Wall motion and perfusion analysis of transmyocardial laser revascularization.
OBJECTIVE
Transmyocardial laser revascularization (TMLR) creates channels in the myocardium. The aim of the treatment is to relieve angina in patients with end-stage coronary artery disease. We studied the effect of TMLR on myocardial function and perfusion with the combination of cine magnetic resonance imaging (MRI) and thallium scintigraphy.


METHODS
Eight patients with severe triple-vessel coronary artery disease were studied with MRI and thallium scintigraphy before and 6 months after laser treatment.


RESULTS
TMLR did not improve global left ventricular (LV) function or myocardial perfusion. However, systolic wall thickening deprived in segments with fixed perfusion defects in 6 months and laser treatment prevented this deprivation (p = 0.03). In addition single photon emission computed tomography (SPECT) imaging indicated that TMLR prevented conversion of reversible into fixed defects.


CONCLUSIONS
In severe, progressing coronary artery disease TMLR does not improve global LV function or myocardial perfusion, but it preserves systolic wall thickening in fixed defects (scar). It also prevents changes from ischemic myocardial regions to scar.
Holmström
Miia
M
Department of Radiology, Helsinki University Central Hospital, Finland. Miia.Holmstrom@hus.fi
Hänninen
Helena
H
Simpanen
Jarmo
J
Virtanen
Kari S
KS
Werkkala
Kalervo
K
Aronen
Hannu J
HJ
Lauerma
Kirsi
K
D000368:Aged; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery*; D003326:Coronary Circulation; D015444:Exercise; D005260:Female; D005500:Follow-Up Studies; D006321:Heart / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D007834:Lasers; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization; D010477:Perfusion; D011877:Radionuclide Imaging; D013793:Thallium
D013793:Thallium