title: Functional significance of coronary angiography in recognition of residual myocardial viability in patients with previous myocardial infarction.
abstract: 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.
authors.affiliation: Division of Cardiology, Helen Joseph Hospital, Johannesburg, South Africa.
authors.forename: L
authors.initials: L
authors.lastname: Goldberg
authors.forename: P
authors.initials: P
authors.lastname: Bortz
authors.forename: P
authors.initials: P
authors.lastname: Landless
mesh_terms: 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