Impact of aortic stiffness in prediction of exercise tolerance after percutaneous coronary intervention in patients with stable angina pectoris

Background : Percutaneous coronary intervention (PCI) is an established procedure for the treatment of coronary artery disease. Its usefulness in symptom relief is well established. Aortic stiffness constant is the best single predictor of ACS. Aortic stiffness was reported to be a predictor of cardiovascular morbidity and mortality and can be assessed by noninvasive methods. Aim of the work: The aim of our study is to study the aortic stiffness in patients with stable coronary artery disease and its association with exercise tolerance and myocardial function before and after percutnaeous coronary intervention Ptaients and methods: This study was carried out in cardiology department, Zagazig University. This study included (60) person, 40 patients with ischemic heart disease underwent elective PCI. These patients included 28 male (70 %) and 12 female (30%), their ages ranged from 44 to 66 years with mean age of 55.7 ± 5.8 years. The 20 healthy person (13 males and 7 females) “65 % and 35 % respectively ”, ranging in age from 43 to 65 years old with a mean of 56.7± 7.2 years with normal findings on the resting ECG and echocardiography served as controls Results: As regard to risk factors, there was significant difference between both patient and control groups as regard diabetes mellitus (p 0.05, significnat) and hypertension (p < 0.001), highly significant)and smoking(p 0.05, significnat). Both groups were comparable as regards age and sex (p 0.05). As regard to echocardiographic parameters of both patient and control groups. there were a highly significant difference between the two groups as regard Transmitral E wave (p < 0.001). Transmitral A wave (p < 0.001). Transmitral E/A wave (p < 0.001). and ASI (p < 0.001). As regard exercise tolerance in patients assessed by exercise ECG before and three months after PCI. There is significant difference between before and after PCI with significant improvement of patients as regard METs before (ranged from 4.7-10.2 with a mean ± SD of 7.87 ± 1.75) and after (ranged from 7-13 with a mean ± SD of 10.2 ± 1.9). As regard results, positive exercise ECG patients were 32 patients before PCI and 2 patients after PCI and negative exercise ECG patients were 2 patients before PCI and 34 patients after PCI.Equivaocal test showed 6 patients before PCI and 4 patients after PCI with significant improvement of patients after PCI. As regard echocardiographic parameters before PCI and 3 months after PCI. There were highaly significant differences as regard transmitral Doppler and non-significant differences as regard LVESD, LVEDD,EF,FS and transtricuspid Doppler Conclusion: M-mode echocardiography is a noninvasive and widely available technique and a simple measure that allows the sensitive detection of aortic diameter used in assesment of aortic stiffness which is a predictor of cardiovascular morbidity and mortality. Our work clarifies that increased aortic stiffness index was significantly associated with impaired exercise tolerance and functional capacity after PCI with a cutoff value of > 25 for ASI which is valid in prediction of improvement as sensitivity was 83.3% and accuracy was 80%.