Reversal of Segmental Hypokinesis by Coronary Angioplasty in Patients With Unstable

To evaluate the significance of persistent negative T waves during severe ischemia, we prospectively studied 62 patients admitted for unstable angina without evidence of recent or ongoing myocardial infarction. A critical stenosis on the left anterior descending coronary artery (LAD), considered as the culprit lesion, was successfully treated by percutaneous transluminal coronary angioplasty (PTCA). The patients were divided into two groups according to the admission electrocardiogram: T NEG group (n =32) had persistent negative T waves, and the T POS group (n=30) had normal positive T waves on precordial leads. The two groups had similar baseline clinical, hemodynamic, and angiographic characteristics. All patients underwent a complete clinical and angiographic evaluation (coronary arteriography and left ventriculography) before undergoing PTCA and 8±3 months later. Left ventricular anterior wall motion was evaluated by the percent shortening of three areas (S1, S2, and S3) considered as LAD-related segments on left ventriculograms. Before PTCA, there was no significant difference in global ejection fraction between the two groups despite a significant depression in anterior mean percent area shortening in the T NEG compared with the T POS group (S1, 44 versus 54, p<0.01; S2, 39 versus 48, p<0.01; S3, 44 versus 50, NS). At repeated angiography, the anterior mean percent area shortening improved significantly in the T NEG group (S1, from 44 to 61,p<0.001; S2, from 39 to 58,p<0.001; S3, from 44 to 61,p<0.001). This resulted in a reduced end-systolic volume (from 41±14 to 31+ 13 ml/m2, p <0.01) and improved ejection fraction (from 61±8% to 69±10%, p<O.OOl) compared with baseline. The negative T waves present on the admission electrocardiogram became normalized in 31 patients (97%). There were no differences in any of the data studied between baseline and follow-up in the T POS group. We conclude that 1) the clinical syndrome of unstable angina with LAD stenosis and persistent negative T waves on precordial leads is associated with resting anterior hypokinesis that is absent in patients without this electrocardiogram pattern but who are otherwise similar; 2) successful reperfusion by PTCA of LAD can normalize the abnormal electrocardiogram and anterior regional shortening, suggesting that myocardial stunning is present in this syndrome. (Circulation 1990;82:913-921)