Objectives. The purpose of this ongoing study is to determine whether transmyocardial laser revascularization (TMLR) can lessen inducible ischemia and improve contractile reserve in patients with refractory angina pectoris.

Background. TMLR is an emerging surgical technique for the treatment of myocardial ischemia and angina pectoris not amenable to conventional percutaneous or surgical revascularization. Objective data documentating a reduction in ischemia during noninvasive stress testing after TMLR are rare.

Methods. Fifteen patients with severe coronary artery disease unsuitable for treatment with standard revascularization techniques were studied with dobutamine stress echocardiography (DSE) before TMLR. Of the 12 patients who underwent TMLR, DSE was repeated at 3 months postoperatively in 11 patients and at 6 months in 9 patients. Stress echocardiograms were analyzed for inducible ischemia, with calculation of the wall motion score index (WMSI). Heart rate and dobutamine dose achieved at peak stress were also assessed as indexes of stress tolerance.

Results. Compared with that before TMLR, wall motion at rest for all myocardial segments did not change significantly after TMLR, although there was a mild improvement in the WMSI of the lased myocardial regions ([mean ± SD] 1.64 ± 0.34 after vs. 1.78 ± 0.34 before TMLR, p < 0.05). Overall WMSI at peak stress improved markedly after TMLR (1.70 + 0.30 after vs. 2.06 + 0.31 before TMRL, p < 0.002, with improvement in WMSI limited to the lased segments only (p < 0.0004). The improvement in WMSI resulted primarily from a decrease in the percentage of ischemic segments. The reduction in ischemic wall motion abnormalities and improved stress tolerance persisted at 6 months, without evidence of further improvement or deterioration of function over time.

Conclusions: TMLR performed in patients with refractory angina pectoris reduces ischemic wall motion abnormalities and improves stress-induced tolerance during dobutamine echocardiography. These beneficial effects persist up to 6 months postoperatively. (J Am Coll Cardiol 1997;30:607-12)