SYNCHRONIZED CORONARY VENOUS RETROPERFUSI ON - CAN RETROGRADE DELIVERY OF FLOW IDENTIFY HIBERNATING MYOCARDIUM

ECG-synchronized retroperfusion (SRP) via the coronary sinus has been recently demonstrated to efficiently deliver arterial blood to ischemi c myocardium in an experimental setting and during PTCA. To assess the potential of SRP for identifying hibernating myocardium by improved c ontractile function resulting from retrograde delivery of oxygen, 10 p atients (M/F = 9/1; age 56 +/- 9 years) with ischemic wall motion abno rmalities, but, according to ECG-criteria, no transmural infarction in the territory of a totally occluded LAD, underwent 30 min of SRP at a flow rate of 145-250 ml/min prior to mechanical recanalization. Seria l digital ventriculograms were obtained before, after 30 min of SRP an d, finally, after successful PTCA at follow-up of 28 +/- 4 days. Resul ts: Wall motion analysis revealed improved global and regional contrac tile function in seven of 1 0 patients, which was maintained after suc cessful PTCA. Continuous SRP over 30 min resulted in an improvement of global and segmental systolic function. Left ventricular ejection fra ction (LVEF) increased from 53 +/- 8 % to 58 +/- 5 % with 30 min of SR P (p < 0.03) and significant improvement in regional function was dete cted in the anterobasal, apical and inferior segment of the left ventr icular circumference (p < 0.05). Conclusion: An improved contractile r esponse to retrograde delivery of oxygen by SRP appears to document th e reversibility of myocardial hibernation. Thus, ECG-synchronized SRP via the coronary sinus has the potential to unmask viable myocardium l ikely to completely recover from contractile dysfunction after success ful antegrade recanalization. Moreover, continuous SRP procedure over 30 min was safe and had no hazardous side-effects.