Assessment of Regional Myocardial Function using Tissue Doppler Imaging before and after PTCA of left anterior descending coronary Artery

INTRODUCTION: Regional wall motion abnormalities are frequently seen in coronary artery disease and diastolic function is impaired before systolic dysfunction in these patients. Reperfusion with percutaneous coronary intervention has been shown to improve the left ventricular systolic and diastolic function. Changes in the regional ventricular function may appear before alteration of global ventricular function in coronary artery disease. The most recent approach to analysis of regional wall motion is with Doppler tissue imaging or Speckle tissue tracking. Systolic and diastolic velocities of myocardium in cardiac cycle can be recorded quantitatively by Tissue Doppler Imaging and thereby provides a newer way of assessing left ventricular function which is more sensitive than traditional methods. Tissue Doppler imaging has a high sensitivity, high feasibility, reproducibility and ease of application in acute coronary syndrome Tissue Doppler imaging is easily available in most of the centres. Tissue Doppler parameters such as Sm (peak systolic velocity), Em (early diastolic velocity) and Am (late diastolic velocity) are powerful predictors of cardiac mortality. AIM OF THE STUDY: 1. To evaluate the Regional Myocardial Function using Tissue Doppler Imaging before and after Percutaneous Transluminal Coronary Angioplasty. 2. To assess the extent to which these tissue Doppler indices change 24 hours before Percutaneous Transluminal Coronary Angioplasty, 24 hours after Percutaneous Transluminal Coronary Angioplasty and 3 months after Percutaneous Transcutaneous Coronary Angioplasty. 3. To evaluate how this helps to know the success of Percutaneous Transluminal Coronary angioplasty. MATERIALS AND METHODS: This prospective non randomized follow up study was carried out at Rajiv Gandhi Government General Hospital, Chennai. This study was done between March 2012 to January 2013. This study was approved by our institution ethical committee. SELECTION OF STUDY SUBJECTS: INCLUSION CRITERIA: 1. All patients with Stable angina and prior Myocardial Infarction with age above 30 years and both sex. 2. Patients with prior coronary angiogram showing isolated Left anterior descending coronary artery disease suitable for elective percutaneous intervention and stenting were included. EXCLUSION CRITERIA: Patients with any of the following criteria were excluded from the study 1. Patients with Non ST Elevation Myocardial Infarction, Unstable angina, Acute ST Elevation Myocardial Infraction 2. Patients with multivessel coronary artery disease, left circumflex coronary artery disease, right coronary artery disease. 3. Patients with valvular heart disease, cardiomyopathy, atrial fibrillation, prior coronary revascularization, congenital heart disease, moderate to severe left ventricular systolic dysfunction (Ejection Fraction less than 40%). CONCLUSION: From our prospective follow up study, we showed that tissue Doppler myocardial imaging indices such as Sm, Em, Am will be helping us to decide the improvement in left ventricle function following angioplasty. Our findings are similar to previous animal and human studies. In conclusion we can use tissue Doppler imaging as an easily available technique to assess the reperfusion and change in regional ventricle function and success of angioplasty