Original Articles
Continuous Monitoring of Global Left Ventricular Ejection Fraction During Percutaneous Transluminal Coronary Angioplasty 1

https://doi.org/10.1016/S0002-9149(98)00005-8Get rights and content

Abstract

Continuous monitoring of left ventricular (LV) function during percutanous transluminal coronary angioplasty (PTCA) was performed in 40 patients (53 ± 2 years) with a miniature, nuclear detector system after labeling the patients’ red blood cells with technetium-99m. Balloon dilation (113 seconds, range 60 to 240) induced on average a 0.12 ejection fraction (EF) unit (19%) decrease in the LVEF, which was explained by a 34% increase in end-systolic counts. Balloon dilation of the left anterior descending artery (n = 23) produced a decrease in the LVEF of 0.17 ± 0.13 EF units compared with the decrease of 0.06 ± 0.07 EF units in patients undergoing dilation of the left circumflex artery (n = 9) and 0.05 ± 0.04 EF units in patients treated for a stenosis of the right coronary artery (n = 8), (p = 0.02). Balloon deflation was associated with an immediate return to pre-PTCA levels. In 10 patients with 2 identical balloon occlusions, the second occlusion led to a significantly less decrease in the LVEF ( 0.41 ± 0.14 vs 0.44 ± 0.15 ) and electrocardiographic ST-segment deviation (88 ± 54 μV vs 65 ± 42 μV ) than the first. We conclude that PTCA is associated with an abrupt transient decrease in the LVEF. The effect of balloon occlusion of the left anterior descending artery is more pronounced than balloon occlusion of the left circumflex and the right coronary arteries. Neither single nor multiple balloon occlusions were associated with post-PTCA global LV dysfunction, whereas the lesser degree of LV dysfunction and electrocardiographic signs of myocardial ischemia during the second of 2 identical balloon occlusions suggests that preconditioning can be induced during PTCA.

Section snippets

Patients

All patients referred for elective PTCA were eligible for the study.

Exclusion criteria were cardiac arrhythmia, LVEF <35%, LV hypertrophy on electrocardiogram, left bundle branch block, or a prior coronary artery bypass graft. The study population comprised 50 patients. Of these, 5 were excluded because of arrhythmia during the PTCA procedure; 3 had poor radioactive blood labeling, and in 2 patients positioning of the detector was not possible because the detector interfered with the x-ray

Left Ventricular Function

Fig. 1 shows typical examples of the effect of a single balloon inflation on the LVEF in 3 patients undergoing dilation of the left anterior descending artery, the circumflex artery, and the right coronary artery, respectively. Average values of the LVEF, LV end-diastolic counts, LV end-systolic counts, and heart rate during the PTCA procedure in the total population are given in Table I.

Insertion of the guidewire in the coronary artery was associated with a mean rise of 0.04 EF units (7%) in

The Cardioscint

The advantage of the Cardioscint system for LV monitoring during PTCA is the small size and high sensitivity of its detector. Once positioned, the system can monitor global LV function continuously with a temporal resolution of 10 ms, thus yielding an unusual opportunity for analyzing the effect of acute transient occlusion of a coronary artery on global LV function. In the present study the main problem in using the Cardioscint system was that fluoroscopy interfered with the detector’s

References (33)

Cited by (10)

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This study was supported by the Danish Heart Foundation, Copenhagen, Denmark; and the Laerdal Foundation for Acute Medicine, Stavanger, Norway.

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