Assessment ofleft ventricular performance during percutaneoustransluminal coronary angioplasty: a study byintravenous digital subtraction ventriculography

Leftventricular performance during percutaneous transluminal coronary angioplasty wasassessed in52patients byintravenous digital subtraction ventriculography. After injection of contrast into theright atrium ventriculograms wereobtained before andduring balloon inflation. In37patients theywerealsoobtained after theprocedure. A 12leadelectrocardiogram was monitored throughout. During balloon inflation theleft ventricular ejection fraction fell (from 73%to57%)inallbutonepatient; thedecreases inpatients withsingle vessel ormultivessel disease weresimilar. Thefall inleft ventricular ejection fraction during percutaneous transluminal coronary angioplasty oftheleft anterior descending artery (19%)wassignificantly greater thanthat during balloon inflation intheright coronary (10%)orcircunflex (8%)coronary arteries. Italso reduced anterobasal, anterior, andapical segmental shortening while right coronary percutaneous transluminal coronary angioplasty affected inferior andapical segments. In33(63%)patients the ST segment wasaltered during balloon inflation. Thefall inleft ventricular ejection fraction correlated significantly withthemagnitude ofbothST segment elevation (r= 0637)andST depression (r= 0396). Leftventricular ejection fraction andregional wallmotionreturned to baseline values after theprocedure. Balloon inflation during percutaneous transluminal coronary angioplasty produces considerable abnormalities ofglobal andregional left ventricular performance andthis indicates thepresence of myocardial ischaemia, whichmaynotbeapparent onelectrocardiographic monitoring. Intraven- ousdigital subtraction ventriculography isuseful formonitoring left ventricular performance during controlled episodes ofcoronary occlusion produced byballoon inflation.