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(Circulation. 1999;100:II-134.)
© 1999 American Heart Association, Inc.

Surgery for Coronary Artery Disease

Measurement of Myocardial Blood Flow With Positron Emission Tomography Before and After Transmyocardial Laser Revascularization

Ornella Rimoldi, MD; Sharon M. Burns, MRCP; Stuart D. Rosen, MA, MD, MRCP, FESC; Trevor E. Wistow, MD; Peter M. Schofield, FRCP; Gordon Taylor, PhD; Paolo G. Camici, MD, FESC, FRCP

From the MRC Cyclotron Unit–Imperial College School of Medicine, Hammersmith Hospital, London, UK (O.R., S.D.R., P.G.C.); Papworth Hospital, Cambridge, UK (S.M.B., T.E.W., P.M.S., G.T.); and CNR Centro per le Ricerche Cardiovascolari, Milano, Italy (O.R.).

Correspondence to Dr Ornella Rimoldi, MRC Cyclotron Unit, Hammersmith Hospital, Du Cane Rd, London W12 0NN, UK. E-mail ornella{at}cu.rpms.ac.uk

Background—Transmyocardial laser revascularization (TMLR) has been proposed for treatment of refractory angina. It has been hypothesized that transmural left ventricular channels created by laser improve myocardial blood flow (MBF) in the treated zones. We aimed to assess the effect of TMLR on MBF and coronary vasodilator reserve (CVR).

Methods and Results—We measured MBF by means of PET with ¹⁵O-labeled water in 7 patients with refractory angina, Canadian Cardiovascular Society (CCS) class 3.6±0.5, on 3 occasions: before and at 7.5±2.8 weeks (FU-1) and 34.6±4.7 weeks (FU-2) after TMLR performed with a synchronized, high-powered CO₂ laser. In each study, MBF was measured at rest and during maximal intravenous dobutamine. CVR was computed as dobutamine divided by resting MBF. After TMLR, CCS class was 2.2±1.7 at FU-1 and 2.4±1 at FU-2 (P=0.04 versus pre-TMLR). Resting MBF in both lasered and nonlasered regions was unchanged after TMLR. Dobutamine MBF at baseline was 1.45±0.52 and 1.55±0.52 mL · min^-1 · g^-1 in lasered and nonlasered regions, respectively (P=NS). At FU-1, dobutamine MBF in nonlasered regions had increased significantly to 1.89±0.82 mL · min^-1 · g^-1 (P<0.05) and was higher than in lasered regions (1.51±0.61 mL · min^-1 · g^-1; P<0.05 versus nonlasered). At FU-2, dobutamine MBF in nonlasered regions was still higher than in lasered regions (1.56±0.54 versus 1.21±0.44 mL · min^-1 · g^-1; P<0.01). CVR was comparable in nonlasered and lasered regions at baseline and FU-1, whereas it was higher in nonlasered regions at FU-2 (1.86±0.67 versus 1.53±0.72 mL · min^-1 · g^-1; P<0.05).

Conclusions—TMLR has been shown to reduce angina in severely diseased patients. The results of our study do not support the hypothesis that the symptomatic benefit of TMLR can be ascribed to improved myocardial perfusion or CVR in lasered areas.

Key Words: coronary disease • revascularization • laser • myocardium • blood flow • imaging