[Left ventricular systolic function in patients with refractory angina pectoris treated with percutaneous myocardial laser revascularisation, results of long-term follow-up].
BACKGROUND
Percutaneous myocardial laser revascularisation (PMLR) has been developed for treatment of patients with refractory angina pectoris. This study was designed to evaluate long-term impact of PMLR on left ventricular systolic function.


METHODS
Ten patients with refractory angina pectoris who underwent PMLR were studied with dobutamine stress echocardiography before procedure, at early follow-up after 1-3 months and at long-term follow-up after 2-3 years post procedure. Wall motion score index (WMSI) and ejection fraction (EF) were calculated at rest as well during infusion of dobutamine with low and high rate.


RESULTS
Mean WMSI at rest decreased significantly from 1.71 +/- 0.24 before PMLR to 1.55 +/- 0.21 at early follow-up (p=0.0189) and 1.48 +/- 0.26 (p=0.009) at long-term follow-up. Mean WMSI during low-rate dobutamine infusion decreased significantly from 1.39 +/- 0.29 to 1.25 +/- 0.25 (p=0.0276) at early follow-up, but was not significantly different in long-term. Mean WMSI during high-rate dobutamine infusion decreased significantly from 1.83 +/- 0.21 before PMLR to 1.56 +/- 0.2 at early follow-up and 1.57 +/- 0.29 (p<0.03) at long-term evaluation. Mean EF at rest increased significantly from 48 +/- 8.6% before PMLR to 56.9 +/- 7.9% (p=0.0189) at early follow-up. At long-term follow-up mean EF at rest was 52.7 +/- 8.3% and was not significantly different from baseline. Mean EF during low-rate dobutamine infusion was not significantly different from baseline both at early and long-term follow-up. Mean EF during high-rate dobutamine infusion increased significantly from 44.5 +/- 8.6% before PMLR to 58.1 +/- 7.0% (p=0.0093) at early follow-up while in long-term it was 51.3 +/- 9.8%, which was not significantly different from baseline. These changes were accompanied by significant decrease of mean CCS score from 3.52 +/- 0.51 before procedure to 2.54 +/- 0.78 (p<0.0001) after 1 month and 2.78 +/- 0.65 after 24 months.


CONCLUSIONS
In patients with refractory angina pectoris treated with PMLR significant early improvement of systolic left-ventricular function is observed with trend toward improvement in long-term. It is accompanied with significant long-term angina relief.
Zmudka
Krzysztof
K
Zakład Hemodynamiki i Angiokardiografii, Instytut Kardiologii, Uniwersytet Jagielloński, Collegium Medicum, Kraków, Szpital im. Jana Pawła II. mczmudka@cyf-kr.edu.pl
Trebacz
Jarosław
J
Podolec
Piotr
P
Olszowska
Maria
M
Hlawaty
Marta
M
Kostkiewicz
Magdalena
M
Rudziński
Paweł
P
Sadowski
Jerzy
J
Tracz
Wiesława
W
Dudek
Dariusz
D
Dubiel
Jacek
J
D000368:Aged; D000787:Angina Pectoris / Q000503:physiopathology* / Q000601:surgery*; D017222:Angioplasty, Balloon, Laser-Assisted; D025401:Echocardiography, Stress; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D013318:Stroke Volume; D013599:Systole; D013997:Time Factors; D016277:Ventricular Function, Left