Comparison of Left Ventricular Function Utilizing Transthoracic Echocardiography in Anterior Wall Myocardial Infarction (AWMI) Before and after Percutaneous Coronary Intervention (PCI) to Left Anterior Descending Artery (LAD) in Single Vessel Disease
- Dr Aaqib Ali Wajid , Resident Cardiology, PIC Lahore
- Dr Sajjad Ahmad , Professor of Cardiology, PIC Lahore
- Dr Samra Haque , Consultant Cardiologist, PIC Lahore
- Dr Sadaf , Consultant Cardiologist, PIC Lahore
- Dr Aswan Ahmad , Resident Cardiology, PIC Lahore
- Dr Zohaib Sadiq , SR Cardiology, PIC Lahore
Article Information:
Abstract:
Objective: To determine the frequency of left ventricular remodeling and mean change in LV function parameters, after PCI to LAD in single vessel disease. Study Design: Prospective cross-sectional study. Place and Duration of Study: Cardiology department of PIC, Lahore from 16 May 2024 to 16 November 2025. Methodology: This study was done after taking ethical approval from IRB of Punjab Institute of Cardiology, Lahore. This study was done on 74 patients diagnosed with anterior wall MI and undergoing PCI to LAD in single vessel disease. Data collection was done using pre-designed proforma. At baseline and 3 months follow echocardiography was done LV remodeling was defined as increase in LVEF with corresponding decrease in LVEDD and LVESD compared to baseline values. Data analysis was performed using SPSS version 26, with p-value 0.05 considered significant. Results: The mean increase in LVEF was 5.22 ± 0.14 (95% CI: −5.254 to −5.188; t = −312.79; p < 0.001), mean decrease in LVEDD was 2.11 ± 0.09 mm (95% CI: 2.087 to 2.131; t = 193.29; p < 0.001), and mean decrease in LVESD was 2.06 ± 0.05 mm (95% CI: 2.043 to 2.067; t = 353.30; p < 0.001). Left ventricular remodeling was observed in 25 (34%) patients. Conclusion: The results of this study suggest that PCI to LAD results into left ventricular remodeling in patients with anterior wall myocardial infarction, and potentially improving overall cardiac performance.
Keywords:
Article :
Comparison of Left Ventricular Function Utilizing Transthoracic Echocardiography in Anterior Wall Myocardial Infarction (AWMI) Before and after Percutaneous Coronary Intervention (PCI) to Left Anterior Descending Artery (LAD) in Single Vessel Disease :
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Comparison of Left Ventricular Function Utilizing Transthoracic Echocardiography in Anterior Wall Myocardial Infarction (AWMI) Before and after Percutaneous Coronary Intervention (PCI) to Left Anterior Descending Artery (LAD) in Single Vessel Disease
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INTRODUCTION
Globally, the prevalence of Myocardial Infarction (MI) in individuals under 60 years of age was estimated at about 3.8%, and in those over 60 years at about 9.5%. (1) Meanwhile, in Pakistan it has been estimated that one in every five adults may have underlying coronary artery disease, and the incidence of acute MI is on the rise. (2)
When not managed promptly, acute MI often resulted in severe complications due to left ventricular dysfunction. (3) Early restoration of blood flow improved patient survival by reducing infarct size, preserving LV function, and minimizing post-infarction complications. (4) PCI emerged as the standard treatment for acute STEMI, with primary goal of restoring arterial patency while preserving myocardial cell integrity and thereby improving overall ventricular function. (5)
In survivors of acute MI, recovery of left ventricular is key determinant of long-term outcomes. LV performance may change over time due to ventricular remodeling and gradual myocardial recovery. (6) Previous studies consistently demonstrated significant improvements in LV function following PCI. (7)
Infarction involving left anterior descending artery is particularly associated with more extensive myocardial damage and higher likelihood of LV dysfunction due to its large perfusion territory. (8) While advanced imaging methods like cardiac MRI and strain imaging can assess these changes, they are costly and less accessible. (9) Echocardiography, being inexpensive, non-invasive, and widely available, remains the preferred tool for evaluating LV function and monitoring recovery. (10)
Objective
Given these observations, the present study aimed to generate local data on the frequency and degree of LV remodeling after PCI in patients with anterior wall MI caused by left anterior descending artery.
METHODOLOGY
After obtaining ethical approval from Institutional Review Board, Lahore (Ref: RTPGME-Research-363, dated: 06-05-2025), this prospective observational study was conducted at Department of Cardiology, PIC, Lahore, from 16 May 2025 to 16 November 2025. Data were collected using structured proforma and maintained by principal investigator. Before patient’s enrollment written informed consent was obtained from them. Inclusion criteria: Patients of either gender, aged 18–65 years, diagnosed with acute anterior wall MI or undergoing PCI to left anterior descending artery for single-vessel disease confirmed on coronary angiography were included. Anterior wall MI diagnosed using ECG; ST-segment elevation ≥1 mm in minimum two contiguous precordial leads [V1–V4]. (11)
Exclusion criteria: Patients were excluded if they presented with Killip class III or IV, had pre-PCI LVEF <30%, or having GFR <90 ml/min/m², chronic liver disease, or pulmonary disease. Pregnant females, alcoholics, and patients with prior MI history, PCI, or CABG were also excluded. A sample size of 74 patients was calculated, based on 95% confidence level, 10% absolute precision, and expected frequency of left ventricular remodeling after PCI of 26%. (12) Patients were enrolled through non-probability consecutive sampling. All enrolled patients underwent thorough clinical assessment. Demographic data including name, age, gender, and BMI were recorded. Risk factors such as diabetes mellitus (HbA1c >7%), hypertension (BP >140/90 mmHg), dyslipidemia, and smoking status were documented. Baseline investigations including CBC, RFTs, cardiac enzymes, and ECG were performed. Baseline transthoracic echocardiography was conducted to measure LVEF, LV end-diastolic dimension, and LV end-systolic dimension prior to PCI. All patients underwent PCI performed by team of cardiologists with a minimum of four years’ interventional experience, and achievement of reperfusion (defined as TIMI grade 3 flow) was recorded. Post-procedure, patients remained admitted in coronary care unit for at least 24 hours. All patients received standard post-PCI therapy. Lifestyle modifications, including dietary control, smoking cessation, and management of blood pressure and glycemic levels, were reinforced.
Repeat transthoracic echocardiography was performed at three months post-PCI to re-evaluate LVEF, LVEDD, and LVESD. Echocardiography was performed by single experienced cardiologist using the same ultrasound machine for consistency. Left ventricular remodeling was defined as an increase in LVEF with corresponding decrease in LVEDD and LVESD compared to baseline values. Patients who expired or were lost to follow-up during the study period were excluded from the final analysis. Data analysis was performed using SPSS version 26.0. Quantitative variables were presented as mean ± standard deviation. Qualitative variables were presented as frequencies and percentages. Changes in echocardiographic parameters before and after PCI were compared using paired sample t-test. Post-stratification, chi-square test was applied to assess associations of LV remodeling with age, gender, and risk factors; p-value <0.05 was considered statistically significant.
Figure: Patient Flow Diagram
Total patients assessed for eligibility (n = 98)
↓
Excluded (n = 24)
• Did not meet inclusion criteria (n = 15)
• Declined to participate (n = 5)
• Lost before baseline assessment (n = 4)
↓
Patients enrolled (n = 74)
↓
Underwent PCI to LAD artery (n = 74)
↓
Follow-up at 3 months completed (n = 74)
↓
Included in final analysis (n = 74)
RESULTS
As shown in table mean age of patients was 54.66 ± 8.21 years (range: 35–65 years). Out of the total, 45 (61%) were male and 29 (39%) were female. The mean BMI was 23.05 ± 1.91 kg/m². Among the participants, 24 (32.4%) were diabetics, 27 (36.5%) had hypertension, 20 (27.0%) had dyslipidemia, and 21 (28.4%) were smokers (Table 1)
Table 1. Clinico-demographic characteristics of participants (n=74)
|
Age (years) |
Mean ± SD |
54.66 ± 8.21 |
|
|
Minimum |
35 |
|
|
Maximum |
65 |
|
Gender frequency (%) |
Male |
45 (61%) |
|
|
Female |
29 (39%) |
|
BMI (kg/m2) |
|
23.05 ± 1.91 |
|
Diabetics |
|
24 (23.4%) |
|
Hypertension |
|
27 (36.5%) |
|
Dyslipidemias |
|
20 (27%) |
|
Smoker |
|
21 (28.4%) |
The mean change in left ventricular parameters showed statistically significant difference before and after PCI as shown in table II. The mean increase in LVEF was 5.22 ± 0.14 (95% CI: −5.254 to −5.188; t = −312.79; p < 0.001), the mean decrease in LVEDD was 2.11 ± 0.09 mm (95% CI: 2.087 to 2.131; t = 193.29; p < 0.001), and mean decrease in LVESD was 2.06 ± 0.05 mm (95% CI: 2.043 to 2.067; t = 353.30; p < 0.001) (Table 2).
Table 2. Mean change in left ventricular parameters (n=74)
|
|
Mean± SD |
95% CI of Difference
|
t |
df |
p-value |
|
|
|
|
Lower |
Upper |
|
|
|
|
Pre LVEF – Post LVEF |
5.22± 0.143 |
-5.254 |
-5.188 |
-312.792 |
73 |
<0.001* |
|
Pre LVEDD –post LVEDD |
-2.109 ± 0.093 |
2.087 |
2.131 |
193.293 |
73 |
<0.001* |
|
Pre LVESD - Post LVESD |
-2.055 ± 0.050 |
2.043 |
2.067 |
353.298 |
73 |
<0.001* |
Left ventricular (LV) remodeling was observed in 25 (34%) patients, while 49 (66%) showed no remodeling as shown in figure
Figure: Frequency of left ventricular remodeling (n=74)
Stratification of data with respect to effect modifiers showed no statistically significant association of LV remodeling with gender (p = 0.688), diabetes (p = 0.231), hypertension (p = 0.654), dyslipidemia (p = 0.551), smoking (p = 0.959), or age group (p = 0.809) (Table 3).
Table 3. Data stratification with respect to effect modifiers
|
Variable
|
Category |
LV remodeling
|
Total |
p-value |
|
|
|
|
Yes Frequency (%) |
No Frequency (%) |
|
|
|
Gender |
Male |
16 (64.0%) |
29 (59.2%) |
45 (60.8%) |
0.688 |
|
|
Female |
9 (36.0%) |
20 (40.8%) |
29 (39.2%) |
|
|
Diabetes |
Yes |
10 (40.0%) |
14 (28.6%) |
24 (32.4%) |
0.231 |
|
|
No |
15 (60.0%) |
35 (71.4%) |
50 (67.6%) |
|
|
Hypertension |
Yes |
10 (40.0%) |
17 (34.7%) |
27 (36.5%) |
0.654 |
|
|
No |
15 (60.0%) |
32 (65.3%) |
47 (63.5%) |
|
|
Dyslipidemia |
Yes |
7 (28.0%) |
13 (26.5%) |
20 (27.0%) |
0.551 |
|
|
No |
18 (72.0%) |
36 (73.5%) |
54 (73.0%) |
|
|
Smoker |
Yes |
7 (28.0%) |
14 (28.6%) |
21 (28.4%) |
0.959 |
|
|
No |
18 (72.0%) |
35 (71.4%) |
53 (71.6%) |
|
|
Age group |
Upto 45 years |
5 (20.0%) |
11 (22.4%) |
16 (21.6%) |
0.809 |
|
|
>45 years |
20 (80.0%) |
38 (77.6%) |
58 (78.4%) |
|
DISCUSSION
In current study, after PCI to LAD mean increase in LVEF, mean decrease in LVEDD, and mean decrease in LVESD was statistically significant; p < 0.001. Overall, left ventricular remodeling was observed in 34% patients. Similarly, Mahmoud Abd el-Sabour, conducted study involving 152 patients with acute STEMI, and 32.2% found to have LV remodeling, defined LVEDV increase of more than 20% six months post-PCI.(13) Sabry et al, found 26% incidence of LV remodeling at three-month follow-up in patients with anterior STEMI who underwent successful PCI.(12) In contrast, larger cohort study conducted by Lei et al, found that only 18.9% patients experienced LV remodeling during six-month follow-up period.(14) Hou et al, show an increase in LVEF post-PCI in around 50% patients.(15) Zhang et al, observed early LV remodeling (24-hours post PCI) in 54.8% and among 29.9% at 6 months follow-up.(16) However, in current study only LV remodeling assessed at 3-months follow-up. Adly et al, observed LV remodeling in 38.7%, and its long-term predictors included extensive anterior myocardial infarction (p < 0.001) and left anterior descending artery as infarct-related vessel (p = 0.03). (17) Infarct size following PCI has been shown to correlate with decreased risk of left ventricular LV remodeling, underscoring the importance of timely intervention.(18) PCI not only limits infarct expansion but also contributes to improvement in LV ejection fraction and reduction in LV hypertrophy, reflecting favorable impact on overall cardiac function.(19) However, despite successful revascularization and significant enhancement in LV performance, some patients may still develop adverse ventricular remodeling. This highlights the need for continuous post-procedural monitoring and appropriate management strategies to prevent or minimize long-term structural and functional deterioration of the heart. (20)
In current study, cardiac and cerebrovascular events were not assessed during follow-up period, which limits the ability to evaluate the long-term prognostic impact of left ventricular remodeling after PCI. Additionally, no comparison group was included, which restricts the study’s capacity to determine relative outcomes or causality. Furthermore, follow-up was limited to three months, and longer-term echocardiographic and clinical outcomes were not evaluated.
CONCLUSION
The results of the current study suggest that PCI to LAD promotes favorable left ventricular remodeling in patients with anterior wall myocardial infarction, and potentially improving overall cardiac performance.
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