Exercise radionuclide ventriculography in evaluating successful transluminal coronary angioplasty

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Abstract
To evaluate the ability of transluminal coronary angioplasty (TCA) to relieve myocardial ischemia, 44 patients with single vessel disease underwent exercise gated radionuclide ventriculography (GRNV) before and 2.8 ± 1.3 days following angiographically successful TCA. Pre-TCA GRNV was abnormal in 11 of 14 patients with right coronary artery (RCA) stenosis and 24 of 30 with left anterior descending (LAD) stenosis. Following TCA there was an increase in exercise duration from 500 ± 288 sec to 625 ± 273 sec (P < 0.001), and in maximum double product from (209 ± 69) × 102 to (263 ± 70) × 102 (P < 0.001). The number of patients with stress-induced ST-T abnormalities decreased from 13 to 4 (P < 0.05), and the number with chest pain during exercise decreased from 18 to one (P < 0.001). Whereas resting ejection fraction was unchanged (0.58 ± 0.10 vs 0.59 ± 0.11) following TCA, the ejection fraction at peak exercise increased from 0.61 ± 0.13 to 0.66 ± 0.12 (P < 0.001). Of 24 patients with resting abnormalities, regional wall motion improved in 13. In 22 of 31 patients with stress-induced asynergy, the wall motion response to exercise improved (P < 0.001). Of 19 patients restudied angiographically and with exercise GRNV at 6–12 months, restenosis of ≥ 50% had occurred in six, four of whom had abnormal studies. In six in whom the degree of stenosis of the dilated artery had remained ≥20% the exercise GRNV study remained normal. It is concluded that GRNV is helpful in documenting the improvement in resting left ventricular function and functional reserve in patients with angiographically successful TCA. In the limited number of patients with late follow-up studies, data suggest that GRNV may be a valuable test to detect restenosis.

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