Evaluation of right ventricular function in patients with right coronary artery chronic total occlusion combined with old inferior wall myocardial infarction

doi:10.3969/j.issn.1006-7795.2017.04.023

Abstract

Abstract: Objective To investigate the changes of right ventricular function in patients with right coronary artery (RCA) chronic total occlusion(CTO)combined with old inferior wall myocardial infarction(OIWMI) with two-dimensional echocardiography and to explore its clinical significance. Methods We studied 28 consecutive patients with RCA-CTO accompanied by OIWMI in Beijing Anzhen hospital, from June 2013 to October 2015. The patients were divided into the coronary collateral circulation(CCC) group and non-CCC group according to the results of coronary angiography. Echocardiography was performed in order to measure the right ventri cular fractional area change(RVFAC), tricuspid annular plane systolic excursion(TAPSE), myocardial performance index (MPI). Doppler echocardiography was used to measure tricuspid value diastolic blood flow velocity (E, A peak), this Dopplor measurement of tricuspid annulus diastolic velocity (e' and a'). The clinical features, interventional treatment, postoperative cardiovascular adverse events and average hospital stay were observed. Results Patients in the non-CCC group had lower TAPSE and RVFAC and a higher MPI, E/A ratio and E/e' ratio, it was suggested that the right ventricular systolic and diastolic function of non-CCC group were lower than those in the CCC group(P<0.05). Comparison of the two groups of interventional surgery, severe arrhythmia occurred in 0 cases in the CCC group and 8 cases(44.4%) in the non-CCC group, the difference was statistically significant(P<0.05). Postoperative severe arrhythmia occurred in the CCC group was 0 case and 7 cases(38.9%) in the non-CCC group, the difference was statistically significant(P<0.05). Comparison of the average number of hospital days in both groups, the average length of stay was longer in non-CCC group(P<0.05). Conclusion In patients of RCA-CTO combined with OIWMI, the poorly developed coronary collaterals have worse RV functions. Preoperative two-dimensional echocardiography can be used to evaluate the difference between the CCC group and non-CCC group and has a certain clinical significance.

Key words: echocardiography, right coronary artery chronic total occlusion(RCA-CTO), old inferior wall myocardial infarction(OIWMI), right ventricular function

CLC Number:

Zhang Qi, Chen Zhenwen. Evaluation of right ventricular function in patients with right coronary artery chronic total occlusion combined with old inferior wall myocardial infarction[J]. Journal of Capital Medical University, 2017, 38(4): 609-614.

0
/ / Recommend

Add to citation manager EndNote|Reference Manager|ProCite|BibTeX|RefWorks

URL: https://journal03.magtech.org.cn/Jweb_sdykdxxb/EN/10.3969/j.issn.1006-7795.2017.04.023

https://journal03.magtech.org.cn/Jweb_sdykdxxb/EN/Y2017/V38/I4/609

References

[1] Missiri A M, Guindy R R. Echocardiographic assessment of right ventricular functions in patients with proximal right coronary artery chronic total occlusion[J]. Int J Cardiovasc Imaging, 2016, 32(6):895-903.
[2] Suero J A, Marso S P, Jones P G, et al. Procedural outcomes and long-term survival among patients undergoing percutaneous coronary intervention of a chronic total occlusion in native coronary arteries: a 20-year experience[J]. J Am Coll Cardiol, 2001, 38(2): 409-414.
[3] Pancholy S B, Boruah P, Ahmed I, et al. Meta analysis of effect on mortality of percutaneous recanalization of coronary chronic total occlusions using a stent-based strategy[J]. Am J Cardiol, 2013, 111(4):521-525.
[4] Hoebers L P, Claessen B E, Dangas G D, et al. Contemporary overview and clinical perspectives of chronic total occlusions [J]. Nat Rev Cardiol, 2014, 11(8): 458-469.
[5] Engström A E, Vis M M, Bouma B J, et al. Right ventricular dysfunction is an independent predictor for mortality in ST-elevationmyocardial infarction patients presenting with cardiogenic shock on admission[J]. Eur J Heart Fail, 2010, 12(3):276-282.
[6] Schlangen J, Fischer G, Steendijk P, et al. Does left ventricular size impact on intrinsic right ventricular function in hypoplastic left heart syndrome[J].Int J Cardiol,2013,167(4): 1305-1310.
[7] Gibson C M, Dotani M I, Murphy S A, et al. Correlates of coronary blood flow before and after percutaneous coronary intervention and their relationship to angiographic and clinical outcomes in the RESTORE trial. Randomized efficacy study of tirofiban for outcomes and RESTENOSIS[J]. Am Heart J,2002, 144(1): 130-135.
[8] Kohi M P, Ordovas K G, Naeger D M, et al. CMR assessment of right ventricular function in patients with combined pulmonary stenosis and insufficiency after correction of tetralogy of Fallot[J].Acta Radiol, 2013, 54(10): 1132-1137.
[9] Lee M Y, Won H S, Jeon E J, et al. Feasibility of using Auto Mod-MPI system,a novel technique for automated measurement of fetal modified myocardial performance index[J].Ultrasound Obstet Gynecol, 2014, 43(6): 640-645.
[10] 赵东晖,柳景华.冠状动脉慢性完全闭塞病变研究最新进展[J].心肺血管病杂志,2013,32(3):371-373.
[11] Sirnes P A, Golf S, Myreng Y, et al.Sustained benefit of stenting chronic coronary occlusion:long-term clinical follow up of the stenting in chronic coronary occlusion(SICCO)study[J].J Am Coll Cardiol, 1998, 32(2):305-310.
[12] Karatasakis A, Karmpaliotis D, Alaswad K, et al. Approaches to percutaneous coronary intervention of right coronary artery chronic total occlusions: insights from a multicentre US registry [J]. EuroIntervention, 2016,12(11):e1326-e1335.
[13] Fefer P, Knudtson M L, Cheema A N, et al. Current perspectives on coronarychronic total occlusions: the canadian multicenter chronic total occlusions registry [J]. J Am Coll Cardiol, 2012, 59(11):991-997.
[14] Jabbar A, Christopoulos G, Karatasakis A, et al. Impact of chronic total occlusion revascularization attempts on subsequent clinical outcomes [J]. J Invasive Cardiol, 2016, 28(12):E185-E192.
[15] Migliorini A, Valenti R, Parodi G, et al. The impact of right coronary artery chronic total occlusion on clinical outcome of patients undergoing percutaneous coronary intervention for unprotected left main disease[J]. J Am Coll Cardiol, 2011,58(2): 125-130.
[16] Takagi K, Ielasi A, Chieffo A, et al. Impact of residual chronic total occlusion of right coronary artery on the long-term outcome in patients treated for unprotected left main disease: the Milan and New-Tokyo registry[J]. Circ Cardiovasc Interv, 2013, 6(2):154-160.
[17] Yang Z K, Shen Y, Hu J, et al. Impact of coronary collateral circulation on angiographic in-stent restenosis in patients with stable coronary artery disease and chronic total occlusion[J]. Int J Cardiol, 2017,227:485-489.
[18] Möbius-Winkler S, Uhlemann M, Adams V, et al. Coronary collateral growth induced by physical exercise: results of the impact of intensive exercise training on coronary collateral circulation in patients with stable coronary artery disease (EXCITE) Trial [J].Circulation, 2016,133(15):1438-1448.
[19] McEntegart M B, Badar A A, Ahmad F A, et al. The collateral circulation of coronary chronic total occlusions [J].EuroIntervention, 2016,11(14):e1596-e1603.