Acta Medica Medianae (Nov 2002)
INFLUENCE OF THE SURGICAL REVASCULARIZATION UPON THE DYNAMICS OF REGIONAL MOTILITY DISORDER AFTER THE ACUTE MYOCARDIAL INFARCTION
Abstract
After the acute myocardial infarction (AIM), the recovery of the hibernated myocardium is possible only after surgical revascularization while the stunned myocardium is experiencing spontaneous recovery. The aim of our paper was to estimate the dynamics of the recovery of qualitatively different disorders of the regional motility depending on surgical revascularization. The examination comprised 120 patients hospitalized because of the AIM. Before their release, the patients were subjected to dobutamine stress echocardiography test (DSE). During the follow-up period (the first three months) the patients were subjected to the coronary angiography while 52 where also subdued to the surgical revascularization (ACB) as well depending on the existence of viable myocardium and/or residual ischemia. The follow-up period was 14±2 months. As for the group of the patients who were subdued to the surgical revascularization, under the basal conditions, there were 594 normokinetic and 238 dyssynergic segments; among them there were 156 hypo-kinetic, 66 akinetic and 16 dyskinetic segments. At the six-month control there were 709 normokinetic and 123 dyssynergic segments; among them, there were 68 hypo-kinetic, 52 akinetic and 3 dyskinetic segments. At the twelve month control, there were 687 normokinetic and 101 dyssynergic segments; among them, there were 63 hypokinetic, 33 akinetic and 3 dyskinetic segments. In the group of the patients who were not subjected to the surgical revascularization (treated with the medicament therapy), under the basal conditions, there were 799 normokinetic and 289 dyssynergic segments registered; among them, there were 185 hypokinetic, 77 akinetic and 27 dyskinetic segments. At the six month control, there were 902 normokinetic and 186 dyssynergic segments; among them, there were 106 hypo-kinetic, 61 akinetic and 19 dyskinetic segments. At the twelve month control, there were 909 normokinetic and 165 dyssynergic segments; among them, there were 85 hypokinetic, 59 akinetic and 21 dyskinetic segments. Among the observed groups, a statistically important difference of the dynamics of the changes of all the regional motility disorders; for the hypokinetic segments the importance of the difference was p<0,01, for akinetic p<0,02 and for dyssynergic 0<0,001. Beside a possible spontaneous recovery of the regional motility after the AIM, the qualitatively more serious disorders of motility can experience the recovery only after the surgical revascularization.
