Clinical, angiographic, hemodynamic, perfusional and functional changes after one-vessel left anterior descending coronary angioplasty

Abstract

Percutaneous transluminal coronary angioplasty (PTCA) was successfully performed in 20 patients with 1-vessel left anterior descending (LAD) coronary artery disease. Exercise capacity in terms of peak workload, heart rate and systolic blood pressure all increased significantly 1 week after PTCA. All patients had some decrease in stenosis size and gradient. All patients except 1 had an improvement in functional class. Eight of 12 patients with abnormal exercise electrocardiograms before PTCA had normal electrocardiograms after the procedure. Exercise thallium-201 (Tl-201) myocardial perfusion images obtained in all 20 patients before and 1 week after PTCA were analyzed using a new computer method designed to quantitate regional myocardial Tl-201 distribution, redistribution and clearance rate. Significant improvement in Tl-201 activity was present in the anterior and septal segments of the left ventricle 1 week after PTCA. This increase in Tl-201 uptake was associated with a significant reduction in the amount of Tl-201 redistribution between initial and delayed postexercise images in the same regions. Tl-201 clearance rate in the segments supplied by the dilated vessel also improved significantly. Abnormal Tl-201 lung uptake was seen in 17 patients before and in 4 patients after PTCA. Exercise ejection fraction response and septal wall motion also improved after PTCA of the LAD stenosis in all 17 patients who had exercise radionuclide ventriculography. Improvement in clinical, angiographic and hemodynamic factors as well as in global and regional myocardial perfusion and function occurs after PTCA for 1-vessel LAD coronary artery disease.