Effect of percutaneous coronary intervention on diastolic function in coronary artery disease

Background: Left ventricle (LV) diastolic dysfunction is often present in patients with significant coronary artery disease (CAD), even in the absence of regional or global LV systolic dysfunction. It has been suggested that abnormalities in LV diastolic function may actually precede LV systolic dysfunction, and therefore, serve as an early and sensitive marker of ischemia. This study aims to find improvement of diastolic function after percutaneous coronary intervention (PCI) in patients with stable or unstable angina. Methods: In this single-center hospital-based study, we enrolled 309 patients with either stable or unstable CAD and with normal systolic function who underwent successful PCI. Two-dimensional transthoracic echocardiography was performed at baseline (before PCI) and repeated 48 h after PCI. LV diastolic parameters were compared before and after PCI using paired samples t-test results. Results: Mean age of study population was 56.65 +/- 9.65 years. Majority of patients were male (63%). There was significant increase in mitral E-wave velocity (68.39 +/- 17.52 cm/s vs. 71.64 +/- 18.23 cm/s), E/A ratio (0.85 +/- 0.29 vs. 0.89 +/- 0.32), and early diastolic mitral annular motion (e') (7.02 +/- 0.89 cm/s vs. 8.45 +/- 0.86 cm/s) following PCI (P < 0.0001). Left atrial volume index (22.53 +/- 4.43 vs. 20.81 +/- 4.14), tricuspid jet velocity (0.91 +/- 0.57 m/s vs. 0.76 +/- 0.67 m/s), and E/e' ratio (10.03 +/- 3.5 vs. 8.62 +/- 2.61) decreased significantly following PCI (P < 0.001). Conclusion: This study suggests that LV diastolic filling pattern is modified significantly as early as 48 h after successful PCI. Improvement in impaired relaxation appears to be most likely explanation for these changes. PCI may be potential therapeutic target to improve diastolic function in patients with CAD.