Regional myocardial dysfunction during coronary angioplasty: Evaluation by two-dimensional echocardiography and 12 lead electrocardiography

Abstract

Balloon inflation performed during percutaneous transluminal coronary angioplasty causes transient total occlusion of the coronary artery and thus provides a model for evaluation of the regional myocardial responses to transient ischemia. Twenty patients with normal left ventricular function undergoing angioplasty of isolated stenosis of the proximal left anterior descending coronary artery were studied. In group A (14 patients) analysis of one inflation-deflation sequence per patient was performed. Group B (six patients) had multiple (greater than 5) inflations; the first and last sequences were analyzed. Assessment included continuous two-dimensional echocardiography with computerized quantitative analysis of regional left ventricular wall motion, and continuous 12 lead electrocardiographic recordings. The mean duration of inflation in group A was 62 +/- 6 seconds (mean +/- SD). The onset of regional left ventricular dysfunction was 12 +/- 5 seconds after inflation. Profound dysfunction was noted in all patients. After 60 seconds of balloon occlusion of the coronary artery, 29% of patients had severe hypokinesia of the ischemic region and 71% had akinesia or dyskinesia. With deflation there was prompt recovery of regional function, with full recovery at 43 +/- 17 seconds. Comparison of data from first and last inflations in group B revealed no significant differences in time to onset of dysfunction, magnitude of dysfunction or time to complete recovery of function. The onset of ischemic electrocardiographic changes lagged behind the onset of wall motion abnormalities, with only 64% of patients showing evidence of ischemia on 12 lead electrocardiograms at 20 seconds of inflation. After 60 seconds, 86% had ischemia detectable by electrocardiography. Thus, balloon inflation during coronary angioplasty leads to profound but reversible regional left ventricular dysfunction. Repeated occlusions of the coronary artery during angioplasty do not have a cumulative ischemic effect. It may be hazardous to apply these findings to patients who have underlying major left ventricular dysfunction and in whom the reversibility of dysfunction and lack of cumulative ischemic effect may not be assured.

Autologous blood perfusion for myocardial protection during coronary angioplasty: a feasibility study.

“…First, it is now well recognized that profound myocardial dysfunction regularly accompanies balloon inflation. [1][2][3][4] 10 min are now being used in some laboratories. 4 It has been shown in experimental animals '5-'7 and in clinical trials2,'4 that hemodynamic and mechanical changes occur shortly after coronary occlusion, typically within 20 sec."…”

“…[1][2][3][4] 10 min are now being used in some laboratories. 4 It has been shown in experimental animals '5-'7 and in clinical trials2,'4 that hemodynamic and mechanical changes occur shortly after coronary occlusion, typically within 20 sec." 2,4 Restoration of flow reverses this ventricular impairment, but only if the ischemic period is short.…”

“…4 It has been shown in experimental animals '5-'7 and in clinical trials2,'4 that hemodynamic and mechanical changes occur shortly after coronary occlusion, typically within 20 sec." 2,4 Restoration of flow reverses this ventricular impairment, but only if the ischemic period is short. In dogs, ischemia of greater than 5 min duration can delay functional recovery for up to 6 hr, '6 with repeated 5 min episodes of occlusion producing actual myocardial necrosis.…”

Altered myocardial perfusion in patients with angina pectoris or silent ischemia during exercise as assessed by quantitative thallium-201 single-photon emission computed tomography.

“…This is not surprising since electrocardiographic ST segment changes as well as angina are recognized as relatively late manifestations of acute myocardial ischemia. [30][31][32] Previous Studies Attempting to Quantify Silent Ischemia Few studies with myocardial scintigraphy have attempted to quantify differences in the extent of perfusion defects between symptomatic and asymptomatic patients.18"9'33 Hecht et al19 reported their observations with 20`TI SPECT and observed a similar number of reversible tomographic segments during exercise imaging in a retrospective analysis of patients with and without chest pain. In contrast to the present report, Hecht et al studied only patients with reversible perfusion defects, the majority of whom had a history of angina and multivessel coronary disease.…”

Diagnostic Value of 2D Strain Imaging In Patients with Suspected Coronary Artery Disease

“…The longitudinal systolic strain/rate has been shown to be linearly correlated with the maximal value of the first LV pressure time derivative and also with the peak elastance, which are both global measures of LV systolic function and contractility [14,15]. Similar to tissue velocity imaging, strain echocardiographic imaging can be accomplished in real time, thus facilitating its clinical feasibility [16].…”