Myocardial Perfusion and Left Ventricular Function Early after Successful PTCA in 1-Vessel Coronary Artery Disease

H. M. Hoffmeister; W. Kaiser; H. Hank; W. Müller-Schauenburg; K. R. Karsch; L. Seipel

doi:10.1055/s-0038-1629681

Nuklearmedizin - NuclearMedicine, Table of Contents

Nuklearmedizin 1994; 33(02): 68-72
DOI: 10.1055/s-0038-1629681

Original Article

Schattauer GmbH

Myocardial Perfusion and Left Ventricular Function Early after Successful PTCA in 1-Vessel Coronary Artery Disease

Authors

H. M. Hoffmeister

¹From the Medizinische Klinik und Poliklinik, Abt. III & Abt. für Nuklearmedizin der Radiologischen Klinik, Universität Tübingen, FRG
W. Kaiser

¹From the Medizinische Klinik und Poliklinik, Abt. III & Abt. für Nuklearmedizin der Radiologischen Klinik, Universität Tübingen, FRG
H. Hank

¹From the Medizinische Klinik und Poliklinik, Abt. III & Abt. für Nuklearmedizin der Radiologischen Klinik, Universität Tübingen, FRG
W. Müller-Schauenburg

¹From the Medizinische Klinik und Poliklinik, Abt. III & Abt. für Nuklearmedizin der Radiologischen Klinik, Universität Tübingen, FRG
K. R. Karsch

¹From the Medizinische Klinik und Poliklinik, Abt. III & Abt. für Nuklearmedizin der Radiologischen Klinik, Universität Tübingen, FRG
L. Seipel

¹From the Medizinische Klinik und Poliklinik, Abt. III & Abt. für Nuklearmedizin der Radiologischen Klinik, Universität Tübingen, FRG

Abstract

Summary

Myocardial perfusion (²⁰¹TI-ECT) and contractile function (^99mTc-Ventriculography) were studied during exercise and rest 3 to 6 days after PTCA in 20 patients (11 with stable and 9 with unstable angina pectoris). All patients had single vessel disease and no previous myocardial infarction. During exercise after PTCA the ejection fraction increased for 3 to 5% and no regional wall motion abnormalities, ST-segment depression or perfusion defects occurred (with exception in one patient with very early restenosis). Therefore, perfusion and wall motion were completely normalized at rest and during exercise within days after technically successful PTCA even in patients with previously unstable angina pectoris. Pathological stress test results after this time should thus be attributed to other causes e.g. early restenosis, multivessel disease, false positive tests) and are not due to the specific situation early after PTCA.

Zusammenfassung

Myokardperfusion (²⁰¹TI-ECT) und kontraktile Funktion (^99mTc-Ventrikulogra-phie) wurden 3-6 Tage nach PTCA bei 20 Patienten (11 mit stabiler und 9 mit instabiler Angina pectoris) in Ruhe und unter Belastung untersucht. Alle Patienten hatten eine 1-Gefäßerkrankung und keinen Myokardinfarkt in der Vorgeschichte. Unter Belastung nach PTCA stieg die Ejektionsfraktion um 3-5% an, regionale Wandbewegungsstörungen, deutliche ST-Segment-Absenkungen im EKG oder Perfusionsdefekte wurden nicht mehr beobachtet (mit Ausnahme eines Patienten mit sehr früher Restenose). Die Ergebnisse zeigen, daß Myokardperfusion und linksventrikuläre Funktion sogar bei den Patienten mit vormals instabiler Angina pectoris innerhalb weniger Tage nach technisch erfolgreicher PTCA vollständig sowohl in Ruhe als auch während Belastung normalisiert sind. Pathologische Belastungstest-Ergebnisse nach diesem Zeitpunkt sollten daher eher anderen Gründen zugeordnet werden (z.B. frühe Restenose, Mehrgefäßerkrankung, falsch-positive Tests) und sind nicht Ausdruck der spezifischen Situation nach PTCA.

Key words

PTCA - ²⁰¹TI scintigraphy - unstable angina pectoris

Schlüsselwörter

PTCA - TI-201 Szintigraphie - instabile Angina pectoris

Full Text

References

REFERENCES
1 Bolli R, Zhu WX, Thornby JI. et al. Time course and determinants of recovery of function after reversible ischemia in conscious dogs. Am J Physiol 1988; 254 Heart Circ Physiol 23 H102-H114.
2 Braunwald E, Kloner RA. The stunned myocardium: prolonged, postischemic ventricular dysfunction. Circulation 1982; 66: 1146-9.
3 Charlat ML, O’Neill PG, Hartley CJ. et al. Prolonged abnormalities of left ventricular diastolic wall thinning in the “stunned” myocardium in conscious dogs: time course and relation to systolic function. J Am Coll Cardiol 1989; 13: 185-94.
4 Danchin N, Haouzi A, Amor M. et al. Sustained improvement in myocardial perfusion four to six years after PTCA in patients with a satisfactory angiographic result, six months after the procedure. Eur Heart J 1988; 9: 454-7.
5 De Kock M, Melin JA, Pouleur H. et al. Alterations in myocardial metabolism and function at rest in stable angina pectoris: relations with the amount of exercise-induced thallium-201 perfusion defect. Cath Cardiovas Diag 1986; 12: 391-8.
6 De Puey G, Leatherman LL, Leachman RD. et al. Restenosis after transluminal coronary angioplasty detected with exercise-gated radionuclide ventriculography. J Am Coll Cardiol 1984; 4: 1103-13.
7 Grenz R, Maul FD, Standke R. et al. Ergebnisse der kombinierten Myokardszintigraphie und Radionuklidventrikulogra-phie vor und nach transluminaler Koronar-angioplastik kritischer Koronararterienste-nosen. Nucl-Med 1986; 25: 106-13.
8 Hakki AH, Iskandrian AS, Kane SA. et al. Thallium-201 myocardial scintigraphy and left ventricular function at rest in patients with rest angina pectoris. Am Heart J 1984; 108: 326-23.
9 Heyndrickx GR, Millard RW, Mc Ritchie RJ. et al. Regional myocardial functional and electrophysiological alterations after brief coronary artery occlusion in conscious dogs. J Clin Invest 1975; 56: 978-85.
10 Hirzel HO, Nuesch K, Gruentzig AR. et al. Short- and long-term changes in myocardial perfusion after percutaneous transluminal coronary angioplasty assessed by thallium-201 exercise scintigraphy. Circulation 1981; 63: 1001-7.
11 Hoffmeister HM, Hanke H, Unterberg R. et al. Ischämieerkennung mit Thallium-201-Single-Photon-Emissionscomputertomographie (SPECT) und Radionuklidventrikulo-graphie im Vergleich zur Belastungscine-ventrikulographie. Z Kardiol 1988; 77: 115-9.
12 Hoffmeister HM, Hanke H, Unterberg R. et al. Quantification of myocardial ischemia and infarction with single photon emission computed tomography. Eur J Nucl Med 1989; 15: 26-31.
13 Jain A, Mahmarian JJ, Raizner AE. et al. Thallium-201 single photon emission tomography using oral disopyridamole in the assessment of coronary stenosis in patients undergoing coronary angioplasty. J Am Coll Cardiol 1986; 7: 213A.
14 Kanemoto N, Hör G, Kobcr G. et al. Noninvasive assessment of left ventricular performance following transluminal coronary angioplasty. Int J Cardiol 1983; 3: 281-92.
15 Kent KM, Bonow RO, Rosing DR. et al. Improved myocardial function during exercise after successful percutaneous transluminal coronary angioplasty. N Engl J Med 1982; 306: 441-6.
16 Kipfer P, Hess OM, Suter Th. et al. Exercise-induced ST-segment depression after successful PTCA: Incomplete revascularization or myocardial stunning?. Eur Heart J 1988; 9 (Suppl A): 101.
17 Kipfer P, Hess OM, Kraycnbühl HP. Zunahme der ST-Senkung nach erfolgreicher PTCA: Frührezidiv, Stunning oder abnorme Vasomotorik?. Z Kardiol 1991; 80 (Suppl 6): 10.
18 Kloner RA, Przyklenk K, Patel B. Altered myocardial states: the stunned and hibernating myocardium. Am J Med 1989; 86 Suppl 1A 14-22.
19 Lewis JF, Verani MS, Poliner LR. et al. Effects of transluminal coronary angioplasty on left ventricular systolic and diastolic function at rest and during exercise. Am Heart J 1985; 109: 792-8.
20 Mahmarian JJ, Boyce TM, Goldberg RK. et al. Quantitative exercise thallium-201 single photon emission computed tomography for the enhanced diagnosis of ischemic heart disease. J Am Coll Cardiol 1990; 15: 318-29.
21 Manyari DE, Knudtson M, Kloibcr R. et al. Sequential thallium-201 myocardial perfusion studies after successful percutaneous transluminal coronary artery angioplasty: delayed resolution of exercise-induced scintigraphic abnormalities. Circulation 1988; 77: 86-95.
22 Nienaber CA, Brunken RC, Sherman CT. et al. Metabolic and functional recovery of ischemic human myocardium after coronary angioplasty. J Am Coll Cardiol 1991; 18: 966-78.
23 Nixon JV, Brown CN, Smithcrman TC. Identification of transient and persistent segmental wall motion abnormalities in patients with unstable angina by two-dimensional echocardiography. Circulation 1982; 65: 1497-503.
24 Nohara R, Kambara H, Suzuki Y. et al. Stress scintigraphy using single-photon emission computed tomography in the evaluation of coronary artery disease. Am J Cardiol 1984; 53: 1250-4.
25 Okada RD, Lim YL, Boucher CA. et al. Clinical, angiographic, hemodynamic, pcr-fusional and functional changes after one-vessel left anterior descending coronary angioplasty. Am J Cardiol 1985; 55: 347-56.
26 Rahimtoola SH. The hibernating myocardium. Am Heart J 1989; 117: 211-21.
27 Reed DC, Bcller GA, Nygaard TW. et al. The clinical efficacy and scintigraphic evaluation of post-coronary bypass patients undergoing percutaneous transluminal coronary angioplasty for recurrent angina pectoris. Am Heart J 1989; 117: 60-71.
28 Scholl JM, Chaitman BR, David PR. et al. Exercise electrocardiography and myocardial scintigraphy in the serial evaluation of the results of percutaneous transluminal coronary angioplasty. Circulation 1982; 66: 380-90.
29 Schroeder E, Marchandise B, De Coster P. et al. Detection of restenosis after coronary angioplasty for single-vessel disease: How reliable are exercise electrocardiography and scintigraphy in asymptomatic patients?. Eur Heart J 1989; 10 Suppl G 18-21.
30 Verani MS, Tadros S, Raizner AE. et al. Quantitative analysis of thallium-201 uptake and washout before and after transluminal coronary angioplasty. Int J Cardiol 1986; 13: 109-24.
31 Wijns W, Serruys PW, Simoons ML. et al. Predictive value of early maximal exercise test and thallium scintigraphy after successful percutaneous transluminal coronary angioplasty. Br Heart J 1985; 53: 194-200.
32 Wijns W, Serruys PW, Reiber JHC. et al. Early detection of restenosis after successful percutaneous transluminal coronary angioplasty by exercise-redistribution thallium scintigraphy. Am J Cardiol 1985; 55: 357-61.