Do transmyocardial and percutaneous laser revascularization induce silent XXXX ? An assessment by exercise testing.

@entity1 @entity662 @entity308 @entity63 @entity951 @entity158
BACKGROUND: Transmyocardial and percutaneous laser revascularization (TMR, PTMR) may reduce @entity951 and increase exercise tolerance in otherwise untreatable @entity951 @entity1 , although the mechanism is unknown and the placebo effect may be significant. One other proposed mechanism is cardiac denervation leading to silent @entity63 . METHODS: Electrocardiograms obtained during symptom-limited exercise (ETT, modified Bruce protocol) at baseline and 12 months were analyzed (blinded core laboratory) from 182 @entity1 randomized to TMR (n = 92) or medical therapy alone (MED(TMR), n = 90) and 219 @entity1 randomized to PTMR (n = 109) or medical therapy alone (MED(PTMR), n = 110). RESULTS: Exercise duration increased 1 year after TMR or PTMR relative to medically treated @entity1 (6.8 +/- 3.4 min vs 8.6 +/- 3.5 min for TMR; 7.3 +/- 3.1 min vs 9.1 +/- 3.6 min for PTMR, P <.05). At baseline, 20% of TMR and MED(TMR) subjects had ST @entity308 >1.0 mm, >80% had @entity951 during exercise, but only 3% had ST changes without @entity662 (silent @entity63 ). This did not change after TMR. In the PTMR group, more subjects exercised to >1.0 mm ST @entity308 (from 17% to 34%, P <.05), with no change in MED(PTMR), but the proportion with silent @entity63 did not change in either group. CONCLUSION: Exercise tolerance improved after TMR and after PTMR. Relative to PTMR, TMR more effectively suppressed @entity158 during exercise and @entity308 . However, neither TMR nor PTMR induced significant silent @entity63 . These results suggest that denervation may not be a significant factor contributing to @entity951 relief after these procedures. The contribution of the placebo effect was not determined by these results.
