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[Improvement in myocardial function and perfusion after recanalizing a chronic coronary artery occlusion]
C Schacherer1, H Klepzig, C Heck
1Zentrum der Inneren Medizin, Abteilung für Kardiologie, Frankfurt am Main.
Insights
Recanalization of chronic coronary artery occlusions improved left ventricular ejection fraction and myocardial perfusion. However, restenosis after the procedure can lead to a decrease in ejection fraction and recurrence of symptoms.
Area of Science:
- Cardiology
- Interventional Cardiology
- Nuclear Cardiology
Background:
- Chronic coronary artery occlusions significantly impair left ventricular function and myocardial perfusion.
- Recanalization aims to restore blood flow, but long-term efficacy and impact on cardiac function require evaluation.
Purpose of the Study:
- To assess the improvement in left ventricular ejection fraction (EF) and myocardial perfusion following recanalization of chronic coronary artery occlusions.
- To evaluate the impact of restenosis on cardiac function and symptoms after recanalization.
Main Methods:
- Patients underwent rest and exercise radionuclide ventriculography and myocardial scintigraphy.
- Examinations were performed before, shortly after, and 4 months after recanalization.
- Clinical symptoms (chest pain) and exercise electrocardiogram (ECG) findings were monitored.
Main Results:
- Recanalization led to a significant increase in global and sectorial rest ejection fraction (EF).
- Exercise-induced chest pain and ST-segment depression decreased significantly after recanalization.
- Restenosis after 4 months was associated with a decrease in EF and recurrence of symptoms in some patients.
Conclusions:
- Recanalization of chronic coronary occlusions improves left ventricular EF and myocardial perfusion.
- Long-term success is influenced by restenosis, which can negate functional improvements and lead to symptom recurrence.
- Radionuclide imaging and ECG are valuable for assessing outcomes and detecting restenosis post-recanalization.
Abstract:
The purpose of the study was to evaluate the improvement of the left ventricular ejection fraction and myocardial perfusion after recanalization of chronic coronary artery occlusions. The patients were investigated by rest and exercise radionuclide ventriculography (25/31) and rest and exercise myocardial scintigraphy (22/31). The examinations were performed 3 +/- 1 days before and within 7 days and 4 months after recanalization. Exercise-induced chest pain was present in 77% (24/31) of the patients before, in 10% (3/31) after recanalization and in 23% (7/31) during follow-up. Six of the 7 patients with exercise-induced chest pain after 4 months developed restenosis in the former reopened coronary artery. The results of the exercise-ECG present that 71% (22/31) of the patients had ST-segment-depression before, 19% (6/31) after catheter-intervention and 26% (8/31) during follow-up. Six of the 8 patients with exercise-induced ST-depression after 4 months had a restenosis in the former reopened coronary artery. Reopening resulted in an increase of global rest ejection fraction (EF) from 51 +/- 11% to 54 +/- 13% (p < 0.05) and sectorial EF from 56 +/- 17% to 61 +/- 21% (p < 0.01) after recanalization. After 4 months patients with excellent angiographic results still had an increased global and sectorial EF at rest (global: 54 +/- 9%, sectorial: 59 +/- 17%; n.s.). Patients with restenosis (note: no reocclusion) developed a decrease of global and sectorial rest EF (global: 49 +/- 14%, sectorial: 57 +/- 19%; n.s.).(ABSTRACT TRUNCATED AT 250 WORDS)