الفهرس 
History and Physical ExaminationOnly 14 pages are availabe for public view
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Abstract
Impairment of the left ventricular function is the major
predictor of mortality after acute coronary syndrome (White HD
et al 1987).
In patients with ventricular dysfunction related CAD and/or
MI, coronary artery intervention may improve ventricular function
and consequently, prognosis (Anselmi at al 1998).
Global and regional myocardial dysfunction due to post
infarction ischemia lessens significantly after significantly
successful coronary angioplasty of the infarct-related coronary
artery with long term sustained normal, complete flow (Miketic S
et al 1995).
The aim of this study was to search for echocardiographic
evidence of possible short term improvement of left ventricular
global and regional systolic function as well as diastolic function,
following PCI in patients presenting with unstable angina/non ST
elevation myocardial infarction (UA/NSTEMI).
Twenty five patients (23 males and 2 females) presenting
with UA/NSTEMI, who underwent successful PTCA and stenting
for significant coronary artery disease, with uneventual follow up
using echocardiographic-Doppler study one day, four days and
seven days post angioplasty was included in the study.
summary
150
During the follow up period all patients in the study were
subjected to:
1. History taking.
2. Clinical examination.
3. Twelve-lead ECG.
4. Risk factors evaluation (hypertension, diabetes,
dyslipidemia…..…).
5. Resting echocardiography Doppler study before, one day,
four days, and seven days following intervention to
evaluate:
I. Global systolic function, measured by ejection fraction
(EF% and FS%).
II. Regional systolic function, it can be measured by 2
ways:
i) Number of segments with abnormal
motion pattern
ii) Segmental wall motion score index
(SWMI). As recommended by the
American society of echocardiography.
III. Diastolic function measured by E/A ratio.
Patients in the study failed to achieve any improvement in
post-angioplasty LV end diastolic volumes and dimensions;
however it showed significant reduction in LV end systolic
volumes and dimensions. Also, no significant changes in diastolic
function were detected.
There was significant improvement following angioplasty in
systolic function detected by EF% (64.24 9.78 pre-angioplasty
versus 69.52 4.00 at seven days post angioplasty, P < 0.05) and
FS% (29.4 6.8 pre-angioplasty versus 33.76 5.29 at seven days
post angioplasty, P < 0.05). Also there was significant
summary
151
improvement in regional function detected four days and seven
days post angioplasty versus pre-angioplasty. Regional function
was detected by SWMI (1.15 0.1 pre-angioplasty versus 1.08
0.05 at four days, and 1.07 0.06 at seven days post angioplasty,
P< 0.05).
Patients with improvement in global and regional systolic
function had more extensive baseline regional and global
abnormalities.
There was no significant correlation between various risk
factors, such as age, sex, diabetes, hypertension, smoking or
Dyslipideamia and out come of LV function following angioplasty.
Thus it is concluded from the study that:
1. Global left ventricular systolic function is significantly
improved one week following PTCA for UA/NSTEMI
patients.
2. Regional left ventricular systolic function may improve
significantly four days and seven days following PTCA.
3. Patients with worse baseline global and regional LV
systolic function may exhibit greater improvement both
in clinical and echocardiographic out come.
4. There was no significant improvement in diastolic
function.
5. No significant relation between age, sex, diabetes,
hypertension, smoking or Dyslipideamia and out come of
LV functions following angioplasty.
Conclusion
152
Conclusion
from this study it concluded that
1. Global left ventricular systolic function is significantly improved
one week following PTCA for UA/NSTEMI patients.
2. Regional left ventricular systolic function may improve
significantly four days following PTCA for UA/NSTEMI patients.
Also further improvement may be noticed seven days following
PTCA.
3. Patients with worse baseline global and regional LV systolic
function may exhibit greater improvement both in clinical and
echocardiographic out come.
4. There was no significant improvement in diastolic function one
week following PTCA for patients presented with UA/NSTEMI.
5. One week following PTCA for patients presented with
UA/NSTEMI, showed significant improvement in LV end systolic
volumes and dimensions. However Patients in the study failed to
achieve any improvement in post-angioplasty LV end diastolic
volumes and dimensions
6. No significant relation between age, sex, diabetes, hypertension,
smoking or Dyslipideamia and out come of LV functions
following angioplasty.
Recommendations
153
Recommendations
In the light of our study, the following was recommended:
1. Echocardiography should be done if possible to all patients with
acute ischemic syndromes to assess left ventricular function,
infarct size and/or the extent of jeopardized myocardium so as to
guide therapy, including revascularization by PTCA.
2. Serial echocardiography follow up should be done at least one to
two times in the first week following revascularization to allow for
assessment of recovery of stunned myocardium caused by PTCA.
However, longer follow up may be adviced to avoid the
confounding effect of stunning or hyperkinesias possibly still
present in some patients beyond the first week.
3. Coronary angiography and subsequently PTCA, even if delayed,
should be encouraged in all survivors of acute coronary syndrome
with evidence of viable myocardium, Especially in patients with
depressed LV systolic function, congestive heart failure or
malignant ventricular arrhythmias.
4. wall motion score index in resting echocardiography should be
encouraged for more widespread use in patients with acute
coronary syndromes being easy test to assess regional wall motion,
and for its ability to predict the extent of viable myocardium, thus
replacing the more expensive and tedious tests for viability.