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Percutaneous coronary intervention in patients with impaired left ventricular function 

Percutaneous coronary intervention in patients with impaired left ventricular function
Chapter:
Percutaneous coronary intervention in patients with impaired left ventricular function
Author(s):

Divaka Perera

and Simon Redwood

DOI:
10.1093/med/9780199569083.003.017
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date: 24 November 2020

Changes in left ventricular (LV) function are an early manifestation of the ischaemic cascade and often precede the well-recognized markers of ischaemia, such as ST segment changes or chest pain. Decreased ventricular compliance, diminished regional and global contractility, and elevated end-diastolic pressure occur within a few seconds of interruption of coronary blood flow by balloon occlusion, whereas recovery of these parameters can lag several minutes behind balloon deflation, restoration of blood flow, and resolution of electrocardiogram (ECG) changes. Prolonged postischaemic myocardial dysfunction, or stunning, can occur following recurrent ischaemia, which may persist for several hours or days even when blood flow is restored. The impact of transient or repetitive coronary occlusion on LV function is rarely of clinical consequence when percutaneous coronary intervention (PCI) is performed in patients with preserved ventricular function, but is potentially hazardous in those who have LV impairment at the outset, particularly when there is a large amount of myocardium at risk. These patients have attenuated haemodynamic reserve and may recover incompletely from post-ischaemic stunning, which increases the risk of entering a deteriorating spiral of decreasing cardiac output and worsening ischaemia that could culminate in cardiogenic shock or ventricular arrhythmias. Furthermore, patients with impaired LV function tend to be older and have more advanced comorbidities, which are independently associated with an adverse outcome following any form of revascularization.

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