Introduction: Percutaneous myocardial laser revascularisation (PMLR) has been developed for treatment of patients with refractory angina pectoris. This study was designed to evaluate long-term impact of PMLR on left ventricular systolic function.
Material and methods: Ten patients with refractory angina pectoris who underwent PMLR were studied with dobutamine stress echocardiography before procedure, at early follow-up after 1-3 months and at long-term follow-up after 2-3 years post procedure. Wall motion score index (WMSI) and ejection fraction (EF) were calculated at rest as well during infusion of dobutamine with low and high rate.
Results: Mean WMSI at rest decreased significantly from 1.71 +/- 0.24 before PMLR to 1.55 +/- 0.21 at early follow-up (p=0.0189) and 1.48 +/- 0.26 (p=0.009) at long-term follow-up. Mean WMSI during low-rate dobutamine infusion decreased significantly from 1.39 +/- 0.29 to 1.25 +/- 0.25 (p=0.0276) at early follow-up, but was not significantly different in long-term. Mean WMSI during high-rate dobutamine infusion decreased significantly from 1.83 +/- 0.21 before PMLR to 1.56 +/- 0.2 at early follow-up and 1.57 +/- 0.29 (p<0.03) at long-term evaluation. Mean EF at rest increased significantly from 48 +/- 8.6% before PMLR to 56.9 +/- 7.9% (p=0.0189) at early follow-up. At long-term follow-up mean EF at rest was 52.7 +/- 8.3% and was not significantly different from baseline. Mean EF during low-rate dobutamine infusion was not significantly different from baseline both at early and long-term follow-up. Mean EF during high-rate dobutamine infusion increased significantly from 44.5 +/- 8.6% before PMLR to 58.1 +/- 7.0% (p=0.0093) at early follow-up while in long-term it was 51.3 +/- 9.8%, which was not significantly different from baseline. These changes were accompanied by significant decrease of mean CCS score from 3.52 +/- 0.51 before procedure to 2.54 +/- 0.78 (p<0.0001) after 1 month and 2.78 +/- 0.65 after 24 months.
Conclusions: In patients with refractory angina pectoris treated with PMLR significant early improvement of systolic left-ventricular function is observed with trend toward improvement in long-term. It is accompanied with significant long-term angina relief.