Cor Vasa 2002, 43(3):115-121
Angina is a predictor of myocardial viability in low-ejection fraction patients undergoing percutaneous revascularization
- Klinika Kardiologii Śląskiej Akademii Medycznej, Katowice, Polsko
Introduction:
In patients with regional myocardial contractility abnormalities, revascularization procedures should be preceded by their viability status assessment. In the present work, we investigated if angina may be an indicator of myocardial viability.
Subjects and methods:
In a group of 80 patients with baseline left ventricular ejection fraction (EF) Ł 40% who underwent PTCA, the following echocardiographic parameters were assessed before and after angioplasty: EF, wall motion index (WMI), asynergy area index (AAI) and contractility of revascularized segments. Patients were divided into group A - 29 pts with anginal symptoms only, group B - 27 pts with concomitant angina and heart failure symptoms, and group C - 24 pts with dyspnea without angina.
Results:
EF improved significantly after PTCA in groups A and B (from 34 ± 1% to 38 ± 2%; p = 0.005 and from 32 ± 1% to 37 ± 1.5%; p = 0.001, respectively). WMI also improved significantly only in groups A and B (from 2 ± 0.006 to 1.7 ± 0.07; p = 0.001 and from 1.9 ± 0.007 to 1.7 ± 0.07; p = 0.001, respectively). AAI improved significantly only in group A (from 63 ± 3.3 to 55 ± 4; p = 0.01). Groups A and B differed significantly from group C in the magnitude of improvement of revascularized segment contractility (p = 0.001 and p = 0.01, respectively). The proportion of patients with an at least 5% increase in EF after PTCA was 59% in group A, 56% in group B and 17% in group C (p = 0.004). The 5% increase in EF occurred in 57% of pts with angina (combined groups A and B) and in only 17% of pts without angina (group C); p = 0.004. The following values of sensitivity, specificity, positive predictive value and negative predictive value were achieved for angina as a predictor of contractility improvement: 88%, 48%, 61% and 83%, respectively.
Conclusions:
The significantly more pronounced improvement in global and regional myocardial contractility after PTCA in pts with angina indicates that this symptom may serve as a viability indicator.
Keywords: Angina; Myocardial viability
Published: March 1, 2002 Show citation