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Reversal of chronic ischemic myocardial dysfunction after transluminal coronary angioplasty
M Cohen1, R Charney, R Hershman
1Department of Medicine, Mount Sinai School of Medicine, University of New York, New York.
Insights
Coronary angioplasty can salvage chronically ischemic myocardium, improving heart function in patients with reversible left ventricular dysfunction. This procedure offers a valuable treatment option for hibernating myocardium.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Physiology
Background:
- Chronic myocardial ischemia can lead to reversible left ventricular dysfunction, often termed hibernating myocardium.
- Identifying patients with hibernating myocardium is crucial for selecting appropriate revascularization strategies.
- Persistent angina and specific ventriculogram/imaging findings can indicate reversible ischemic dysfunction.
Purpose of the Study:
- To evaluate the efficacy of coronary angioplasty in salvaging chronically ischemic myocardium.
- To determine if revascularization could improve left ventricular function in patients with hibernating myocardium.
- To assess the clinical outcomes following coronary angioplasty for reversible chronic ischemia.
Main Methods:
- A cohort of patients with chronic ischemia underwent coronary angioplasty.
- Left ventricular function was assessed using ventriculograms before and after angioplasty.
- Regional wall motion analysis and global ejection fraction calculation were performed.
Main Results:
- Coronary angioplasty significantly improved global ejection fraction (46% to 62%, p<0.005).
- The extent of left ventricular asynergy decreased significantly post-angioplasty (29% to 10%, p<0.005).
- Most patients experienced symptom relief and maintained improved function during follow-up.
Conclusions:
- Coronary angioplasty is effective in salvaging hibernating myocardium.
- Easily obtainable clinical data can identify patients who may benefit from this intervention.
- Revascularization improves cardiac function and clinical outcomes in selected patients with chronic ischemia.
Abstract:
From a cohort of patients referred for elective transluminal coronary angioplasty, a subset of patients was evaluated to determine whether revascularization using coronary angioplasty could salvage chronically ischemic myocardium. Reversible chronic ischemic left ventricular dysfunction was identified by a severe wall motion abnormality at rest and at least one of the following: 1) persistent angina pectoris; 2) postextrasystolic ventricular contraction potentiation of motion in the asynergic zone on baseline ventriculogram; and 3) thallium-201 uptake in the asynergic zone. Twelve patients were identified as having reversible chronic ischemia and underwent coronary angioplasty. Their mean age was 63 +/- 11 years and duration of symptoms 8.3 +/- 9.7 weeks. Immediate pre- and postangioplasty left ventriculograms were obtained. Regional wall motion was analyzed using a radial axis model, and global ejection fraction was calculated. After angioplasty, tension development (heart rate-systolic pressure product) increased in the absence of an increase in left ventricular end-diastolic pressure. Global ejection fraction increased from 46 +/- 20 to 62 +/- 19% (p less than 0.005). The percent of left ventricular diastolic perimeter showing asynergy decreased from 29 +/- 11 to 10 +/- 13% (p less than 0.005). During follow-up ranging from 6 to 51 months, sudden death occurred in one patient who had had no improvement in wall motion after angioplasty, repeat angioplasty was performed in three patients and eight patients remained asymptomatic. Application of easily obtainable clinical data identifies a subset of patients with chronically ischemic myocardium. Coronary angioplasty in such patients is useful in salvaging hibernating myocardium.