Preoperative Prediction of Reversible Myocardial Asynergy by Postexercise Radionuclide Ventriculography

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Abstract
Myocardial asynergy is sometimes reversed by coronary bypass, and a noninvasive method of predicting which cases are reversible would be desirable. To assess whether changes in myocardial wall motion observed immediately after exercise can differentiate reversible from nonreversible myocardial asynergy, we evaluated 53 patients by radionuclide ventriculography before and after exercise and again at rest after coronary bypass surgery. Preoperative improvement in wall motion immediately after exercise was highly predictive of the surgical outcome (average chance-corrected agreement, 91 per cent). At surgery the asynergic segments that had improved after exercise were free of grossly apparent epicardial scarring. The accuracy of these predictions for postoperative improvement was significantly greater (P<0.01) than that of analysis of Q waves on resting electrocardiography (average chance-corrected agreement, 40 per cent), in contrast, preoperative changes in left ventricular ejection fraction after exercise were not predictive of postoperative resting ejection fraction.