Early recovery of wall motion abnormalities after recanalization of chronic totally occluded coronary arteries: a dobutamine echocardiographic, prospective, single-center experience.
BACKGROUND
Patients with symptomatic myocardial ischemia from a chronic totally occluded coronary (TOC) artery are usually referred for coronary artery bypass surgery. Because guide wire technology has improved considerably in recent years, percutaneous coronary angioplasty has become a useful technique in opening chronic TOC arteries. We evaluated the early functional results of successful percutaneous recanalization by performing dobutamine stress echocardiography (DSE).


METHODS
Fifteen patients with a chronic TOC artery who underwent a successful recanalization were prospectively studied. Each patient had a DSE within 24 hours before and 48 hours after the procedure. Wall motion was scored according to a 16-segment/5-point model. A clinical and angiographic follow-up of 6 months was obtained.


RESULTS
The wall motion score index at rest improved from 1.26+/-0.23 before to 1.22+/-0.21 after the procedure (P < .05). Of those 10 segments that improved at rest, 7 were collateral recipients and 3 were collateral donors. The number of ischemic segments decreased from 46 before to 4 after the procedure (P < .0001). Wall motion score index at peak stress improved from 1.34+/-0.20 before to 1.15+/-0.12 after the procedure (P < .05). DSE was positive for ischemia in 15 patients before and 2 patients after the procedure (P < .0001). Angina was present in 12 patients before and in 2 patients after recanalization (P < .0001). Two patients (13%) had angiographic reocclusion and 5(33%) restenosis after 6 months of follow-up.


CONCLUSIONS
Successful percutaneous recanalization of chronic TOC artery results in an early improvement of both clinical status and resting or stress-induced wall motion abnormalities, as detected by DSE.
Rambaldi
R
R
Thoraxcenter, University Hospital Rotterdam-Dijkzigt, and Erasmus University, Rotterdam, The Netherlands.
Hamburger
J N
JN
Geleijnse
M L
ML
Poldermans
D
D
Kimman
G J
GJ
Aiazian
A A
AA
Fioretti
P M
PM
Ten Cate
F J
FJ
Roelandt
J R
JR
Serruys
P W
PW
D000328:Adult; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D002316:Cardiotonic Agents; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000628:therapy; D004280:Dobutamine; D004452:Echocardiography / Q000379:methods; D005260:Female; D006334:Heart Function Tests; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies
D002316:Cardiotonic Agents; D004280:Dobutamine