TY - JOUR
T1 - Early postoperative changes in regional systolic and diastolic left ventricular function after transmyocardial laser revascularization
AU - Hughes, G. Chad
AU - Shah, Ashish S.
AU - Yin, Bangliang
AU - Shu, Ming
AU - Donovan, Carolyn L.
AU - Glower, Donald D.
AU - Lowe, James E.
AU - Landolfo, Kevin P.
PY - 2000/3/15
Y1 - 2000/3/15
N2 - OBJECTIVES. The purpose of this study was to determine the short-term effects of transmyocardial laser revascularization (TMR) on regional left ventricular systolic and diastolic function, myocardial blood flow (MBF) and myocardial water content (MWC). BACKGROUND. Clinical studies of TMR have noted a significant incidence of cardiac complications in the early postoperative period. However, the early post-treatment effects of laser therapy on the myocardium and their potential contribution to postoperative cardiac morbidity are unknown. METHODS. Swine underwent holmium:yttrium-aluminum-garnet (holmium:YAG) (n = 12) or carbon dioxide (CO2) (n = 12) laser TMR. Regional systolic function for the lased and nonlased regions was quantitated using preload recruitable work area (PRWA) and regional diastolic function with the ventricular stiffness constant alpha. RESULTS. Preload recruitable work area was significantly decreased in the lased regions both 1 (59.8 ± 13.0% of baseline, p = 0.02) and 6 h (64.2 ± 9.4% of baseline, p = 0.02) after holmium: YAG TMR. This decreased PRWA was associated with a significant reduction in MBF to the lased regions (13.2% reduction at 1 h, p = 0.02; 18.4% decrease at 6 h post-TMR, p = 0.01). These changes were not seen after CO2 laser TMR. A significant increase in MWC (1.4 ± 0.3% increase with holmium:YAG, p = 0.004; 1 ± 0.2% increase with CO2, p = 0.002) and alpha (217.4 ± 44.2% of baseline 6 h post-holmium:YAG TMR, p = 0.05; 206 ± 36.7% of baseline 6 h post-CO2 TMR, p = 0.03) was seen after TMR with both lasers. CONCLUSIONS. In the early postoperative setting, impaired regional systolic function in association with regional ischemia is seen after TMR with a holmium:YAG laser. Both holmium:YAG and CO2 lasers are associated with increased MWC and impaired diastolic relaxation in the lased regions. These changes may explain the significant incidence of early postoperative cardiac morbidity. The impact of these findings on anginal relief and long-term outcome are not known. (C) 2000 by the American College of Cardiology.
AB - OBJECTIVES. The purpose of this study was to determine the short-term effects of transmyocardial laser revascularization (TMR) on regional left ventricular systolic and diastolic function, myocardial blood flow (MBF) and myocardial water content (MWC). BACKGROUND. Clinical studies of TMR have noted a significant incidence of cardiac complications in the early postoperative period. However, the early post-treatment effects of laser therapy on the myocardium and their potential contribution to postoperative cardiac morbidity are unknown. METHODS. Swine underwent holmium:yttrium-aluminum-garnet (holmium:YAG) (n = 12) or carbon dioxide (CO2) (n = 12) laser TMR. Regional systolic function for the lased and nonlased regions was quantitated using preload recruitable work area (PRWA) and regional diastolic function with the ventricular stiffness constant alpha. RESULTS. Preload recruitable work area was significantly decreased in the lased regions both 1 (59.8 ± 13.0% of baseline, p = 0.02) and 6 h (64.2 ± 9.4% of baseline, p = 0.02) after holmium: YAG TMR. This decreased PRWA was associated with a significant reduction in MBF to the lased regions (13.2% reduction at 1 h, p = 0.02; 18.4% decrease at 6 h post-TMR, p = 0.01). These changes were not seen after CO2 laser TMR. A significant increase in MWC (1.4 ± 0.3% increase with holmium:YAG, p = 0.004; 1 ± 0.2% increase with CO2, p = 0.002) and alpha (217.4 ± 44.2% of baseline 6 h post-holmium:YAG TMR, p = 0.05; 206 ± 36.7% of baseline 6 h post-CO2 TMR, p = 0.03) was seen after TMR with both lasers. CONCLUSIONS. In the early postoperative setting, impaired regional systolic function in association with regional ischemia is seen after TMR with a holmium:YAG laser. Both holmium:YAG and CO2 lasers are associated with increased MWC and impaired diastolic relaxation in the lased regions. These changes may explain the significant incidence of early postoperative cardiac morbidity. The impact of these findings on anginal relief and long-term outcome are not known. (C) 2000 by the American College of Cardiology.
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U2 - 10.1016/S0735-1097(99)00645-2
DO - 10.1016/S0735-1097(99)00645-2
M3 - Article
C2 - 10732904
AN - SCOPUS:0034653719
SN - 0735-1097
VL - 35
SP - 1022
EP - 1030
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 4
ER -