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[Reversibility of akinetic segments in coronary heart disease]
Insights
Akinetic heart segments may recover function after bypass surgery, challenging the assumption of irreversible scar tissue. This study found improved contractions in 29% of patients, particularly in the anterior wall, leading to better ejection fraction.
Area of Science:
- Cardiology
- Cardiac Surgery
- Diagnostic Imaging
Context:
- Akinetic left ventricular segments are typically considered irreversible scar tissue.
- Improved blood supply after aorto-coronary bypass surgery is not expected to restore function to these segments.
- This study investigates functional recovery in akinetic segments post-bypass surgery.
Purpose:
- To evaluate the functional recovery of akinetic left ventricular segments after aorto-coronary bypass surgery.
- To determine the impact of bypass surgery on global and regional ejection fraction in patients with akinetic segments.
- To compare the recovery of anterior versus inferior wall akinesia.
Summary:
- Ventriculograms of 24 patients undergoing bypass surgery were analyzed pre- and postoperatively.
- Seven patients (29%) showed improved contraction in previously akinetic segments, with patent bypass grafts.
- Global ejection fraction significantly increased in patients with improved akinesia (47% to 65%).
Impact:
- Findings challenge the traditional view of akinetic segments as non-viable scar tissue.
- Improved contractility was more pronounced in anterior wall akinesia, leading to higher regional ejection fraction.
- The study suggests potential for functional recovery in specific akinetic myocardial regions following revascularization.
Abstract:
Akinetic wall segments not exhibiting contractions following nitroglycerin administration or in a post-extrasystolic beat are usually considered to consist of scar tissue; i.e. even by re-established or improved blood supply following aorto-coronary bypass surgery no functional improvement is expected. In the present study, the pre- and postoperative ventriculograms (RAO projection) of 24 patients undergoing bypass surgery were analyzed. Ventriculography was routinely performed following sublingual nitroglycerin and a post-extrasystolic contraction. In each patient the akinetic segment had received a bypass graft which was found to be patent on reangiography. In 7 of 24 patients (29%) the formerly akinetic segment exhibited improved contraction postoperatively; in 17 patients the segment remained akinetic. Global ejection fraction rose in the group of patients with improved akinesia from 47 +/- 10 to 65 +/- 10% (p less than 0.05). In the patients with unchanged contraction pattern, ejection fraction was found to be 56 +/- 12% prior to surgery and 54 +/- 16% after surgery (n.s.). The increase in ejection fraction was more pronounced in those patients showing improvement of anterior wall akinesia (from 39 to 72%) than it was in patients exhibiting improved inferior wall akinesis (from 54 to 59%). According to these findings, the regional ejection fraction was found to be higher postoperatively in patients with former anterior wall akinesis (78%) than in those showing inferior wall contraction abnormalities (49%). End-diastolic and end-systolic left ventricular volume changes postoperatively did not reach statistical significance, although end-systolic volume showed a clear trend to decrease (preoperative: 114 +/- 54 ml/1.73 m2; postoperative: 79 +/- 29 ml/1.73 m2; n.s.).(ABSTRACT TRUNCATED AT 250 WORDS)