IMPROVEMENT OF SYSTOLIC AND DIASTOLIC LEFT-VENTRICULAR WALL MOTION BY SERIAL ECHOCARDIOGRAMS IN SELECTED PATIENTS TREATED FOR UNSTABLE ANGINA

The purpose of the study was to evaluate the effect of antiischemic treatment on left ventricular function in selected patients with unstable angina pectoris that was due to severe proximal left anterior descending coronary artery narrowing and to identify subgroups liable to an adverse outcome (mean term 2.7 years). Effect of antiischemic treatment on systolic and diastolic left ventricular wall motion was studied in 35 patients who had unstable angina pectoris and an electrocardiogram that indicated severe proximal left anterior descending coronary artery narrowing. Treatment consisted of either a revascularization procedure (17 patients) or antianginal drug therapy (18 patients). All patients underwent a two-dimensional echocardiographic study within 48 hours (mean 20 hours) of entry into the study. This study semiquantitatively analyzed systolic performance of the ischemia-related segments by calculation of a total wall motion score. In 16 patients this investigation was combined with a continuous detailed recording of only the apical interventricular septal wall motion. This detailed study included measurements for regional function by providing a typification of the pattern of systolic and early diastolic excursion of the endocardial border of the apical interventricular septum. A repeat ultrasonic study was performed at least 1 month (median 2 months, 7 days) after admission. Results of the systolic wall motion analyses of all 35 patients showed, in both treatment groups, a significant improvement in systolic wall motion of the anterior and apical segments (mean total wall motion score at early study vs late study: revascularization, 6.9 vs 2.2 and medical therapy, 4.6 vs 1.0). During the detailed recordings of the interventricular septal systolic and early diastolic wall motion, the 16 patients demonstrated significant amelioration in regional systolic and early diastolic myocardial function (mean type of excursion at early study vs late study: 4.5 vs 2.2). The present study could not identify those who were likely to have a less favorable outcome: 80% of patients who eventually had a cardiac event after serial echocardiography showed a normal systolic wall motion at the repeat two-dimensional echocardiographic study. The data indicate that regional myocardial function normalizes or improves in the majority of these selected patients who were successfully treated for unstable angina that was due to severe proximal left anterior descending coronary artery disease. The findings suggest, amount other things, stunning and hibernation as mechanisms.