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Improved regional ventricular function after successful surgical revascularization.

B H Brundage, B M Massie, E H Botvinick

    Journal of the American College of Cardiology
    |April 1, 1984
    PubMed
    Summary
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    Coronary bypass surgery can permanently reverse resting left ventricular dysfunction if myocardial perfusion improves. This indicates reversible asynergy may reflect chronic ischemia, improving with enhanced blood flow.

    Area of Science:

    • Cardiology
    • Nuclear Cardiology
    • Cardiovascular Surgery

    Background:

    • Reversible asynergy at rest correlates with exercise-induced myocardial perfusion defects.
    • The impact of improved perfusion on resting asynergy post-revascularization requires further investigation.

    Purpose of the Study:

    • To assess if improved myocardial perfusion after coronary artery bypass surgery (CABS) eliminates resting left ventricular asynergy.
    • To correlate changes in segmental ventricular function and perfusion with graft patency.

    Main Methods:

    • Exercise thallium-201 scintigraphy and contrast ventriculography were performed pre- and post-CABS in 23 angina patients.
    • Coronary arteriography and selective graft angiography assessed graft patency.
    • Segmental ventricular function was quantified, and scintigrams were compared with ventriculograms.

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    Main Results:

    • Postoperatively, 19 of 29 segments with preoperative asynergy normalized function, all showing improved perfusion and patent grafts.
    • Persistent abnormal wall motion in 9 of 10 segments correlated with occluded or poorly functioning grafts.
    • Improved perfusion post-surgery was observed in segments with initially normal and abnormal function.

    Conclusions:

    • Resting asynergy is permanently reversed post-CABS when improved myocardial perfusion is achieved.
    • Findings support the hypothesis that reversible asynergy reflects chronic ischemia, potentially treatable with revascularization.