Myocardial performance after transmyocardial revascularization with CO(2)laser. A dobutamine stress echocardiographic
L Aaberge1, S Aakhus, K Nordstrand
1Department of Cardiology, Division of Heart and Lung Diseases, The National Hospital, University of Oslo, Oslo, Norway. laaaberg@online.no
Insights
Transmyocardial laser revascularization worsened resting heart function and increased non-viable heart segments in patients with severe angina. This treatment did not improve heart wall motion during stress tests.
Area of Science:
- Cardiology
- Cardiovascular Surgery
Background:
- Transmyocardial laser revascularization (TMLR) is an option for severe angina unresponsive to conventional treatments.
- The impact of TMLR on myocardial function and reversible ischemia requires further clarification.
Purpose of the Study:
- To evaluate the effects of TMLR on myocardial function and reversible ischemia in patients with refractory angina.
Main Methods:
- 100 patients with refractory angina were randomized to medical treatment or TMLR plus medical treatment.
- Dobutamine stress echocardiography was performed at baseline and 3, 12 months post-randomization.
- Myocardial function and ischemia were assessed using a 16-segment model from cineloop interpretation.
Main Results:
- TMLR led to increased resting left ventricular wall motion abnormalities (P<0.01).
- Wall motion during dobutamine stimulation remained unchanged.
- The number of non-viable segments increased (P<0.01), while ischemic segments decreased.
- Chest pain reduction was not statistically significant.
Conclusions:
- TMLR worsened resting myocardial function, evidenced by increased wall motion abnormalities.
- TMLR did not improve myocardial wall motion during dobutamine stress.
- The procedure increased the number of non-viable myocardial segments.
Aims:
Transmyocardial laser revascularization is a treatment for patients with severe angina pectoris not eligible for conventional revascularization. The effects on myocardial function and reversible ischaemia have not been clarified.
Methods And Results:
One hundred patients with refractory angina not eligible for conventional revascularization were randomized 1:1 to receive continued optimal medical treatment or transmyocardial revascularization with CO(2)laser in addition to medical treatment. Dobutamine stress echocardiography examinations were performed at baseline and at 3 and 12 months after randomization. The effects of transmyocardial revascularization on myocardial function and reversible ischaemia were assessed by visual interpretation of cineloops at rest and during stress in a 16-segment model. After transmyocardial revascularization resting left ventricular wall motion abnormalities increased (P<0.01), whereas wall motion during dobutamine stimulation remained unchanged. The number of probably non-viable segments increased (P<0.01) with a corresponding decrease in the number of ischaemic segments. Fewer patients had the dobutamine infusion discontinued because of chest pain after transmyocardial revascularization with laser, but the chest pain threshold did not increase significantly.
Conclusion:
Following transmyocardial revascularization, resting wall motion abnormalities worsened, wall motion abnormalities during dobutamine stimulation remained unchanged and the number of probably non-viable segments increased.
