REGIONAL MYOCARDIAL BLOOD-FLOW, GLUCOSE-UTILIZATION AND CONTRACTILE FUNCTION BEFORE AND AFTER REVASCULARIZATION AND ULTRASTRUCTURAL FINDINGS IN PATIENTS WITH CHRONIC CORONARY-ARTERY DISEASE

In patients with chronic coronary artery disease, follow-up measuremen ts of myocardial blood flow, metabolism and function were correlated w ith histology. In 41 patients with chronic coronary artery disease and a severely stenosed left anterior descending coronary artery, a posit ron emission tomographic (PET) flow/metabolism study and nuclear angio graphy were performed immediately before and 3 months after bypass sur gery. Biopsies were taken from the left ventricular anterior wall at t he time of surgery. Control biopsies were taken from donor hearts for cardiac transplantation and from hearts of patients with a defect of t he atrial septum. A significant improvement of flow (P<0.01) and regio nal contractile function (P<0.01) was observed in the mismatch group. Glucose utilization was significantly lower (P<0.001) as compared to p reoperative values. The group with preserved flow and the PET match gr oup revealed no significant changes in flow, metabolism or function. C ontrol biopsies revealed significantly less myolytic cells as compared to biopsies taken from both match and mismatch groups (P<0.01) and le ss fibrosis as compared to biopsies taken from the match group (P<0.01 ). Postoperatively, linear relationships were found between flow and b oth % fibrosis (r = 0.71, P<0.001) and regional anterior ejection frac tion (r = 0.7, P<0.001). Only mismatch areas revealed significant reco very of both flow and function after revascularization with a disappea rance of enhanced glucose uptake. The better linear correlation betwee n flow and % fibrosis after surgery as compared to preoperatively was probably due to improvement of flow values in the mismatch group.