Improvement in inducible ischemia during dobutamine stress echocardiography after transmyocardial laser revascularization in patients with refractory angina pectoris

Carolyn L. Donovan, Kevin P. Landolfo, James E. Lowe, Fiona Clements, Robin B. Coleman, Thomas Ryan

Research output: Contribution to journalReview article

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Abstract

Objectives. The purpose of this ongoing study is to determine whether transmyocardial laser revascularization (TMLR) can lessen inducible ischemia and improve contractile reserve in patients with refractory angina pectoris. Background. TMLR is an emerging surgical technique for the treatment of myocardial ischemia and angina pectoris not amenable to conventional percutaneous or surgical revascularization. Objective data documentating a reduction in ischemia during noninvasive stress testing after TMLR are rare. Methods. Fifteen patients with severe coronary artery disease unsuitable for treatment with standard revascularization techniques were studied with dobutamine stress echocardiography (DSE) before TMLR. Of the 12 patients who underwent TMLR, DSE was repeated at 3 months postoperatively in 11 patients and at 6 months in 9 patients. Stress echocardiograms were analyzed for inducible ischemia, with calculation of the wall motion score index (WMSI). Heart rate and dobutamine dose achieved at peak stress were also assessed as indexes of stress tolerance. Results. Compared with that before TMLR, wall motion at rest for all myocardial segments did not change significantly after TMLR although there was a mild improvement in the WMSI of the lased myocardial regions ([mean ± SD] 1.64 ± 0.34 after vs. 1.78 ± 0.34 before TMLR, p < 0.05). Overall WMSI at peak stress improved markedly after TMLR (1.70 ± 0.30 after vs. 2.06 ± 0.31 before TMLR, p < 0.002), with the improvement in WMSI limited to the lased segments only (1.47 ± 0.31 after vs. 2.15 ± 0.34 before TMLR, p < 0.0004). The improvement in WMSI with stress resulted primarily from a decrease in the percentage of ischemic segments (47% before vs. 23% after TMLR, p < 0.0008), with no change in the percentage of infarcted segments (23% before vs. 26% after TMLR). Heart rate (83 ± 5 beats/min before vs. 102 ± 21 beats/min after TMLR, p = 0.01) and dobutamine infusion rate (26 ± 9 μg/kg body weight per min before vs. 34 ± 9 μg/kg per min after TMLR) achieved at peak stress also increased postoperatively, consistent with improved stress tolerance. The reduction in ischemic wall motion abnormalities and improved stress tolerance persisted at 6 months, without evidence of further improvement or deterioration of function over time. Conclusions. TMLR performed in patients with refractory angina pectoris reduces ischemic wall motion abnormalities and improves stress-induced tolerance during dobutamine echocardiography. These beneficial effects persist up to 6 months postoperatively.

Original languageEnglish (US)
Pages (from-to)607-612
Number of pages6
JournalJournal of the American College of Cardiology
Volume30
Issue number3
DOIs
StatePublished - Jul 1997
Externally publishedYes

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Transmyocardial Laser Revascularization
Stress Echocardiography
Angina Pectoris
Ischemia
Dobutamine
Heart Rate

ASJC Scopus subject areas

  • Nursing(all)

Cite this

Improvement in inducible ischemia during dobutamine stress echocardiography after transmyocardial laser revascularization in patients with refractory angina pectoris. / Donovan, Carolyn L.; Landolfo, Kevin P.; Lowe, James E.; Clements, Fiona; Coleman, Robin B.; Ryan, Thomas.

In: Journal of the American College of Cardiology, Vol. 30, No. 3, 07.1997, p. 607-612.

Research output: Contribution to journalReview article

Donovan, Carolyn L. ; Landolfo, Kevin P. ; Lowe, James E. ; Clements, Fiona ; Coleman, Robin B. ; Ryan, Thomas. / Improvement in inducible ischemia during dobutamine stress echocardiography after transmyocardial laser revascularization in patients with refractory angina pectoris. In: Journal of the American College of Cardiology. 1997 ; Vol. 30, No. 3. pp. 607-612.
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title = "Improvement in inducible ischemia during dobutamine stress echocardiography after transmyocardial laser revascularization in patients with refractory angina pectoris",
abstract = "Objectives. The purpose of this ongoing study is to determine whether transmyocardial laser revascularization (TMLR) can lessen inducible ischemia and improve contractile reserve in patients with refractory angina pectoris. Background. TMLR is an emerging surgical technique for the treatment of myocardial ischemia and angina pectoris not amenable to conventional percutaneous or surgical revascularization. Objective data documentating a reduction in ischemia during noninvasive stress testing after TMLR are rare. Methods. Fifteen patients with severe coronary artery disease unsuitable for treatment with standard revascularization techniques were studied with dobutamine stress echocardiography (DSE) before TMLR. Of the 12 patients who underwent TMLR, DSE was repeated at 3 months postoperatively in 11 patients and at 6 months in 9 patients. Stress echocardiograms were analyzed for inducible ischemia, with calculation of the wall motion score index (WMSI). Heart rate and dobutamine dose achieved at peak stress were also assessed as indexes of stress tolerance. Results. Compared with that before TMLR, wall motion at rest for all myocardial segments did not change significantly after TMLR although there was a mild improvement in the WMSI of the lased myocardial regions ([mean ± SD] 1.64 ± 0.34 after vs. 1.78 ± 0.34 before TMLR, p < 0.05). Overall WMSI at peak stress improved markedly after TMLR (1.70 ± 0.30 after vs. 2.06 ± 0.31 before TMLR, p < 0.002), with the improvement in WMSI limited to the lased segments only (1.47 ± 0.31 after vs. 2.15 ± 0.34 before TMLR, p < 0.0004). The improvement in WMSI with stress resulted primarily from a decrease in the percentage of ischemic segments (47{\%} before vs. 23{\%} after TMLR, p < 0.0008), with no change in the percentage of infarcted segments (23{\%} before vs. 26{\%} after TMLR). Heart rate (83 ± 5 beats/min before vs. 102 ± 21 beats/min after TMLR, p = 0.01) and dobutamine infusion rate (26 ± 9 μg/kg body weight per min before vs. 34 ± 9 μg/kg per min after TMLR) achieved at peak stress also increased postoperatively, consistent with improved stress tolerance. The reduction in ischemic wall motion abnormalities and improved stress tolerance persisted at 6 months, without evidence of further improvement or deterioration of function over time. Conclusions. TMLR performed in patients with refractory angina pectoris reduces ischemic wall motion abnormalities and improves stress-induced tolerance during dobutamine echocardiography. These beneficial effects persist up to 6 months postoperatively.",
author = "Donovan, {Carolyn L.} and Landolfo, {Kevin P.} and Lowe, {James E.} and Fiona Clements and Coleman, {Robin B.} and Thomas Ryan",
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T1 - Improvement in inducible ischemia during dobutamine stress echocardiography after transmyocardial laser revascularization in patients with refractory angina pectoris

AU - Donovan, Carolyn L.

AU - Landolfo, Kevin P.

AU - Lowe, James E.

AU - Clements, Fiona

AU - Coleman, Robin B.

AU - Ryan, Thomas

PY - 1997/7

Y1 - 1997/7

N2 - Objectives. The purpose of this ongoing study is to determine whether transmyocardial laser revascularization (TMLR) can lessen inducible ischemia and improve contractile reserve in patients with refractory angina pectoris. Background. TMLR is an emerging surgical technique for the treatment of myocardial ischemia and angina pectoris not amenable to conventional percutaneous or surgical revascularization. Objective data documentating a reduction in ischemia during noninvasive stress testing after TMLR are rare. Methods. Fifteen patients with severe coronary artery disease unsuitable for treatment with standard revascularization techniques were studied with dobutamine stress echocardiography (DSE) before TMLR. Of the 12 patients who underwent TMLR, DSE was repeated at 3 months postoperatively in 11 patients and at 6 months in 9 patients. Stress echocardiograms were analyzed for inducible ischemia, with calculation of the wall motion score index (WMSI). Heart rate and dobutamine dose achieved at peak stress were also assessed as indexes of stress tolerance. Results. Compared with that before TMLR, wall motion at rest for all myocardial segments did not change significantly after TMLR although there was a mild improvement in the WMSI of the lased myocardial regions ([mean ± SD] 1.64 ± 0.34 after vs. 1.78 ± 0.34 before TMLR, p < 0.05). Overall WMSI at peak stress improved markedly after TMLR (1.70 ± 0.30 after vs. 2.06 ± 0.31 before TMLR, p < 0.002), with the improvement in WMSI limited to the lased segments only (1.47 ± 0.31 after vs. 2.15 ± 0.34 before TMLR, p < 0.0004). The improvement in WMSI with stress resulted primarily from a decrease in the percentage of ischemic segments (47% before vs. 23% after TMLR, p < 0.0008), with no change in the percentage of infarcted segments (23% before vs. 26% after TMLR). Heart rate (83 ± 5 beats/min before vs. 102 ± 21 beats/min after TMLR, p = 0.01) and dobutamine infusion rate (26 ± 9 μg/kg body weight per min before vs. 34 ± 9 μg/kg per min after TMLR) achieved at peak stress also increased postoperatively, consistent with improved stress tolerance. The reduction in ischemic wall motion abnormalities and improved stress tolerance persisted at 6 months, without evidence of further improvement or deterioration of function over time. Conclusions. TMLR performed in patients with refractory angina pectoris reduces ischemic wall motion abnormalities and improves stress-induced tolerance during dobutamine echocardiography. These beneficial effects persist up to 6 months postoperatively.

AB - Objectives. The purpose of this ongoing study is to determine whether transmyocardial laser revascularization (TMLR) can lessen inducible ischemia and improve contractile reserve in patients with refractory angina pectoris. Background. TMLR is an emerging surgical technique for the treatment of myocardial ischemia and angina pectoris not amenable to conventional percutaneous or surgical revascularization. Objective data documentating a reduction in ischemia during noninvasive stress testing after TMLR are rare. Methods. Fifteen patients with severe coronary artery disease unsuitable for treatment with standard revascularization techniques were studied with dobutamine stress echocardiography (DSE) before TMLR. Of the 12 patients who underwent TMLR, DSE was repeated at 3 months postoperatively in 11 patients and at 6 months in 9 patients. Stress echocardiograms were analyzed for inducible ischemia, with calculation of the wall motion score index (WMSI). Heart rate and dobutamine dose achieved at peak stress were also assessed as indexes of stress tolerance. Results. Compared with that before TMLR, wall motion at rest for all myocardial segments did not change significantly after TMLR although there was a mild improvement in the WMSI of the lased myocardial regions ([mean ± SD] 1.64 ± 0.34 after vs. 1.78 ± 0.34 before TMLR, p < 0.05). Overall WMSI at peak stress improved markedly after TMLR (1.70 ± 0.30 after vs. 2.06 ± 0.31 before TMLR, p < 0.002), with the improvement in WMSI limited to the lased segments only (1.47 ± 0.31 after vs. 2.15 ± 0.34 before TMLR, p < 0.0004). The improvement in WMSI with stress resulted primarily from a decrease in the percentage of ischemic segments (47% before vs. 23% after TMLR, p < 0.0008), with no change in the percentage of infarcted segments (23% before vs. 26% after TMLR). Heart rate (83 ± 5 beats/min before vs. 102 ± 21 beats/min after TMLR, p = 0.01) and dobutamine infusion rate (26 ± 9 μg/kg body weight per min before vs. 34 ± 9 μg/kg per min after TMLR) achieved at peak stress also increased postoperatively, consistent with improved stress tolerance. The reduction in ischemic wall motion abnormalities and improved stress tolerance persisted at 6 months, without evidence of further improvement or deterioration of function over time. Conclusions. TMLR performed in patients with refractory angina pectoris reduces ischemic wall motion abnormalities and improves stress-induced tolerance during dobutamine echocardiography. These beneficial effects persist up to 6 months postoperatively.

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