Author + information
- Received April 26, 1983
- Revision received October 17, 1983
- Accepted October 21, 1983
- Published online April 1, 1984.
- ↵aDr. Botvinick is an Established Investigator of the American Heart Association, and is supported in part by the Ripple Foundation, Morristown, New Jersey.
Left ventricular segments with reversible asynergy at rest demonstrate reversible myocardial perfusion defects on exercise thallium-201 scintigrams. To determine if improved perfusion eliminates asynergy at rest, 23 patients with angina (stable in 21, unstable in 2) were studied before and after coronary artery bypass surgery. All patients underwent exercise myocardial perfusion scintigraphy, contrast ventriculography and coronary arteriography before and after surgery. Selective graft angiography was performed during the postoperative catheterization to determine graft patency. Segmental ventricular function was quantitated by a regional fraction method. The scintigrams were divided into five regions and compared with the corresponding regions of the ventriculogram.
Seventy-one of a possible 142 ventricular segments exhibited exercise-induced perfusion deficits. Preoperative regional ejection fraction was normal in 42 of these segments and abnormal in 29. Postoperatively, in 19 of the abnormal segments, function improved or normalized. All these segments had improved perfusion during exercise after surgery and were supplied by a patent bypass graft. Nine of the 10 segments in which abnormal wall motion persisted postoperatively continued to have exercise-induced perfusion deficits, and 9 of the 10 segments were supplied by an occluded or stenotic graft or one with poor run off. Of the 42 segments with normal wall motion preoperatively, 30 had improved perfusion after surgery and 35 maintained normal function.
This study indicates that asynergy at rest is permanently reversed after coronary bypass surgery if improved myocardial perfusion can be documented. These findings are consistent with but do not prove the concept that reversible rest asynergy may reflect chronic ischemia or a prolonged effect from previous ischemic episodes.
↵* Present address and address for reprints: Bruce H. Brundage, MD, Cardiology Section, Department of Medicine, University of Illinois at Chicago, P.O. Box 6998, Chicago, Illinois 60680.
This study was supported in part by the George D. Smith Fund, Inc., San Francisco, California. The data was presented in part at the 28th Scientific Sessions of the American College of Cardiology, Miami Beach, Florida, 1979.
- Received April 26, 1983.
- Revision received October 17, 1983.
- Accepted October 21, 1983.
- American College of Cardiology Foundation