LACK OF PREDICTORS OF LEFT-VENTRICULAR FUNCTIONAL IMPROVEMENT FOLLOWING CORONARY ANGIOPLASTY

Coronary angioplasty is frequently performed in a vessel with correspo nding regional wall motion abnormalities. However, late improvement of left ventricular function remains questionable in many cases and is d ifficult to predict. A retrospective analysis of 115 patients with sin gle vessel disease and corresponding abnormal regional left ventricula r function at the time of coronary angioplasty was performed. All pati ents had control coronary angiography and a new contrast ventriculogra phy 5.6 +/- 3.1 months later (range 0.8-11.8 months). Among those pati ents, 61 (53%) showed improvement of regional left ventricular functio n, which was not seen in the 54 (47%) others. Global ejection fraction increased significantly in the former group, whereas it remained unch anged in the later group. Before angioplasty, patients with and withou t improvement of systolic left ventricular function were indistinguish able in terms of history, medication, rest and stress electrocardiogra m, and angiographic characteristics. During angioplasty, angina was mo re frequent (65% vs. 44%, p < 0.02) in patients with subsequent left v entricular functional improvement. At follow-up study, significant ang iographic restenosis was more frequently encountered (68% vs. 43%, p < 0.05) in patients with no evidence of functional improvement. Thus, c oronary angioplasty in a vessel responsible for left ventricular systo lic dysfunction is followed in only half the cases by improvement of t his parameter. No predictor of the functional outcome of the myocardiu m can be pointed out before the procedure is performed.