Functional significance of coronary angiography in recognition of residual myocardial viability in patients with previous myocardial infarction.
The relationship between the epicardial blood supply to the akinetic area, its 'residual myocardial viability' and 'contractile reserve' were the subjects of this study involving 29 postinfarct patients with double- or triple-vessel coronary disease and ejection fraction less than 45%. Eighty-one of 232 analysed segments (34.9%) were akinetic. Nineteen akinetic segments (23.5%) were defined as viable and 12 (14.8%) demonstrated residual contractility. The epicardial blood flow supply to 32 (39.5%) akinetic segments was moderately decreased, 11 (34.4%) of them were viable, and 9 (28.1%) demonstrated contractile reserve. The epicardial blood flow to 49 (60.5%) akinetic segments appeared severely limited; only 8 (16.3%) of them were viable and 3 (6.1( demonstrated contactile reserve. The incidence of viability of the akinetic segments was not significantly (P<0.061) different in those regions with different epicardial blood supply (16.3% v. 34.4%). However, the contractile reserve was significantly (P<0.006) more often preserved in akinetic segments with better epicardial blood flow (28.1% v. 6.1%). We concluded that the extent of coronary disease defined by angiography does not predict residual myocardial viability of the akinetic myocardium in postinfarct patients. However, well&hyphen preserved epicardial flow is associated with a significantly increased incidence of preserved contractile reserve and weakly preserved epicardial flow is associated with a very low incidence of contractile reserve in these patients.
Goldberg
L
L
Division of Cardiology, Helen Joseph Hospital, Johannesburg, South Africa.
Bortz
P
P
Landless
P
P
D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging; D003326:Coronary Circulation; D006801:Humans; D008875:Middle Aged; D009200:Myocardial Contraction; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000503:physiopathology*; D017682:Myocardial Stunning / Q000000981:diagnostic imaging / Q000503:physiopathology*; D012189:Retrospective Studies; D015899:Tomography, Emission-Computed, Single-Photon