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[Serial changes in left ventricular global and regional function during exercise after percutaneous transluminal
Insights
Complete coronary revascularization (CR) via PTCA significantly improves left ventricular (LV) function, especially when CR is maintained. First-pass radionuclide angiography (FRNA) effectively assesses CR completeness and guides repeat angiography.
Area of Science:
- Cardiology
- Interventional Cardiology
- Nuclear Cardiology
Background:
- Complete coronary revascularization (CR) is crucial for improving outcomes in patients with coronary artery disease.
- Percutaneous transluminal coronary angioplasty (PTCA) is a common method for achieving CR.
- Assessing the impact of CR on left ventricular (LV) function is essential for patient management.
Purpose of the Study:
- To evaluate the effect of complete CR achieved by PTCA on global and regional LV function at rest and during exercise.
- To assess the utility of first-pass radionuclide angiography (FRNA) in evaluating the completeness of CR.
- To determine if FRNA can provide guidelines for repeat angiography in cases of restenosis.
Main Methods:
- First-pass radionuclide angiography (FRNA) was used to assess ejection fraction (EF), LV volumes, and systolic blood pressure/end-systolic volume index (SP/ESVI).
- 23 patients with CR were evaluated before PTCA, 14 days after (early FU), and 4-12 months after (late FU).
- Patients were divided into groups with continued CR (G-I), discontinued CR due to restenosis (G-II), and normal subjects (G-C). Regional function was assessed in LAD artery subgroups.
Main Results:
- Exercise-induced global LV dysfunction significantly improved at early and late follow-up in patients with continued CR (G-I).
- Patients with discontinued CR (G-II) showed insignificant improvement at early follow-up and no change at late follow-up.
- Regional LV dysfunction during exercise improved significantly in G-I LAD patients but not sufficiently in G-II LAD patients.
Conclusions:
- Complete CR achieved by PTCA significantly improves global and regional LV function, particularly when CR is maintained.
- FRNA is a valuable tool for assessing the completeness of CR after PTCA.
- FRNA findings can guide decisions regarding repeat angiography to ensure optimal revascularization.
Abstract:
In order to evaluate the effect of complete coronary revascularization (CR) with PTCA on global LV function at rest and during exercise, EF, LV volumes and systolic blood pressure/end-systolic volume index (SP/ESVI) were assessed in 23 patients with CR before, 14 days after (early FU) and 4 to 12 months after PTCA (late FU) by first-pass radionuclide angiography (FRNA). The subjects were divided into 3 groups in this study, G-I which consisted of 14 patients with continued CR, G-II, 9 patients with discontinued CR due to restenosis and G-C, 7 normal subjects. To further assess anterior (Ant) and apical (Ap) regional EFs, 15 patients with dilatation of left anterior descending artery were subdivided into 9 patients with continued success (G-I LAD) and 6 patients with restenosis (G-II LAD). Exercise-induced global LV dysfunction improved significantly both at early FU and late FU in G-I, however improved insignificantly at early FU and did not change at late FU in G-II. Even response to exercise (delta EF, % delta SP/ESVI) at late FU in G-I was significantly (p less than 0.05) less than those in G-C. Regional dysfunction during exercise already improved significantly (Ant: p less than 0.05, Ap: p less than 0.01) at early FU in G-I LAD, but did not improve sufficiently in G-II LAD. In conclusion, FRNA may be useful for the assessment of completeness of coronary revascularization by PTCA and may give guidelines for repeat angiography.