TY - JOUR
T1 - Simultaneous assessment of myocardial perfusion and left ventricular function during transient coronary occlusion
AU - Gallik, Donna M.
AU - Obermueller, Steve D.
AU - Swarna, Udaya S.
AU - Guidry, Gerald W.
AU - Mahmarian, John J.
AU - Verani, Mario S.
N1 - Funding Information:
Results. The mean size -+ SD of the perfusion defect during coronary occlusion was 23 -+ 18%, with significantly larger defects observed for occlusions of the left anterior descending coronary artery (39 +-20%) than for occlusions of the left circumflex (15 -+ 11%) or right (15 -+ 9%) coronary artery (p < 0.05). The Coronary occlusion during percutaneous transluminal coronary angioplasty provides an intriguing in vivo model for examining the effects of acute myocardial ischemia on ventricular function and perfusion and may have potential implications for assessing patients with acute myocardial infarction or unstable angina. Jones et al. (1) documented a fair overall correlation between perfusion defect size and left ventricular dysfunction during exercise. More recently, these investigators have shown changes in perfusion and function to be significantly greater during coronary occlusion than with exercise (2). Previous studies using echocardiography (3-6), hemodynamic measurements (1,7,8) or perfusion imaging (9-11), have attempted to assess the extent of jeopardized myocardium From the Section of Cardiology,D epartment of Medicine, Baylor Collegeo f Medicine and The Methodist Hospital, Houston, Texas. Computational assistance was provided by the CLINFO Project, funded by the Division of Research Resources of the National Institutes of Health, Bethesda, Maryland, under Grant RR-00350. Manuscript receivedA ugust 1, 1994; revisedm anuscriptr eceivedJ anuary 19, 1995, accepted February 2, 1995. Address for corresoondence: Dr. Mario S. Verani, Department of Medicine, Baylor College of Medicine and Department of Nuclear Cardiology, The Methodist Hospital, 6535 Fannin, F-905, Houston, Texas 77030.
PY - 1995/6
Y1 - 1995/6
N2 - Objectives. We used technetium-99m sestamibi imaging to evaluate the magnitude of changes in left ventricular function and perfusion and to investigate their interdependence during transient coronary occlusion. Background. Transient coronary occlusion during coronary angioplasty provides a unique opportunity for examining the effects of acute myocardial ischemia on left ventricular function and perfusion. Methods. Thirty-five patients with normal left ventricular function underwent first-pass radionuclide angiography with technetium-99m sestamibi using a multicrystal gamma camera during balloon occlusion of a coronary artery. Single-photon tomography was performed 2.1 ± 1.7 h later. Subsequently, all scans were repeated at rest. Results. The mean size ± SD of the perfusion defect during coronary occlusion was 23 ± 18%, with significantly larger defects observed for occlusions of the left anterior descending coronary artery (39 ± 20%) than for occlusions of the left circumflex (15 ± 11%) or right (15 ± 9%) coronary artery (p < 0.05). The mean change in ejection fraction from recovery to occlusion was -17 ± 17% and was significantly larger for left anterior descending (-26 ± 21%) and left circumflex (-15 ± 11%) than for right (-8 ± 10%) coronary artery occlusions (p < 0.05). For the entire group, ejection fraction during occlusion correlated significantly with perfusion defect size ( r= 0.63, p = 0.0004), whereas the extent of ischemic myocardium correlated with the decrease in ejection fraction (r = 0.69, p = 0.0001). The defects present during occlusion reversed within a few hours. Conclusions. Changes in left ventricular function and perfusion develop pari passu during coronary occlusion and are more severe when the left anterior descending artery is occluded. Although a significant correlation exists between the extent of the perfusion defect and the severity of the decrease in ejection fraction, there is a substantial individual variation with respect to changes in both myocardial perfusion and ventricular function during acute coronary occlusion.
AB - Objectives. We used technetium-99m sestamibi imaging to evaluate the magnitude of changes in left ventricular function and perfusion and to investigate their interdependence during transient coronary occlusion. Background. Transient coronary occlusion during coronary angioplasty provides a unique opportunity for examining the effects of acute myocardial ischemia on left ventricular function and perfusion. Methods. Thirty-five patients with normal left ventricular function underwent first-pass radionuclide angiography with technetium-99m sestamibi using a multicrystal gamma camera during balloon occlusion of a coronary artery. Single-photon tomography was performed 2.1 ± 1.7 h later. Subsequently, all scans were repeated at rest. Results. The mean size ± SD of the perfusion defect during coronary occlusion was 23 ± 18%, with significantly larger defects observed for occlusions of the left anterior descending coronary artery (39 ± 20%) than for occlusions of the left circumflex (15 ± 11%) or right (15 ± 9%) coronary artery (p < 0.05). The mean change in ejection fraction from recovery to occlusion was -17 ± 17% and was significantly larger for left anterior descending (-26 ± 21%) and left circumflex (-15 ± 11%) than for right (-8 ± 10%) coronary artery occlusions (p < 0.05). For the entire group, ejection fraction during occlusion correlated significantly with perfusion defect size ( r= 0.63, p = 0.0004), whereas the extent of ischemic myocardium correlated with the decrease in ejection fraction (r = 0.69, p = 0.0001). The defects present during occlusion reversed within a few hours. Conclusions. Changes in left ventricular function and perfusion develop pari passu during coronary occlusion and are more severe when the left anterior descending artery is occluded. Although a significant correlation exists between the extent of the perfusion defect and the severity of the decrease in ejection fraction, there is a substantial individual variation with respect to changes in both myocardial perfusion and ventricular function during acute coronary occlusion.
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U2 - 10.1016/0735-1097(95)00092-I
DO - 10.1016/0735-1097(95)00092-I
M3 - Article
C2 - 7759703
AN - SCOPUS:0029025871
VL - 25
SP - 1529
EP - 1538
JO - Journal of the American College of Cardiology.
JF - Journal of the American College of Cardiology.
SN - 0735-1097
IS - 7
ER -