Acute changes in global and regional rest left ventricular function after successful coronary angioplasty: Comparative results in stable and unstable angina

AbstractThe immediate effects of successful percutaneous transluminal coronary angioplasty on global and regional left ventricular function were assessed by comparing 30° right anterior oblique left ventricular angiograms performed immediately before and after angioplasty on 39 patients undergoing 42 successful procedures. Mean (±SD) lesion stenosis decreased from 88 ± 10% to 35 ± 11% (p ≤ 0.001), whereas left ventricular ejection fraction increased from 57 ± 11% to 64 ± 10% (p ≤ 0.001) for the entire group.Left ventricular functional changes were further subgrouped according to stability of angina. Eighteen procedures were performed on 17 patients with stable angina; 24 procedures were performed on 22 patients with unstable angina defined as angina at rest or on minimal activity or recently accelerated angina. There were no significant subgroup differences in mean age, gender ratio, vessel anatomy, drug therapy or extent of coronary stenosis before or after angioplasty. Global ejection fraction increased significantly for the unstable group (from 54 ± 11% to 66 ± 9%, p ≤ 0.001) but was unchanged for the stable group (from 61 ± 9% to 61 ± 11%, p = NS). In unstable angina, regional ejection fraction (segmental area method) increased for both jeopardized (from 37 ± 11 % to 52 ± 9%, p ≤ 0.001) and nonjeopardized myocardial segments (from 43 ± 13% to 51 ± 13%, p ≤ 0.001), but improvement was significantly (p ≤ 0.02) greater in jeopardized segments. In contrast, there was no change in jeopardized (from 46 ± 10% to 46 ± 11%, p = NS) or nonjeopardized myocardial segments (from 41 ± 12% to 43 ± 12%, p = NS) for patients with stable angina.Therefore, in patients with unstable angina, successful coronary angioplasty is associated with immediate increases in rest global and predominantly jeopardized segmental ejection fraction, which represents a normalization of previously depressed functional performance. In contrast, patients with stable angina have normal baseline global and regional left ventricular function that remains unchanged after successful angioplasty