Effect of flecainide on regional left ventricular wall motion after acute intravenous, acute oral and chronic oral administration late after coronary artery bypass grafting

Epicardial marker motion was measured in 14 patients before flecainide administration, immediately after an intravenous dose of 2 mg/kg over 15 minutes (maximum 150 mg) and 15 minutes thereafter. Platinum epicardial markers had been implanted more than 4 years earlier at the time of coronary artery bypass grafting. Maximal and minimal marker separation (Lmax and Lmin) during the cardiac cycle were measured and regional shortening fraction (Lmax - Lmin)/Lmax) was determined as a percentage. After intravenous flecainide, a significant increase in end-diastolic (immediately after 2.8%; after 15 minutes 2.1%) and end-systolic (3.6% and 3.2%) regional dimensions was observed, together with a decrease in regional myocardial shortening (9.3% and 9.0%). One week later, after a single oral dose of 200 mg of flecainide, Lmax and Lmin had increased 2.4

Assessment of percutaneous transluminal coronary angioplasty by quantitative coronary angiography: diameter versus densitometric area measurements

Cineangiograms of 138 patients who underwent percutaneous transluminal coronary angioplasty (PTCA) were analyzed with a computer-based coronary angiography analysis system. The results before and after dilatation are presented. In a first study group (120 patients), the severity of the obstructive lesions derived from the automatically detected contours was evaluated in absolute terms and in percent-diameter reduction. In a second group of patients, 18 coronary lesions were selected for their extreme severity and symmetric aspect before angioplasty as assessed from multiple views. In the second group, the densitometric percent-area stenosis was used to assess the changes in cross-sectional area after PTCA and was compared with the circular percent-area stenosis computed from the diameter measurements. Before PTCA, a good agreement exists between the densitometric percent-area stenosis and the circular percent-area stenosis. After PTCA, important discrepancies between these 2 types of measurements are observed. It is suggested that these discrepancies in results after PTCA can be accounted for by asymmetric morphologic changes in luminal cross section, which cannot be assessed accurately from diameter measurements in a single-plane view

Comparison of preoperative, operative and postoperative variables in asymptomatic or minimally symptomatic patients to severely symptomatic patients three years after coronary artery bypass grafting: analysis of 423 patients

During a follow-up period of 3 years, among a consecutive series of 423 patients who gave informed consent for recatheterization both 1 and 3 years after coronary artery bypass grafting, the incidence of severely symptomatic patients with New York Heart Association class III or IV was 19% (79 of 423). The predictive value of approximately 80 clinical, angiographic and perioperative variables was too low to be of clinical value. Adverse clinical outcome was associated with a high closure rate of the grafts. Forty-six percent of the patients could not undergo reoperation because of unsuitable coronary anatomy. With intensive medical therapy half of these patients improved to functional class I or II, while of those patients who were reoperable 32% improved to class I or II with intensive pharmacologic treatment instead of reoperation. The nonresponders underwent reoperation, which resulted in improvement of symptoms to functional class I or II in most (83%)

Epicardial wall motion and left ventricular function during coronary graft angioplasty in humans

Epicardial wall motion and left ventricular function changes during temporary coronary artery occlusion were assessed in a patient at the time of percutaneous transluminal angioplasty performed on a previously placed stenotic coronary artery bypass graft. Epicardial wall motion was analyzed using biplane cineradiography with frame to frame measurements of distances between pairs of radiopaque epicardial markers placed at the time of previous cardiac surgery. Bypass graft occlusion after initial dilation led to the early onset of a biphasic epicardial late systolic lengthening and early diastolic shortening similar to the regional wall motion abnormality preceding the procedure

Recovery from circulatory depression after coronary artery bypass surgery

The direct traumatic effects of coronary artery bypass surgery may counter-balance the expected improvement of myocardial function in the early postoperative period. In 55 patients, the regional shortening fraction was measured over 12 months using radiopaque epicardial markers pairs implanted during surgery in the newly perfused regions. The time course of cardiothoracic ratio, heart rate and cuff blood pressure was documented. All patients were catheterized before surgery and 1 year afterwards. There is an initial depression in myocardial function lasting up to 3 months after surgery which is not directionally related to changes in loading conditions or chronotropic state, but most likely to recovery of the myocardium from periopera

Regional wall motion from radiopaque markers after intravenous and intracoronary injections of nifedipine

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Effect of long-term oral nifedipine therapy on left ventricular regional wall function at rest and during supine bicycle exercise

15 patients, 1 to 3 year after coronary bypass surgery, underwent symptom limited supine bicycle exercise tests without nifedipine and after acute and chronic (3 months) administration of the drug. Haemodynamic variables were monitored as was epicardial marker motion, using biplane cineradiography during exercise, the markers having been implanted at the time of surgery. We found significant (P less than 0.001) reductions in end-diastolic and end-systolic regional dimensions at maximal exercise after oral nifedipine, associated with a significant reduction in exertional angina, which persisted during long-term treatment. No adverse effects of the drug were observed

Relative value of clinical variables, bicycle ergometry, rest radionuclide ventriculography and 24 hour ambulatory electrocardiographic monitoring at discharge to predict 1 year survival after myocardial infarction

The relative value of predischarge clinical variables, bicycle ergometry, radionuclide ventriculography and 24 hour ambulatory electrocardiographic monitoring for predicting survival during the first year in 351 hospital survivors of acute myocardial infarction was assessed. Discriminant function analysis showed that in patients eligible for stress testing the extent of blood pressure increase during exercise slightly improved the predictive accuracy beyond that of simple clinical variables (history of previous myocardial infarction, persistent heart failure after the acute phase of infarction and use of digitalis at discharge), whereas radionuclide ventriculography and 24 hour electrocardiographic monitoring did not. The predictive value for mortality was 12% with clinical variables alone and 15% with the stress test added. Radionuclide ventriculography and 24 hour electrocardiographic monitoring were slightly additive to clinical information in the whole group of patients independent of the eligibility for stress testing (predictive value for mortality 24% with clinical variables alone and 26% with radionuclide ejection fraction and 24 hour electrocardiographic monitoring added). It is concluded that the appropriate use of simple clinical variables and stress testing is sufficient for risk stratification in postinfarction patients, whereas radionuclide ventriculography and 24 hour electrocardiographic monitoring should be limited to patients not eligible for stress testing

Angina pectoris, one to 10 years after aortocoronary bypass surgery

The incidence of angina pectoris (AP) after bypass surgery was assessed in 1041 patients operated on consecutively between 1971 and 1980. Of the 977 survivors, 920 (94%) participated in the study with a followup time varying from 1 to 10 years (mean 3.5 years). Post-operative angina pectoris was present at 1 year in 277 patients (30%), at 3 years in 46%, at 8 years in 50%. The pain limited usual physical activities in 17.5%, 30% and 25%, respectively at these times. Nonetheless, 89% of the respondents felt improved by surgery. Factors without predictive value for late outcome were sex, number of pre-operative diseased vessels, and pre-operative ejection fraction. A correlation was found between post-operative AP and younger age at surgery in the males only (P less than 0.001); between AP and patency rate of the bypass graft (P less than 0.005) and with the status of the coronary arterial tree at three years post-operatively (P less than 0.001) in both sexes. The percentage of patients with recurrent AP increased with time after surgery up to 3 years, but remained stable thereafter. In conclusion, post-operative AP seems initially related to decreased functioning of the bypass graft, later to progression of coronary sclerosis in the native circulation

Change in diameter of coronary artery segments adjacent to stenosis after percutaneous transluminal coronary angioplasty: failure of percent diameter stenosis measurement to reflect morphologic changes induced by balloon dilation

To determine the changes in stenotic and nonstenotic segments of a dilated coronary artery, detailed quantitative angiographic measurements were performed in 342 patients (398 lesions) immediately after angioplasty and at a predetermined follow-up time of 30, 60, 90 or 120 days after the dilation. Measurements of the stenotic segments were expressed as minimal luminal diameter, and the adjacent nonstenotic segments were expressed as interpolated reference diameter (both in millimeters). A follow-up rate of 86% was achieved. In the patients followed up at 30 and 60 days, there was no significant change in either the mean minimal luminal diameter or the mean reference diameter. However, at 90 and 120 days, there was significant deterioration in both the mean minimal luminal diameter (-0.37 and -0.42 mm, respectively) and the mean reference diameter (-0.17 and -0.26 mm, respectively), all of the changes being highly significant (p less than 0.00001). The reference diameter is involved in the dilation process and may be subject to the same restenosis process that takes place in initially stenotic segments. Percent diameter stenosis measurements, which