Resting 12-lead electrocardiogram as a reliable predictor of functional recovery after recanalization of chronic total coronary occlusions.
BACKGROUND
A major goal of revascularization is the recovery of left ventricular (LV) function. Nuclear imaging techniques are widely used for detecting recovery of function with a good sensitivity, but only moderate specificity. Predictors of recovery in chronic total coronary occlusions (CTO) are not investigated.


OBJECTIVE
The 12-lead-resting electrocardiogram (ECG) is a predictor of LV recovery after successful recanalization of CTO.


METHODS
Successful recanalization of CTO was performed in 127 patients. Of these, 62 patients, who constitute the study group, had impaired regional wall motion prior to recanalization. The 12-lead resting ECG was evaluated for Q-wave areas and parameters of QT dispersion. Impairment of regional wall motion was evaluated by LV angiogram at baseline and at follow-up.


RESULTS
Angiographic follow-up after 5 +/- 1.4 months documented reocclusion in eight patients. Complete follow-up with a patent coronary artery and an ECG without bundle-branch block was available in 43 patients. Wall motion severity index (WMSI) improved from -2.92 +/- 0.28 to -1.34 +/- 0.61 (p < 0.001) in patients without Q waves, whereas it was unchanged in patients with Q waves (-3.01 +/- 0.30 and -2.81 +/- 0.32). Absence of Q waves at baseline predicted recovery of regional wall motion with 89% sensitivity and 67% specificity. Positive predictive value for recovery was 68% in patients without Q waves, but only 11% in patients with Q waves. In multivariate analysis, only absence of Q waves predicted improvement in WMSI (p = 0.01).


CONCLUSIONS
In patients with recanalization of CTO, recovery of regional wall motion is reliably predicted by analysis of the resting 12-lead ECG for pathologic Q waves.
Surber
Ralf
R
Department of Internal Medicine I, Division of Cardiology and Angiology, Friedrich Schiller University, Jena, Germany. ralf.surber@med.uni-jena.de
Schwarz
Gero
G
Figulla
Hans R
HR
Werner
Gerald S
GS
D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery; D004562:Electrocardiography / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction / Q000502:physiology; D009204:Myocardial Revascularization; D011237:Predictive Value of Tests; D012146:Rest / Q000502:physiology*; D012189:Retrospective Studies; D016896:Treatment Outcome; D016277:Ventricular Function, Left / Q000502:physiology*