IMPROVEMENT OF MYOCARDIAL-FUNCTION AND PE RFUSION AFTER RECANALIZATION OF CHRONIC CORONARY-OCCLUSION

The purpose of the study was to evaluate the improvement of the left v entricular ejection fraction and myocardial perfusion after recanaliza tion of chronic coronary artery occlusions. The patients were investig ated by rest and exercise radionuclide ventriculography (25/31) and re st and exercise myocardial scintigraphy (22/31). The examinations were performed 3 +/- 1 days before and within 7 days and 4 months after re canalization. Exercise-induced chest pain was present in 77% (24/31) o f the patients before, in 10% (3/31) after recanalization and in 23% ( 7/31) during follow-up. Six of the 7 patients with exercise-induced ch est pain after 4 months developed restenosis in the former reopened co ronary artery. The results of the exercise-ECG present that 71% (22/31 ) of the patients had ST-segment-depression before, 19% (6/31) after c atheter-intervention and 26% (8/31) during follow-up. Six of the 8 pat ients with exercise-induced ST-depression after 4 months had a resteno sis in the former reopened coronary artery. Reopening resulted in an i ncrease of global rest ejection fraction (EF) from 51 +/- 11% to 54 +/ - 13% (p < 0.05) and sectorial EF from 56 +/- 17% to 61 +/- 21% (p < 0 .01) after recanalization. After 4 months patients with excellent angi ographic results still had an increased global and sectorial EF at res t (global: 54 +/- 9%, sectorial: 59 +/- 17%; n. s.). Patients with res tenosis (note: no reocclusion) developed a decrease of global and sect orial rest EF (global: 49 +/- 14%, sectorial: 57 +/- 19%; n. s.). Afte r recanalization the global exercise EF increased from 51 +/- 14% to 5 6 +/- 14 % (p < 0.01) and the sectorial exercise EF from 51 +/- 18% to 62 +/- 20% (p < 0.01). Four months later patients with excellent angi ographic results had a further improvement during exercise (global: 60 +/- 12%, P < 0.05; sectorial: 65 +/- 21%, p < 0.05). Patients with re stenosis revealed a new decrease during exercise (global: 51 +/- 18%, sectorial: 56 +/- 24%; n. s.). Within 7 days after recanalization the 99mTc-Sestamibi uptake increased from 66 +/-10 rel.-% to 68 +/- 10 rel .-% (n. s.) at rest and from 55 +/- 15 rel.-% to 64 +/- 11 rel.-% (p < 0.001) during exercise. Four months later patients with excellent ang iographic results showed further improvement at rest (72 +/- 9 rel.-%; p < 0.01) as well as during exercise (74 +/- 12 rel.-%; p < 0.001). P atients with restenosis showed a decrease at rest (71 +/- 6 rel.-%; n. s.) as well as during exercise (63 +/- 13 rel.-%; n. s.). It ist conc luded that reopening of chronic coronary occlusion leads to an improve ment of left ventricular function and perfusion. This improvement is m ore obvious during exercise than at rest.