Changes in Left Ventricular Function After Coronary Recanalization by Percutaneous Transluminal Coronary Angioplasty (PTCA).
Forty-six patients (21 with stable angina and 25 with chronic myocardial infarction, 37 men) with a total chronic proximal coronary occlusion and collateral vessels to the distal part of the occluded artery (30 LAD, 10 RCA and 6 CX properly distributed in both groups) were studied angiographically before and 2 to 8 months (mean 6) after balloon angioplasty. The patients were divided in six subgroups: A) Angina pectoris no matter the result of recanalization (n = 21); B) Myocardial infarction no matter the result of recanalization (n = 25); C) Angina pectoris with successful recanalization and open coronary (O.C.) > 50% at follow-up (n = 13); D) Angina pectoris with unsuccessful recanalization and/or restenosis or closed coronary (C.C.) at follow-up (n = 8); E) Myocardial infarction with successful recanalization and O.C. > 50% at follow-up (n = 8); F) Myocardial infarction with unsuccessful recanalization and/or restenosis or C.C. at follow-up (n = 17). No subgroup showed statistical differences (p > 0.05) in LVEDP before (B) and at follow-up (FU). On the other hand, several measurements were statistically different in the subgroup A at B and at FU: Ejection fraction (EF) [57.3 +/- 12.3 and 64.2 +/- 19.4%; p = 0.02]; Regional wall motion (RWM) measured in the region of the affected coronary [18.7 +/- 9.6 and 23.6 +/- 11.8%; p = 0.05]; Minimal wall motion (MWM) measured in the site of lesser parietal movement [14.3 +/- 13.1 and 25.8 +/- 26.2%; p = 0.02]. In the subgroup C the following differences were observed: EF [58.4 +/- 12.3 and 69.0 +/- 12.4%; p = 0.003]; RWM [16.3 +/- 8.4 and 25.4 +/- 8.2%; p = 0.005]; MWM [14.7 +/- 15.1 and 27.9 +/- 18.0%; p = 0.0001]. In the other considered subgroups we did not reach significant differences (p > 0.05) in these measurements. We conclude that recanalization of a chronic coronary occlusion improves left ventricular contractile function in the presence of viable myocardium and that MSF is the most sensitive among the studied variables to separate anginal patients from the patients without viable myocardium after successful recanalization.
Gottschall
CA
Instituto de Cardiologia, Fundacao Universitaria de Cardiologia, Av. Princesa Isabel 395, Porto Alegre, RS, Brasil, CEP.
Trindade
I
Miler
V