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Pre-PTCA detection of chronic but reversible postischemic myocardial dysfunction by nicardipine
Insights
The nicardipine test can predict left ventricular wall motion recovery after percutaneous transluminal coronary angioplasty (PTCA) in patients with coronary artery disease. This calcium antagonist effect is particularly useful for predicting recovery in hypokinetic and infarcted segments.
Area of Science:
- Cardiology
- Cardiovascular Medicine
- Interventional Cardiology
Background:
- Left ventricular (LV) wall motion abnormalities are common in patients with coronary artery disease.
- Percutaneous transluminal coronary angioplasty (PTCA) is a common intervention to restore blood flow.
- Predicting the reversibility of LV dysfunction after PTCA is crucial for patient management.
Purpose of the Study:
- To determine if the immediate effect of nicardipine can predict the reversibility of LV wall motion abnormalities after successful PTCA.
- To evaluate the correlation between nicardipine's effect and long-term wall motion recovery.
Main Methods:
- Dynamic quantitative left cineventriculography was performed on 24 patients with one-vessel coronary artery disease at four time points: baseline, after nicardipine, after PTCA, and 6 months post-PTCA.
- Left ventricular myocardial segments were analyzed for wall motion using the hemiaxis method (Xdeltar%).
- Segments were categorized into hypokinetic non-infarcted (PNHS), infarcted (PIS), and normokinetic non-infarcted (PNNS) groups.
Main Results:
- A strong correlation was found between nicardipine-induced improvement and 6-month post-PTCA improvement in wall motion for PNHS (r=0.75) and PIS (r=0.71) segments.
- The nicardipine test showed high sensitivity (95% in PNHS) for predicting reversible LV hypokinesia at 6 months post-PTCA.
- Immediately after PTCA, significant contraction improvement was observed only in PNHS segments.
Conclusions:
- The pre-PTCA effect of nicardipine is a valuable predictor of significant left ventricular wall motion recovery 6 months after successful PTCA, especially in hypokinetic and infarcted segments.
- While nicardipine testing is sensitive, its specificity varies across different myocardial segment types.
- Significant improvement in contraction of poststenotic LV wall segments is expected 6 months after successful PTCA, and this can be predicted by the pre-PTCA nicardipine effect.
Abstract:
The aim of the study was to find out whether in patients (n = 24) with one-vessel coronary artery disease, reversibility of related left ventricular (LV) wall motion abnormalities after successful percutaneous transluminal coronary angioplasty (PTCA) can be predicted by the immediate effect of calcium antagonist nicardipine. Dynamic quantitative left cineventriculography performed four times successively (as the control, 30 minutes after oral nicardipine, 10 minutes after PTCA, and 6 months after PTCA) and hemiaxis method (mean relative hemiaxis shortening or Xdeltar%) were used for wall motion analysis of 48 poststenotic LV myocardial segments divided into three groups: hypokinetic noninfarcted (PNHS, n = 25), infarcted (PIS, n = 12), and normokinetic noninfarcted (PNNS, n = 11) and of 24 normal LV myocardial segments (NS). In PNHS and PIS close correlation (r = 0.75, P < 0.0001 and r = 0.71, P < 0.005) was demonstrated between postnicardipine improvement (21 +/- 4% to 37 +/- 9%, P < 0.0001, and 16 +/- 7% to 20 +/- 8%, P < 0.0005) and 6 months after PTCA improvement (21 +/- 4% to 33 +/- 7%, P < 0.0001, and 16 +/- 7% to 19 +/- 9%, P < 0.0005) of wall motion. It was loose in PNNS and absent in all three groups immediately after PTCA. The sensitivity of the nicardipine test for 6 months after PTCA reversible LV segmental hypokinesia was high in PNHS (95%) and lower in PIS and PNNS (67% and 60%, respectively). The specificity was 100% in PIS, lower in PNNS (67%), and absent in PNHS (owing to lack of true nonresponders). Immediately after PTCA, contraction significantly improved only in PNHS; the nicardipine test was 100% sensitive but nonspecific. Significant improvement of contraction of all groups of poststenotic LV wall segments is expected 6 months after successful PTCA of related artery stenosis, being well predictable by the pre-PTCA effect of nicardipine, at least in PNHS and in PIS. Immediately after PTCA, only in PNHS can significant improvement of contraction be expected.