Author + information
- Received June 23, 1986
- Revision received September 16, 1986
- Accepted October 1, 1986
- Published online April 1, 1987.
- Jean-Paul Melchior, MD1,
- Pierre A. Doriot, PhD1,
- Pierre Chatelain, PhD1,
- Bernhard Meier, MD1,
- Philip Urban, MD1,
- Leo Finci, MD1 and
- Wilhelm Rutishauser, MD, FACC*,1
- ↵*Address for reprints: Wilhelm Rutishauser, MD, Centre de Cardiologie, Hôpital Cantonal Universitaire, CH-1211 Geneva 4, Switzerland.
Twenty patients with a chronic total coronary artery occlusion were studied before and 1 to 48 months (mean 9) after successful recanalization by angioplasty and compared with a group of 20 normal subjects. Before angioplasty, 19 of these 20 patients had angina. Collateral vessels to the distal part of the occluded vessel were visible in all 20 patients. A previous myocardial infarction was documented in 14 patients (9 with a Q wave and 5 with a non-Q wave infarction). At the time of follow-up, three patients were symptomatic: one had unstable angina and two had a positive stress test. The follow-up angiogram showed a significant restenosis in six patients and reocclusion in two. The mean ejection fraction had improved slightly from 59 ± 11% to 63 ± 9% (p < 0.05).
Left ventricular wall motion synchronism was studied using two variables for 128 shortening segments: the “time of peak contraction” and the “time of peak relaxation,” as obtained from biharmonic Fourier transformation for each segment. Their respective standard deviations reflect the synchronism of contraction and relaxation. The mean standard deviations of the two variables expressed in degrees of one cardiac cycle (360°) were respectively: 5.5 ± 0.4° for the time of peak contraction and 6.0 ± 0.5° for the time of peak relaxation in the 20 normal subjects, 11.7 ± 1.7° and 23.0 ± 3.0° before recanalization and 9.6 ± 1.8° and 12.5 ± 2.2° at follow-up in the group of 20 patients. These values were significantly higher (p < 0.05) in the patients than in the normal group. The time of peak relaxation was a more sensitive variable for separating patients with an occluded vessel from the normal subjects. The increase in the standard deviation of each variable was always a consequence of delayed contraction or relaxation in the territory of the occluded vessel. After recanalization, synchronism improved for relaxation (p < 0.002) whereas no significant improvement was observed for contraction.
This study shows improvement in ventricular function after recanalization of chronically occluded coronary arteries. Abnormalities of relaxation probably correspond to regional ischemia and to an absent “erectile effect.”
- Received June 23, 1986.
- Revision received September 16, 1986.
- Accepted October 1, 1986.
- American College of Cardiology Foundation