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Factors influencing outcome of regional wall motion after successful elective single‐vessel percutaneous transluminal coronary angioplasty

BackgroundThe long-term outcome of impaired regional myocardial contractility after successful single vessel percutaneous transluminal coronary angioplasty (PTCA) was angiographically evaluated. MethodsThe ventriculograms prior to PTCA and at mid-term follow-up of 250 consecutive patients with successful elective single-vessel PTCA were analyzed. One hundred of 250 patients demonstrated regional wall motion abnormalities in the PTCA vessel-dependent region by visual analysis before PTCA. The study group comprised 66 of these 100 patients (four women, 62 men, mean age 52 ± 8 years, 50 left anterior descending artery stenoses and 16 right coronary artery stenoses) in whom paired ventriculograms could be analyzed quantitatively by the centerline method. Results: Ejection fraction increased from 58% ± 7% to 60% ± 7%. Hypokinesis in the central distribution area of the PTCA vessel decreased from −1.3 ± 0.8 to −0.9 ± 0.7 standard deviations/chord (SD/chord) (P < 0.001). The circumferential extent (percentage of left ventricular contour) of hypokinesis worse than −2 SD decreased significantly by 45% at follow-up. Left ventricular function improved the most in patients with more severe depressed function or more severe stenosis at baseline. Previous (more than 6 weeks old) myocardial infarction (40% of patients) did not preclude functional improvement. Restenosis occurred in 36% of patients, but did not influence function significantly. ConclusionsThe magnitude of left ventricular functional recovery after successful PTCA in patients with chronic ischemia is related to the severity of resting dysfunction and of stenosis prior to treatment. Patients with severe hypokinesis as well as with akinesis have the potential to improve, even in the presence of previous infarction.