renewed systolic myocardial velocity decrease. Early diastolic myocardial velocities in ischaemic segments were significantly decreased before PTCA in all the patients, and no increase were found despite effective PTCA.


CONCLUSIONS
Significant coronary artery stenosis leads to left ventricle diastolic function disturbances, however may not result in systolic dysfunction. After PTCA procedure significant systolic left ventricle function improvement, expressed by increase of systolic myocardial velocity in ischaemic segments, no changes of diastolic left ventricle function is seen. Restenosis in patients after PTCA is manifested by renewed decrease of systolic myocardial velocity in ischaemic segments.
Płazak
Wojciech
W
Klinika Chorób Serca i Naczyń, Krakowski Szpital Specjalistyczny im. Jana Pawła II, Instytutu Kardiologii Collegium Medicum, Uniwersytetu Jagiellońskiego w Krakowie. wplazak@szpitaljp2.krakow.pl
Tracz
Wiesława
W
Kabłak-Ziembicka
Anna
A
Krochin
Marek
M
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects; D023903:Coronary Restenosis / Q000000981:diagnostic imaging* / Q000503:physiopathology; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D015150:Echocardiography, Doppler / Q000379:methods*; D004562:Electrocardiography / Q000379:methods; D005080:Exercise Test; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012680:Sensitivity and Specificity