Ralf Surber1, Gero Schwarz, Hans R Figulla, Gerald S Werner. 1. Department of Internal Medicine I, Division of Cardiology and Angiology, Friedrich Schiller University, Jena, Germany. ralf.surber@med.uni-jena.de
Abstract
BACKGROUND: A major goal of revascularization is the recovery of left ventricular (LV) function. Nuclear imaging techniques are widely used for detecting recovery of function with a good sensitivity, but only moderate specificity. Predictors of recovery in chronic total coronary occlusions (CTO) are not investigated. HYPOTHESIS: The 12-lead-resting electrocardiogram (ECG) is a predictor of LV recovery after successful recanalization of CTO. METHODS: Successful recanalization of CTO was performed in 127 patients. Of these, 62 patients, who constitute the study group, had impaired regional wall motion prior to recanalization. The 12-lead resting ECG was evaluated for Q-wave areas and parameters of QT dispersion. Impairment of regional wall motion was evaluated by LV angiogram at baseline and at follow-up. RESULTS: Angiographic follow-up after 5 +/- 1.4 months documented reocclusion in eight patients. Complete follow-up with a patent coronary artery and an ECG without bundle-branch block was available in 43 patients. Wall motion severity index (WMSI) improved from -2.92 +/- 0.28 to -1.34 +/- 0.61 (p < 0.001) in patients without Q waves, whereas it was unchanged in patients with Q waves (-3.01 +/- 0.30 and -2.81 +/- 0.32). Absence of Q waves at baseline predicted recovery of regional wall motion with 89% sensitivity and 67% specificity. Positive predictive value for recovery was 68% in patients without Q waves, but only 11% in patients with Q waves. In multivariate analysis, only absence of Q waves predicted improvement in WMSI (p = 0.01). CONCLUSIONS: In patients with recanalization of CTO, recovery of regional wall motion is reliably predicted by analysis of the resting 12-lead ECG for pathologic Q waves.
BACKGROUND: A major goal of revascularization is the recovery of left ventricular (LV) function. Nuclear imaging techniques are widely used for detecting recovery of function with a good sensitivity, but only moderate specificity. Predictors of recovery in chronic total coronary occlusions (CTO) are not investigated. HYPOTHESIS: The 12-lead-resting electrocardiogram (ECG) is a predictor of LV recovery after successful recanalization of CTO. METHODS: Successful recanalization of CTO was performed in 127 patients. Of these, 62 patients, who constitute the study group, had impaired regional wall motion prior to recanalization. The 12-lead resting ECG was evaluated for Q-wave areas and parameters of QT dispersion. Impairment of regional wall motion was evaluated by LV angiogram at baseline and at follow-up. RESULTS: Angiographic follow-up after 5 +/- 1.4 months documented reocclusion in eight patients. Complete follow-up with a patent coronary artery and an ECG without bundle-branch block was available in 43 patients. Wall motion severity index (WMSI) improved from -2.92 +/- 0.28 to -1.34 +/- 0.61 (p < 0.001) in patients without Q waves, whereas it was unchanged in patients with Q waves (-3.01 +/- 0.30 and -2.81 +/- 0.32). Absence of Q waves at baseline predicted recovery of regional wall motion with 89% sensitivity and 67% specificity. Positive predictive value for recovery was 68% in patients without Q waves, but only 11% in patients with Q waves. In multivariate analysis, only absence of Q waves predicted improvement in WMSI (p = 0.01). CONCLUSIONS: In patients with recanalization of CTO, recovery of regional wall motion is reliably predicted by analysis of the resting 12-lead ECG for pathologic Q waves.