[Reversibility of akinetic segments in coronary heart disease]

Abstract

Akinetic wall segments not exhibiting contractions following nitroglycerin administration or in a post-extrasystolic beat are usually considered to consist of scar tissue; i.e. even by re-established or improved blood supply following aorto-coronary bypass surgery no functional improvement is expected. In the present study, the pre- and postoperative ventriculograms (RAO projection) of 24 patients undergoing bypass surgery were analyzed. Ventriculography was routinely performed following sublingual nitroglycerin and a post-extrasystolic contraction. In each patient the akinetic segment had received a bypass graft which was found to be patent on reangiography. In 7 of 24 patients (29%) the formerly akinetic segment exhibited improved contraction postoperatively; in 17 patients the segment remained akinetic. Global ejection fraction rose in the group of patients with improved akinesia from 47 +/- 10 to 65 +/- 10% (p less than 0.05). In the patients with unchanged contraction pattern, ejection fraction was found to be 56 +/- 12% prior to surgery and 54 +/- 16% after surgery (n.s.). The increase in ejection fraction was more pronounced in those patients showing improvement of anterior wall akinesia (from 39 to 72%) than it was in patients exhibiting improved inferior wall akinesis (from 54 to 59%). According to these findings, the regional ejection fraction was found to be higher postoperatively in patients with former anterior wall akinesis (78%) than in those showing inferior wall contraction abnormalities (49%). End-diastolic and end-systolic left ventricular volume changes postoperatively did not reach statistical significance, although end-systolic volume showed a clear trend to decrease (preoperative: 114 +/- 54 ml/1.73 m2; postoperative: 79 +/- 29 ml/1.73 m2; n.s.).(ABSTRACT TRUNCATED AT 250 WORDS)