Improvement in Myocardial Strain after Percutaneous Coronary Intervention in Patients With Ischemic Cardiomyopathy

Background
Myocardial strain is a more sensitive indicator of myocardial function than left ventricular ejection fraction (LVEF). In patients with ischemic cardiomyopathy (ICM) and multivessel coronary artery disease, the effect of revascularization with percutaneous coronary intervention (PCI) on LV function, as measured by global longitudinal strain (GLS) and regional myocardial strain (RMS), has not yet been studied. This study aims to assess if there is an improvement in myocardial function following PCI in patients with ICM.

Methods
33 patients with multivessel coronary artery disease and ICM (baseline LVEF < 45%) who underwent predominantly non-emergent PCI and received pre- and post-PCI transthoracic echocardiograms, were identified for retrospective analysis. TOMTEC software was used for GLS and RMS analysis and myocardial function was compared pre- and post-PCI.

Results
Following PCI, GLS and RMS improved by an average of -3.0 (p = 0.0005) and -2.8 (p = 0.0006), respectively, while LVEF improved by 5.1% (p = 0.0082). Interestingly, in a subset of patients without a statistically significant change in LVEF (n = 28), there was a significant improvement in both GLS (-1.9; p = 0.0098) and RMS (-1.9; p = 0.0125) (Table 1).

Conclusions
In patients with ICM, multivessel coronary artery disease, and reduced LVEF, PCI results in improved myocardial function by both GLS and RMS, suggesting that there is a role for PCI in this population. Further studies evaluating myocardial strain as a predictor of clinical outcomes in this population are warranted.