Effect of percutaneous coronary intervention on myocardial fibrosis and left ventricular function in elderly patients with coronary heart disease / 中华老年医学杂志

ABSTRACT

Objective To compare the changes in myocardial fibrosis degree and left ventricular function before versus after percutaneous coronary intervention (PCI) in elderly patients with coronary heart disease (CHD).Methods 121 elderly patients diagnosed as CHD with a single vessel by coronary angiography were enrolled.All patients were treated with PCI guided by thrombolysis in myocardial ischemia (TIMI) grade,symptoms and fractional flow reserve (FFR) comprehensively,and reviewed by coronary angiography after 12 months.The changes in serum concentration of procollagen type Ⅰ (PC I),procollagen type Ⅲ (PC Ⅲ),laminin (LN),hyaluronic acid (HA) and aldosterone (ALD) before versus 3,12 months after PCI were detected by enzyme-linked immunosorbent assay (ELISA).Left ventricular ejection fraction (LVEF),left ventricular enddiastolic diameter (LVEDD),plasma N-terminal pro-B-type brain natriuretic peptide (NT-proBNP) level and 6-minute walk test (6MWD) were assessed before and 3,12 months after PCI.The correlations were analyzed between FFR and serum procollagen type Ⅲ level,between serum PC Ⅲ level and plasma NT-proBNP level,and between serum ALD level and serum levels of PC Ⅰ,PC Ⅲ,LN,HA.Results All patients were treated with PCI successfully.At 12 months after PCI,stenosis with different degree were found in implanted stents or some large vessels in 6 cases by coronary angiography FFR=0.56-0.82).The serum levels of PC Ⅰ,PC Ⅲ,LN,HA,ALD,LVEDD and the plasma levels of NT-pro BNP were lower at 3 months after PCI than at preoperative follow-up (all P＜0.05),but LVEF was higher at 3 months after PCI than at preoperative fellow-up (P＜0.05),and the change trends in above observations were more significantly at 12 months after PCI.Linear correlation analysis showed that there was negative correlation between FFR and PC Ⅲ (r=-0.67,P＜0.01).There were positive correlations between PC Ⅲ and NT-proBNP,between ALD and PCⅠ,PC Ⅲ,LN,HA respectively (r=0.67,0.52,0.55,0.46,0.51,all P＜0.01).Conclusions PCI comprehensively guided by TIMI grade,symptoms and FFR can reduce myocardial fibrosis,improve cardiac function and quality of life in elderly patients with single coronary heart disease.