Transient Regional Wall Motion Abnormalities Research Articles

High speed rotational coronary atherectomy for patients with diffuse coronary artery disease

High speed rotational coronary atherectomy was undertaken using the Rotabiator in 42 patients who were suboptimal candidates for balloon angioplasty. Most patients (71%) had diffuse coronary artery disease, defined as a stenosis >1 cm in length. Previous restenosis after balloon angioplasty was present in 21% and 10% had an ostial lesicn. Adjunctive balloon angioplasty was not used to reduce residual stenosis after atherectomy.The procedure was successful in 76% of patients. Procedural success was achieved in 92% of patients with a lesion ≤1 cm in length, but in only 70% of patients with a lesion >1 cm in length (p < 0.01). One patient sustained abrupt closure of the target vessel, resulting in emergency bypass surgery and death. Small non-Q wave myocardial infarction occurred in eight patients (19%) and was associated with a longer lesion. The mean peak creatine kinase value in patients with non-Q wave myocardial infarction was 683 U/liter. Transient regional wall motion abnormalities were noted on the postatherectomy left ventricular angiogram in four of the eight patients with non-Q wave myocardial infarction.Follow-up angiography (at a mean interval of 6.2 ± 2.6 months) was performed in 91% of patients and revealed restenosis (>58% narrowing) in 59%. The restenosis rate was 22% for short lesions (≤ cm) and 75% for long lesions (>1 cm) (p < 0.05).In this study, the results of high speed rotational coronary atherectomy were strongly influenced by lesion length. Although short lesions (≤ cm) were treated effectively, longer lesions (>1 cm) were associated with decreased procedural success, increased procedural complications and a higher restenosis rate.

Limitations of dipyridamole-echocardiography in effort angina pectoris

The sensitivity of dipyridamole-2-dimensional (2-D) echocardiography was assessed for detection and localization of ischemia in 21 patients with severe chronic stable angina pectoris, a clearly positive exercise stress test response and multivessel coronary atherosclerosis. Regional wall motion during dipyridamole infusion (0.6 mg/kg intravenously over 4 minutes) was compared with control and recovery by 2 blinded observers in consensus. Transient regional wall motion abnormalities were observed in 11 patients. Angina and ST-segment changes occurred in 9 of these 11 patients with positive responses, but in none of those who showed no transient abnormality of regional wall motion. Localization of regional wall motion abnormalities correlated well with angiographic severity of coronary lesions. Endocardial area contraction, evaluated by a computerized system, was reduced significantly after dipyridamole administration in patients with a positive response (from 51 ±10% to 35 ± 11%, p < 0.001), whereas it did not change significantly in the others (from 43 ± 6% to 42 ± 8%). In the 11 patients with a positive response, coronary reserve assessed by exercise testing (modified Bruce protocol) was more impaired than in those with a negative response (time to 1 mm of ST depression 177 ± 148 seconds and 472 ± 179 seconds, respectively, p < 0.01). In patients with severe angina and multivessel coronary artery disease, dipyridamole-2-D echocardiography appears to identify the vessel in which flow reserve is most limited. Although this information may be valuable, indications for the test are restricted to patients with severely limited exercise capacity.