MAXIMAL MYOCARDIAL PERFUSION BY VIDEODENSITOMETRY IN THE ASSESSMENT OF THE EARLY AND LATE RESULTS OF CORONARY ANGIOPLASTY - RELATIONSHIP WITH CORONARY-ARTERY MEASUREMENTS AND LEFT-VENTRICULAR FUNCTION AT REST

In the assessment of the acute results of percutaneous transluminal co ronary angioplasty (PTCA), myocardial perfusion at maximal vasodilatat ion theoretically has fewer limitations than the coronary flow reserve measurements and quantitative coronary angiography. The purpose of th is study was to compare the myocardial perfusion to the measurements o f the severity of the lesion (minimal luminal diameter and percent are a stenosis) and to relate it to the changes of left ventricular functi on after PTCA. Regional myocardial perfusion was assessed during intra coronary papaverine, using the inverse mean transit time of contrast m edium (1/T-mn), before, 15 min after, 18-24 hr after, and 6 months aft er successful single-vessel PTCA in 14 patients with stable angina. Le ft ventricular angiography (before angioplasty, 18-24 hr after, and 6 months later) was analysed by area-length and centerline methods. Imme diately after PTCA, 1/T-mn increased from 0.14 +/- 0.07 sec(-1) to 0.2 1 +/- 0.09 sec(-1) (P = .001). Maximal myocardial perfusion remained h igher than the pre-PTCA value the day after angioplasty (1/T-mn of 0.2 3 +/- 0.09 sec(-1)), while it reduced to near pre-PTCA values at follo w-up (1/T-mn of 0.16 +/- 0.05 sec(-1)), Before PTCA, three out of ten patients had ejection fraction of <65%, and seven had mild-to-moderate hypokinesis. The day after PTCA the ejection fraction and the regiona l dysfunction improved significantly. The change in ejection fraction 18-24 hr after PTCA did not correlate with minimal luminal diameter an d percent area stenosis and correlated slightly with the improvement o f perfusion (r = 0.54, P = .10). At follow-up left ventricular functio n deteriorated in the whale group, despite the persistence of angiogra phic success of PTCA, possibly because of changes in the loading condi tion, Coronary artery stenosis measurements and 1/T-mn failed to corre late with the left ventricular function. Given the difficulties in rou tine application of the analysis of time-density curves, the measureme nt of minimal luminal diameter remains a more practical assessment of the results of the intervention. However, the improvement of myocardia l perfusion may give more information than coronary artery dimensions of the early recovery of left ventricular function. (C) 1995 Wiley-Lis s, Inc.