Increased intensity of contrast material immediately after late angioplasty of infarct-related coronary artery is associated with reduced ventricularvolumes at six months

To assess the contribution of residual muscle perfusion in the infarcted te rritory to prevent ventricular remodeling, 24 patients with 1-vessel diseas e underwent coronary angiography and angioplasty of a critical left anterio r descending coronary stenosis 18 +/- 11 days after a first anterior myocar dial infarction. The degree of stenosis was assessed using biplane quantita tive angiography, whereas ventricular volumes, together with regional wall motion, were computed from single-plane ventriculography. Patients were ree valuated at 6 months after they had been subdivided according to the videoi ntensity of the territory of the culprit vessel, as assessed from images ob tained during main stem dye contrast injections before and immediately afte r angioplasty using a subtraction technique (group A, increased intensity [ n = 15]; group B, no change [n = 9]), assuming that higher peak intensities reflect greater myocardial blood volume. There was a significant time grou p interaction for ventricular volumes (diastolic, -13 +/- 12% for group A v s +20 +/- 24% for group B, p = 0.008; systolic, -15 +/- 19% for group A vs +18 +/- 36% for group B, p = 0.017), although no interaction was evident fo r the degree of resolution of coronary stenosis or the extent of recovery o f regional dysfunction. The effects on volumes were paralleled by changes i n ventricular end-diastolic pressure (-3 +/- 7 mm Hg in group A vs +5 +/- 6 mm Hg in group B, p = 0.006), although baseline clinical characteristics a nd medical regimen over the 6-month period were quite comparable between th e 2 groups. In conclusion, despite late angioplasty of the culprit vessel, ventricular remodeling is prevented mainly when the procedure guarantees im proved perfusion at the muscular level. The result is not necessarily media ted by recovery of regional systolic function. (C) 1998 by Excerpta Medico, Inc.