Echocardiographic parameters of left ventricle remodeling in patients with reduced ejection fraction before and after various types of myocardial revascularization

Left ventricular (LV) myocardial remodeling after myocardial infarction (MI) is associated with worse prognosis in most cases. In some cases, inaddition to optimal drug therapy, surgical revascularization can be used to stop or slow down the remodeling process. The aim of this study was to identify structural and functional parameters of cardiac remodeling that affect the prognosis and survival of patients after coronary revascularization performed by anyone method, and to compare these parameters in groups of patients who underwent coronary artery bypass grafting (CABG) and coronary artery stenting (CAS). A total of 104 patients with coronary artery disease and reduced ejection fraction (EF) were examined before, shortly after (5–10 days), and 6–12 months after myocardial revascularization. The average age of patients was 58 [54; 66] years old, including 85% men and 15% women. 82% of patients were operated on, of which 62 (59.6%) patients underwent CABG and 23 (22.1%) patients underwent CAS. Complete revascularization was achieved in 24 (28.2%) cases. In addition to the standard linear and volumetric dimensions, the sphericity index was calculated in diastole (end-diastolic diameter, EDD/longitudinal dimension of the LV in diastole) and systole (end-sistolic diameter, ESD/longitudinal dimension of the LV in systole), as well as the integral systolic remodeling index (ISRI), as the ratio of EF to the diastolic sphericity index of the LV in units. The remodeling parameters of interest for assessing the results of revascularization include EDVI, LVEF, diastolic sphericity index and integral systolic remodeling index. In patients who underwent CABG, these parameters reflected a lower degree of left ventricular remodeling: lower left ventricular end-diastolic volume index, diastolic sphericity index, and integral systolic remodeling index, and higher left ventricular ejection fraction.

1. Mareev V.Yu., Ageev F.T., Arutyunov G.P. et al. National guidelines of the OSSN, RKO and RNMOT for the diagnosis and treatment of CHF (fourth revision). Approved at the OSSN Congress on December 7, 2012, at the OSSN Board on March 31, 2013 and the RKO Congress on September 25, 2013. Journal of Heart Failure. Vol. 14, No. 7 (81), 2013. P. 379–472.

2. Gheorghiade M., Sopko G., De Luca L. et al. Navigating the crossroads of coronary artery disease and heart failure. Circulation. 2006. 12; 114(11): P. 1202–1213.

3. Hobbs F.D., Roalfe A.K., Davis R.C. et al. Midlands Research Practices Consortium (MidReC) Prognosis of all-cause heart failure and borderline left ventricular systolic dysfunction: 5 year mortality follow-up of the Echocardiographic Heart of England Screening Study (ECHOES). Eur Heart J. 2007. 28(9): P. 1128–1134.

4. Konstam M.A., Kramer D.G., Patel A.R. et al. Left ventricular remodeling in heart failure: current concepts in clinical significance and assessment. JACC Cardiovasc Imaging. 2011; 4(1): P. 98-108. doi: 10.1016/j.jcmg.2010.10.008. PMID: 21232712.

5. Belov Yu.V., Varaksin V.A. Postinfarction remodeling of the left ventricle of the heart. From concept to surgical treatment. – M.: DeNovo, 2002. – 194 p.

6. Mann D.L. Mechanisms and models in heart failure: A combinatorial approach. Circulation. 1999; 100: P. 999–1008.

7. Ciampi Q., Villari B. Role of echocardiography in diagnosis and risk stratification in heart failure with left ventricular systolic dysfunction. Cardiovasc. Ultrasound. 2007; 5: P. 34. doi: 10.1186/1476-7120-5-34.

8. Nechesova T.A., Korobko I.Yu., Kuznetsova N.I. Left ventricular remodeling: pathogenesis and assessment methods. Journal «Medical News». Archive No. 11. 2008. P. 7–13.

9. Puymirat E., Simon T., Steg P.G. et al. USIK USIC 2000 Investigators; FAST MI Investigators. Association of changes in clinical characteristics and management with improvement in survival among patients with ST-elevation myocardial infarction. JAMA. 2012; 308: P. 998–1006

10. Wijns W., Kolh P., Danchin N. et al. Guidelines on myocardial revascularization: The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Developed with the special contribution of the European Association for Percutaneous Cardiovascular Interventions (EAPCI). European Heart Journal, Volume 31, Issue 20, 1 October 2010, Pages 2501–2555, https://doi.org/10.1093/eurheartj/ehq277

11. Topkara V.K., Cheema F.H., Kesavaramanujam S. Coronary artery bypass grafting in patients with low ejection fraction. Circulation. 2005; 112: P. 344–I-350.

12. Lawton J.S., Tamis-Holland J.E., Bangalore S. et al. 2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2022 Jan 18;145(3):e4-e17. doi: 10.1161/CIR.0000000000001039.

13. Petrie M.C., Jhund P.S., She L. et al. Ten-year outcomes after coronary artery bypass grafting according to age in patients with heart failure and left ventricular systolic dysfunction: an analysis of the extended follow-up of the STICH trial (Surgical Treatment for Ischemic Heart Failure). Circulation. 2016;134: P. 1314–1324.

14. Leancă S.A., Crişu D., Petriş A.O. et al. Left Ventricular Remodeling after Myocardial Infarction: From Physiopathology to Treatment. Life (Basel). 2022. 24; 12(8): P. 1111. doi: 10.3390/life12081111.

15. McCartney P.J., Berry C. Redefining successful primary PCI. Eur. Heart J. Cardiovasc. Imaging. 2019; 20: P. 133–135. doi: 10.1093/ehjci/jey159.

16. Grabka M., Kocierz-Woźnowska M., Wybraniec M. et al. Left ventricular reverse remodeling in patients with anterior wall ST-segment elevation acute myocardial infarction treated with primary percutaneous coronary intervention. PostepyKardiol. Interwencyjnej. 2018;14:373–382. doi: 10.5114/aic.2018.79867.

17. Reindl M., Reinstadler S.J., Tiller C. et al. Prognosis-based definition of left ventricular remodeling after ST-elevation myocardial infarction. Eur. Radiol. 2019;29: P. 2330–2339. doi: 10.1007/s00330-018-5875-3.

18. Vrints C., Andreotti F., Koskinas K.C. et al. ESC Scientific Document Group. 2024 ESC Guidelines for the management of chronic coronary syndromes. Eur Heart J. 2024 Sep 29;45(36):3415-3537. doi: 10.1093/eurheartj/ehae177.

19. Kunadian V., Zaman A., Qiu W. Revascularization among patients with severe left ventricular dysfunction: a meta-analysis of observational studies. Eur J Heart Fail 2011. 13: P. 773–784.

20. Mareev V.Yu., Fomin I.V., Ageev F.T. et al. Clinical guidelines of the Russian Society of Cardiology – Russian Society of Cardiology – Russian Society of Cardiology. Heart failure: chronic (CHF) and acute decompensated (ADHF). Diagnostics, prevention and treatment. Cardiology. 2018; 58(6S): P. 8–158. https://doi.org/10.18087/cardio.2475.

21. Yamazaki S., Numata S., Yaku H. The Ultimate Goals of Surgical Ventricular Reconstruction: Volume, Shape and Viability. Journal of Coronary Artery Disease. 2019; 25: 34 – 38.

22. Mauger C.A., Gilbert K., Suinesiaputra A. et al. Multi-Ethnic Study of Atherosclerosis: Relationship between Left Ventricular Shape at Cardiac MRI and 10-year Outcomes. Radiology. 2023 Feb;306(2):e220122. doi: 10.1148/radiol.220122. Epub 2022 Sep 20. PMID: 36125376; PMCID: PMC9870985.

23. Wu P., Zhao Y. Guo X. Prognostic Value of Resting Left Ventricular Sphericity Indexes in Coronary Artery Disease With Preserved Ejection Fraction. Journal of American Heart Association. 2024; 13:e032169. DOI: 10.1161/JAHA.123.032169.

24. Arnold JR, Kanagala P, Budgeon CA, Jerosch-Herold M. et al. Prevalence and prognostic significance of microvascular dysfunction in heart failure with preserved ejection fraction. J Am Coll Cardiol Img. 2022; 15:1001– 1011. doi: 10.1016/j.jcmg.2021.11.022.

25. Pagliaro BR, Cannata F, Stefanini GG, Bolognese L. Myocardial ischemia and coronary disease in heart failure. Heart Fail Rev. 2020; 25:53–65. doi: 10.1007/s10741-019-09831-z