Early recovery of wall motion abnormalities after recanalization of chronic totally occluded coronary arteries: A dobutamine echocardiographic, prospective, single-center experience

• Published in: The American heart journal Vol. 136; no. 5; pp. 831 - 836
• Main Authors: Rambaldi, Riccardo, Hamburger, Jaap N., Geleijnse, Marcel L., Poldermans, Don, Kimman, Geert J., Aiazian, Aric A., Fioretti, Paolo M., Ten Cate, Folkert J., Roelandt, Jos R.T.C., Serruys, Patrick W.
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01-11-1998; Elsevier
• Subjects: Adult; Aged; Angioplasty, Balloon, Coronary; Biological and medical sciences; Cardiotonic Agents; Coronary Disease - diagnostic imaging; Coronary Disease - physiopathology; Coronary Disease - therapy; Diseases of the cardiovascular system; Dobutamine; Echocardiography - methods; Female; Heart Function Tests; Humans; Male; Medical sciences; Middle Aged; Prospective Studies; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Sonography; Human; Occlusion; Pharmacologic test; Echocardiography; Treatment efficiency; Coronary artery; Instrumentation therapy; Dobutamine; Instrumental dilatation; Stress; Percutaneous route; Chronic; Motion study; Vascular wall
• ISSN: 0002-8703; 1097-6744
• DOI: 10.1016/S0002-8703(98)70128-0

Background Patients with symptomatic myocardial ischemia from a chronic totally occluded coronary (TOC) artery are usually referred for coronary artery bypass surgery. Because guide wire technology has improved considerably in recent years, percutaneous coronary angioplasty has become a useful technique in opening chronic TOC arteries. We evaluated the early functional results of successful percutaneous recanalization by performing dobutamine stress echocardiography (DSE).
Methods Fifteen patients with a chronic TOC artery who underwent a successful recanalization were prospectively studied. Each patient had a DSE within 24 hours before and 48 hours after the procedure. Wall motion was scored according to a 16-segment/5-point model. A clinical and angiographic follow-up of 6 months was obtained.
Results The wall motion score index at rest improved from 1.26 ± 0.23 before to 1.22 ± 0.21 after the procedure (
P < .05). Of those 10 segments that improved at rest, 7 were collateral recipients and 3 were collateral donors. The number of ischemic segments decreased from 46 before to 4 after the procedure (
P < .0001). Wall motion score index at peak stress improved from 1.34 ± 0.20 before to 1.15 ± 0.12 after the procedure (
P < .05). DSE was positive for ischemia in 15 patients before and 2 patients after the procedure (
P < .0001). Angina was present in 12 patients before and in 2 patients after recanalization (
P < .0001). Two patients (13%) had angiographic reocclusion and 5 (33%) restenosis after 6 months of follow-up.
Conclusions Successful percutaneous recanalization of chronic TOC artery results in an early improvement of both clinical status and resting or stress-induced wall motion abnormalities, as detected by DSE. (Am Heart J 1998;136:831-6.)