Related Experiment Videos
[Effect of bypass operation and balloon angioplasty on heart function at rest]
1Abt. für Kardiologie, Klinikum der Johann-Wolfgang-Goethe-Universität, Frankfurt/Main.
Insights
Successful coronary bypass surgery and angioplasty improve resting left-ventricular ejection fraction, especially in patients with severe exercise-induced ischemia. This enhances overall cardiac function post-intervention.
Area of Science:
- Cardiology
- Cardiac Surgery
- Interventional Cardiology
Background:
- Exercise left-ventricular ejection fraction improvement is known after coronary revascularization.
- Identifying patients who benefit most from these procedures at rest is crucial.
Purpose of the Study:
- To determine which patients exhibit improved resting left-ventricular function after aortocoronary bypass operation and transluminal coronary angioplasty.
Main Methods:
- Radionuclide ventriculography and exercise stress tests were performed before and after procedures.
- 34 patients underwent bypass surgery (Group 1), and 69 had angioplasty (Group 2).
- Patients were categorized based on resting ejection fraction changes and exercise-induced ischemia severity.
Main Results:
- After bypass surgery, mean resting ejection fraction increased significantly (42% to 49%, p<0.001).
- Marked improvement (≥5%) occurred in 56% of bypass patients with severe exercise ischemia (ejection fraction increased from 40% to 54%).
- Angioplasty also improved resting ejection fraction (50% to 52%, p<0.001), with the most significant gains in patients exhibiting severe exercise-induced ST-depression.
Conclusions:
- Both bypass surgery and angioplasty enhance resting left-ventricular ejection fraction.
- Patients with severe exercise-induced myocardial ischemia demonstrate the most substantial improvements in left-ventricular function post-intervention.
- Identifying patients with significant exercise-induced ischemia predicts better resting cardiac function recovery.
Abstract:
Improvement of exercise left-ventricular ejection fraction after successful aortocoronary bypass operation and transluminal coronary angioplasty has been demonstrated. The purpose of this study was to investigate in which patients improvement of left-ventricular function at rest can be observed. Radionuclide ventriculography and exercise stress test was carried out in 34 patients before and after successful aortocoronary bypass operation (Group 1), and in 69 patients before and after successful transluminal coronary angioplasty (Group 2). After bypass surgery, mean ejection fraction at rest increased from 42 +/- 11 to 49 +/- 13% (p less than 0.001). Marked improvement (greater than or equal to 5%) was observed in 19 patients (56%) in whom severe myocardial ischemia could be documented during exercise ECG (Group 1.1: Increase of ejection fraction from 40 +/- 14 to 54 +/- 12%, p less than 0.001; ischemia score during exercise test 8.8 +/- 10). In the remaining 15 patients no significant improvement occurred (Group 1.2: 43 +/- 16 vs. 43 +/- 16%, p = n.s.; ischemia score during exercise test 3.2 +/- 2.4, p = 0.02 vs. Group 1.1). After angioplasty, resting left-ventricular ejection fraction increased, on average, from 50 +/- 11 to 52 +/- 12% (p less than 0.001). Comparable to the results observed in patients after surgery, improvement was most pronounced in patients with severe exercise-induced ST-depression (Group 2.1: Increase of ejection fraction from 49 +/- 10 to 58 +/- 10%, p less than 0.001; ischemia score during exercise 2.5 +/- 2.3).(ABSTRACT TRUNCATED AT 250 WORDS)