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. 1983 Aug;50(2):149–156. doi: 10.1136/hrt.50.2.149

Effects of coronary artery bypass grafting on left ventricular function assessed by multiple gated ventricular scintigraphy.

N C Taylor, R W Barber, P Crossland, T A English, E P Wraight, M C Petch
PMCID: PMC481388  PMID: 6603856

Abstract

The effect of coronary artery bypass grafting on global left ventricular ejection fraction and regional contraction was studied in 56 consecutive patients with chronic stable angina pectoris by means of multiple gated ventricular scintigraphy at rest and during dynamic supine exercise before and six weeks after myocardial revascularisation. Before operation, exercise induced a significant fall in ejection fraction and regional wall motion score. Six weeks after operation 52 patients were symptomless. Resting ejection fraction and regional wall motion score were unchanged but during exercise ejection fraction increased significantly, and the previous exercise induced regional wall motion abnormalities were abolished. All four patients with persisting angina showed the same pattern as before operation, with a fall in left ventricular ejection fraction and regional wall motion score during exercise. Multiple gated ventricular scintigraphy affords a safe, objective, reproducible, and non-invasive means of assessing serial ventricular function at rest and during exercise in patients with ischaemic heart disease. The technique confirms that coronary bypass surgery abolishes exercise induced abnormalities of left ventricular function, but has no influence on resting function.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Alderman E. L., Coltart D. J., Wettach G. E., Harrison D. C. Coronary artery syndromes after sudden propranolol withdrawal. Ann Intern Med. 1974 Nov;81(5):625–627. doi: 10.7326/0003-4819-81-5-625. [DOI] [PubMed] [Google Scholar]
  2. Anderson R. P., Rahimtoola S. H., Bonchek L. I., Starr A. The prognosis of patients with coronary artery disease after coronary bypass operations. Time-related progress of 532 patients with disabling angina pectoris. Circulation. 1974 Aug;50(2):274–282. doi: 10.1161/01.cir.50.2.274. [DOI] [PubMed] [Google Scholar]
  3. Arbogast R., Solignac A., Bourassa M. G. Influence of aortocoronary saphenous vein bypass surgery on left ventricular volumes and ejection fraction. Comparison before and one year after surgery in 51 patients. Am J Med. 1973 Mar;54(3):290–296. doi: 10.1016/0002-9343(73)90023-5. [DOI] [PubMed] [Google Scholar]
  4. Barry W. H., Pfeifer J. F., Lipton M. J., Tilkian A. R., Hultgren H. N. Effects of coronary artery bypass grafting on resting and exercise hemodynamics in patients with stable angina pectoris: a prospective, randomized study. Am J Cardiol. 1976 May;37(6):823–830. doi: 10.1016/0002-9149(76)90105-3. [DOI] [PubMed] [Google Scholar]
  5. Bartel A. G., Behar V. S., Peter R. H., Orgain E. S., Kong Y. Exercise stress testing in evaluation of aortocoronary bypass surgery. Report of 123 patients. Circulation. 1973 Jul;48(1):141–148. doi: 10.1161/01.cir.48.1.141. [DOI] [PubMed] [Google Scholar]
  6. Battler A., Ross J., Jr, Slutsky R., Pfisterer M., Ashburn W., Froelicher V. Improvement of exercise-induced left ventricular dysfunction with oral propranolol in patients with coronary heart disease. Am J Cardiol. 1979 Aug;44(2):318–324. doi: 10.1016/0002-9149(79)90323-0. [DOI] [PubMed] [Google Scholar]
  7. Borer J. S., Bacharach S. L., Green M. V., Kent K. M., Epstein S. E., Johnston G. S. Real-time radionuclide cineangiography in the noninvasive evaluation of global and regional left ventricular function at rest and during exercise in patients with coronary-artery disease. N Engl J Med. 1977 Apr 14;296(15):839–844. doi: 10.1056/NEJM197704142961503. [DOI] [PubMed] [Google Scholar]
  8. Borer J. S., Kent K. M., Bacharach S. L., Green M. V., Rosing D. R., Seides S. F., Epstein S. E., Johnston G. S. Sensitivity, specificity and predictive accuracy of radionuclide cineangiography during exercise in patients with coronary artery disease. Comparison with exercise electrocardiography. Circulation. 1979 Sep;60(3):572–580. doi: 10.1161/01.cir.60.3.572. [DOI] [PubMed] [Google Scholar]
  9. Boudoulas H., Lewis R. P., Vasko J. S., Karayannacos P. E., Beaver B. M. Left ventricular function and adrenergic hyperactivity before and after saphenous vein bypass. Circulation. 1976 May;53(5):802–806. doi: 10.1161/01.cir.53.5.802. [DOI] [PubMed] [Google Scholar]
  10. Braunwald E. Coronary artery bypass surgery--an assessment. Postgrad Med J. 1976 Dec;52(614):733–738. doi: 10.1136/pgmj.52.614.733. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Burow R. D., Strauss H. W., Singleton R., Pond M., Rehn T., Bailey I. K., Griffith L. C., Nickoloff E., Pitt B. Analysis of left ventricular function from multiple gated acquisition cardiac blood pool imaging. Comparison to contrast angiography. Circulation. 1977 Dec;56(6):1024–1028. doi: 10.1161/01.cir.56.6.1024. [DOI] [PubMed] [Google Scholar]
  12. Bussmann W. D., Mayer V., Kober G., Kaltenbach M. Ventricular function at rest, during leg raising and physical exercise before and after aortocoronary bypass surgery. Am J Cardiol. 1979 Mar;43(3):488–493. doi: 10.1016/0002-9149(79)90004-3. [DOI] [PubMed] [Google Scholar]
  13. Coltart J., Alderman E. L., Robison S. C., Harrison D. C. Effect of propranolol on left ventricular function, segmental wall motion, and diastolic pressure-volume relation in man. Br Heart J. 1975 Apr;37(4):357–364. doi: 10.1136/hrt.37.4.357. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Dehmer G. J., Falkoff M., Lewis S. E., Hillis L. D., Parkey R. W., Willerson J. T. Effect of oral propranolol on rest and exercise left ventricular ejection fraction, volumes, and segmental wall motion in patients with angina pectoris. Assessment with equilibrium gated blood pool imaging. Br Heart J. 1981 Jun;45(6):656–666. doi: 10.1136/hrt.45.6.656. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Dodek A., Kassebaum D. G., Griswold H. E. Stress electrocardiography in the evaluation of aortocoronary bypass surgery. Am Heart J. 1973 Sep;86(3):292–307. doi: 10.1016/0002-8703(73)90038-0. [DOI] [PubMed] [Google Scholar]
  16. Dwyer E. M., Jr, Wiener L., Cox J. W. Effects of beta-adrenergic blockade (propranolol) on left ventricular hemodynamics and the electrocardiogram during exercise-induced angina pectoris. Circulation. 1968 Aug;38(2):250–260. doi: 10.1161/01.cir.38.2.250. [DOI] [PubMed] [Google Scholar]
  17. Epstein S. E., Braunwald E. Inhibition of the adrenergic nervous system in the treatment of angina pectoris. Med Clin North Am. 1968 Sep;52(5):1031–1039. [PubMed] [Google Scholar]
  18. Frishman W. H., Christodoulou J., Weksler B., Smithen C., Killip T., Scheidt S. Abrupt propranolol withdrawal in angina pectoris: effects on platelet aggregation and exercise tolerance. Am Heart J. 1978 Feb;95(2):169–179. doi: 10.1016/0002-8703(78)90460-x. [DOI] [PubMed] [Google Scholar]
  19. Frishman W., Smithen C., Befler B., Kligfield P., Killip T. Noninvasive assessment of clinical response to oral propranolol therapy. Am J Cardiol. 1975 May;35(5):635–644. doi: 10.1016/0002-9149(75)90049-1. [DOI] [PubMed] [Google Scholar]
  20. Gott V. L. Outlook for patients after coronary artery revascularization. Am J Cardiol. 1974 Mar;33(3):431–437. doi: 10.1016/0002-9149(74)90328-2. [DOI] [PubMed] [Google Scholar]
  21. Greenberg B. H., Drew D., Botvinick E. H., Werner J. A., Klausner S. C., Shames D. M., Parmley W. W. Evaluation of left ventricular performance by gated radionuclide angiography. Clin Nucl Med. 1980 Jun;5(6):245–254. doi: 10.1097/00003072-198006000-00003. [DOI] [PubMed] [Google Scholar]
  22. Hammermeister K. E., Kennedy J. W., Hamilton G. W., Stewart D. K., Gould K. L., Lipscomb K., Murray J. A. Aortocoronary saphenous-vein bypass. Failure of successful grafting to improve resting left ventricular function in chronic angina. N Engl J Med. 1974 Jan 24;290(4):186–192. doi: 10.1056/NEJM197401242900403. [DOI] [PubMed] [Google Scholar]
  23. Hurst J. W., King S. B., 3rd, Logue R. B., Hatcher C. R., Jr, Jones E. L., Craver J. M., Douglas J. S., Jr, Franch R. H., Dorney E. R., Cobbs B. W., Jr Value of coronary bypass surgery. Controversies in cardiology: Part I. Am J Cardiol. 1978 Aug;42(2):308–329. doi: 10.1016/0002-9149(78)90917-7. [DOI] [PubMed] [Google Scholar]
  24. Jengo J. A., Oren V., Conant R., Brizendine M., Nelson T., Uszler J. M., Mena I. Effects of maximal exercise stress on left ventricular function in patients with coronary artery disease using first pass radionuclide angiocardiography: a rapid, noninvasive technique for determining ejection fraction and segmental wall motion. Circulation. 1979 Jan;59(1):60–65. doi: 10.1161/01.cir.59.1.60. [DOI] [PubMed] [Google Scholar]
  25. Jones R. H., McEwan P., Newman G. E., Port S., Rerych S. K., Scholz P. M., Upton M. T., Peter C. A., Austin E. H., Leong K. H. Accuracy of diagnosis of coronary artery disease by radionuclide management of left ventricular function during rest and exercise. Circulation. 1981 Sep;64(3):586–601. doi: 10.1161/01.cir.64.3.586. [DOI] [PubMed] [Google Scholar]
  26. Koch-Weser J., Frishman W. H. beta-Adrenoceptor antagonists: new drugs and new indications. N Engl J Med. 1981 Aug 27;305(9):500–506. doi: 10.1056/NEJM198108273050907. [DOI] [PubMed] [Google Scholar]
  27. Lapin E. S., Murray J. A., Bruce R. A., Winterscheid L. Changes in maximal exercise performance in the evaluation of saphenous vein bypass surgery. Circulation. 1973 Jun;47(6):1164–1173. doi: 10.1161/01.cir.47.6.1164. [DOI] [PubMed] [Google Scholar]
  28. Marshall R. C., Berger H. J., Reduto L. A., Gottschalk A., Zaret B. L. Variability in sequential measures of left ventricular performance assessed with radionuclide angiocardiography. Am J Cardiol. 1978 Mar;41(3):531–536. doi: 10.1016/0002-9149(78)90011-5. [DOI] [PubMed] [Google Scholar]
  29. Marshall R. C., Wisenberg G., Schelbert H. R., Henze E. Effect of oral propranolol on rest, exercise and postexercise left ventricular performance in normal subjects and patients with coronary artery disease. Circulation. 1981 Mar;63(3):572–583. doi: 10.1161/01.cir.63.3.572. [DOI] [PubMed] [Google Scholar]
  30. McIntosh H. D., Garcia J. A. The first decade of aortocoronary bypass grafting, 1967-1977. A review. Circulation. 1978 Mar;57(3):405–431. doi: 10.1161/01.cir.57.3.405. [DOI] [PubMed] [Google Scholar]
  31. Miller R. R., Olson H. G., Amsterdam E. A., Mason D. T. Propranolol-withdrawal rebound phenomenon. Exacerbation of coronary events after abrupt cessation of antianginal therapy. N Engl J Med. 1975 Aug 28;293(9):416–418. doi: 10.1056/NEJM197508282930902. [DOI] [PubMed] [Google Scholar]
  32. Mintz L. J., Ingels N. B., Jr, Daughters G. T., 2nd, Stinson E. B., Alderman E. L. Sequential studies of left ventricular function and wall motion after coronary arterial bypass surgery. Am J Cardiol. 1980 Feb;45(2):210–216. doi: 10.1016/0002-9149(80)90637-2. [DOI] [PubMed] [Google Scholar]
  33. Rerych S. K., Scholz P. M., Newman G. E., Sabiston D. C., Jr, Jones R. H. Cardiac function at rest and during exercise in normals and in patients with coronary heart disease: evaluation by radionuclide angiocardiography. Ann Surg. 1978 May;187(5):449–464. doi: 10.1097/00000658-197805000-00002. [DOI] [PMC free article] [PubMed] [Google Scholar]
  34. Ross R. S. Ischemic heart disease: an overview. Am J Cardiol. 1975 Oct 6;36(4):496–505. doi: 10.1016/0002-9149(75)90901-7. [DOI] [PubMed] [Google Scholar]
  35. Selden R., Neill W. A., Ritzmann L. W., Okies J. E., Anderson R. P. Medical versus surgical therapy for acute coronary insufficiency. A randomized study. N Engl J Med. 1975 Dec 25;293(26):1329–1333. doi: 10.1056/NEJM197512252932601. [DOI] [PubMed] [Google Scholar]
  36. Sharma B., Goodwin J. F., Raphael M. J., Steiner R. E., Rainbow R. G., Taylor S. H. Left ventricular angiography on exercise. A new method of assessing left ventricular function in ischaemic heart disease. Br Heart J. 1976 Jan;38(1):59–70. doi: 10.1136/hrt.38.1.59. [DOI] [PMC free article] [PubMed] [Google Scholar]
  37. Shepherd R. L., Itscoitz S. B., Glancy D. L., Stinson E. B., Reis R. L., Olinger G. N., Clark C. E., Epstein S. E. Deterioration of myocardial function following aorto-coronary bypass operation. Circulation. 1974 Mar;49(3):467–475. doi: 10.1161/01.cir.49.3.467. [DOI] [PubMed] [Google Scholar]
  38. Vatner S. F., Pagani M. Cardiovascular adjustments to exercise: hemodynamics and mechanisms. Prog Cardiovasc Dis. 1976 Sep-Oct;19(2):91–108. doi: 10.1016/0033-0620(76)90018-9. [DOI] [PubMed] [Google Scholar]
  39. Vlietstra R. E., Chesebro J. H., Frye R. L., Wallace R. B. Improvement of left ventricular exercise hemodynamic function after aorta-coronary artery bypass grafting. J Thorac Cardiovasc Surg. 1981 Jan;81(1):85–91. [PubMed] [Google Scholar]
  40. Wolf N. M., Kreulen T. H., Bove A. A., McDonough M. T., Kessler K. M., Strong M., LeMole G., Spann J. F. Left ventricular function following coronary bypass surgery. Circulation. 1978 Jul;58(1):63–70. doi: 10.1161/01.cir.58.1.63. [DOI] [PubMed] [Google Scholar]
  41. Zir L. M., Dinsmore R., Vexeridis M., Singh J. B., Harthorne J. W., Daggett W. M. Effects of coronary bypass grafting on resting left ventricular contraction in patients studied 1 to 2 years after operation. Am J Cardiol. 1979 Oct;44(4):601–606. doi: 10.1016/0002-9149(79)90275-3. [DOI] [PubMed] [Google Scholar]

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