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Impairment of left ventricular function during coronary angioplastic occlusion evaluated with a nonimaging
A Hartmann1, F D Maul, M Zimny
1Department of Cardiology, J.W., Goethe-University Medical Center, Frankfurt, Germany.
Insights
Controlled myocardial ischemia during coronary angioplasty impairs left ventricular systolic and diastolic function. However, function recovers after the procedure, and sequential dilatations do not worsen outcomes if adequate intervals are maintained.
Area of Science:
- Cardiology
- Cardiovascular Physiology
Background:
- Coronary angioplasty involves controlled myocardial ischemia.
- Previous studies suggest impaired left ventricular function during this process.
Purpose of the Study:
- To investigate the impact of short, controlled myocardial ischemia on left ventricular function during coronary angioplasty.
- To assess systolic and diastolic function changes using a nonimaging scintillation probe.
Main Methods:
- Evaluated 18 patients with severe coronary artery stenosis undergoing angioplasty.
- Measured ejection fraction, peak ejection/filling rates, and ventricular volumes before, during, and after balloon inflations.
- Utilized a nonimaging scintillation probe for on-line data acquisition.
Main Results:
- Ejection fraction significantly decreased during balloon inflations (p < 0.01).
- Peak ejection and filling rates were significantly reduced during ischemia (p < 0.01).
- End-systolic and end-diastolic volumes increased significantly during ischemia, returning to normal post-procedure.
Conclusions:
- Short periods of myocardial ischemia during angioplasty temporarily impair left ventricular systolic and diastolic function.
- Adequate intervals between sequential dilatations prevent further functional decline.
Abstract:
Impairment of left ventricular function during controlled myocardial ischemia induced by coronary angioplasty has been reported from angiographic and echocardiographic studies. Ejection fraction, peak ejection, peak filling rates, and end-systolic and end-diastolic volumes were investigated before, during and after coronary occlusion on-line with a nonimaging scintillation probe. The study consisted of 18 patients (mean age 59 +/- 10 years) with coronary artery stenosis of greater than 70%. During balloon inflation of 60 seconds' duration, coronary occlusion pressure was 31.6 +/- 12 mm Hg. There was no significant change in heart rate. Delay between first and second dilatation was 109 +/- 63 seconds. Ejection fraction decreased from 53 +/- 16 to 40 +/- 12% (first dilatation, p less than 0.01) and to 39 +/- 14% (second dilatation, p less than 0.01) and recovered to 51 +/- 16% 5 minutes after the second dilatation. Peak ejection rate was significantly reduced during the first and second balloon inflations. Peak filling rate decreased from 2.5 +/- 0.8 to 2.0 +/- 0.7 end-diastolic volume.s-1 (first dilatation, p less than 0.01) and to 1.8 +/- 0.7 end-diastolic volume.s-1 (second dilatation, p less than 0.01) and remained reduced at 2.2 +/- 0.7 end-diastolic volume.s-1 (p = not significant) at 5 minutes after the second dilatation. End-systolic and end-diastolic volumes increased significantly during the first and second dilatations and returned to normal after dilatation. It is concluded that short, controlled myocardial ischemia during coronary angioplasty leads to a decrease in systolic and diastolic left ventricular function. Sequential dilatations do not further decrease function if a sufficient interval is kept.