CLINICAL STUDIES
Prognostic value of the amount of dysfunctional but viable myocardium in revascularized patients with coronary artery disease and left ventricular dysfunction
Jaroslav Meluzín, MD, PhDa,
Jan  ern , MD, Prof*,
Milan Frélich, MD, PhD*,
Franti ek  t tka, MD*,
Lenka pinarová, MDa,
Jana Popelová, MD, PhD ,
Roman típal, MD, PhD on behalf of the Investigators of This Multicenter Study
a 1st Internal Department, Brno, Czech Republic
* Center of Cardiovascular and Transplant Surgery, Brno, Czech Republic
Internal Department of the Faculty Hospital Motol, Prague, Czech Republic
Internal Department of the Faculty Hospital, Ostrava, Czech Republic
Manuscript received February 25, 1998;
revised manuscript received June 5, 1998,
accepted June 12, 1998.
Address for correspondence: Dr. Jaroslav Meluzín, 1st Internal Department, St. Anna Hospital, Peka ská 53, Brno, 656 91, Czech Republic
jtoman{at}med.muni.cz
Objectives. The purpose of our study was to assess the prognostic importance of the amount of dysfunctional but viable myocardium in revascularized patients with coronary artery disease (CAD) and left ventricular (LV) dysfunction.
Background. The amount of dysfunctional but viable myocardium predicts the functional improvement after revascularization and may offer more precise risk stratification of patients referred for bypass surgery or coronary angioplasty.
Methods. Two hundred and seventy-four consecutive patients with CAD and LV ejection fraction  40% underwent low-dose dobutamine echocardiography for viability assessment. One hundred and thirty-three of them were revascularized using either coronary artery bypass surgery (118 patients) or coronary angioplasty (15 patients) and entered this study. To quantify the amount of dysfunctional but viable myocardium, wall motion was scored using 16-segment model. The dysfunctional segments were defined as viable if they exhibited improvement in their thickening by at least 1 grade with dobutamine infusion. The patients were followed up for a mean period of 20 ± 12 months (range, 2 to 48) for cardiac mortality and nonfatal cardiac events including myocardial infarction, unstable angina pectoris requiring hospitalization and hospitalization for heart failure. Standard follow-up echocardiography was performed 3 to 6 months after revascularization.
Results. Twenty-nine patients exhibited a large amount of dysfunctional but viable myocardium ( 6 segments, group A), 60 patients had a small amount of dysfunctional but viable myocardium (2 to 5 segments, group B) and 44 patients were found to have dysfunctional myocardium irreversibly damaged (group C). Similar prerevascularization LV ejection fractions of 35% ± 5%, 34% ± 4%, 36% ± 4% in groups A, B and C increased to 47% ± 6% (p < 0.01 vs. baseline, p < 0.01 vs. groups B and C), to 40% ± 5% (p < 0.01 vs. baseline) and to 37% ± 6% (p = NS vs baseline), respectively, after revascularization. The greatest functional improvement after revascularization in group A patients was accompanied by a lower rate of cardiac events during follow-up (2 vs. 18 in group B, p < 0.05, and vs. 17 in group C, p < 0.01) and better cardiac event-free survival according to Kaplan–Meier survival analysis (p < 0.05 vs. groups B and C, respectively).
Conclusion. In revascularized patients with CAD and moderate or severe LV dysfunction, the presence of a large amount of dysfunctional but viable myocardium identifies patients with the best prognosis.
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Abbreviations and Acronyms
| | AP | = angina pectoris | | CAD | = coronary artery disease | | DE | = dobutamine echocardiography | | EF | = ejection fraction | | LV | = left ventricular | | MI | = myocardial infarction | | WMS | = wall motion score |
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|
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29(13):
1608 - 1617.
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|
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|
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|
|
|
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January 1, 2008;
117(1):
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|
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|
|
|
|
|
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Late gadolinium enhancement-cardiovascular magnetic resonance as a predictor of response to cardiac resynchronization therapy in patients with ischaemic cardiomyopathy
Europace,
November 1, 2007;
9(11):
1031 - 1037.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
L. Cortigiani, R. Sicari, A. Desideri, R. Bigi, F. Bovenzi, E. Picano, and on behalf of the VIDA (Viability Identification wi
Dobutamine stress echocardiography and the effect of revascularization on outcome in diabetic and non-diabetic patients with chronic ischaemic left ventricular dysfunction
Eur J Heart Fail,
October 1, 2007;
9(10):
1038 - 1043.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. F.L. Schinkel, D. Poldermans, A. Elhendy, and J. J. Bax
Assessment of Myocardial Viability in Patients with Heart Failure
J. Nucl. Med.,
July 1, 2007;
48(7):
1135 - 1146.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
V Rizzello, D Poldermans, A F L Schinkel, E Biagini, E Boersma, A Elhendy, F B Sozzi, A Palazzuoli, A Maat, F Crea, et al.
Outcome after redo coronary artery bypass grafting in patients with ischaemic cardiomyopathy and viable myocardium
Heart,
February 1, 2007;
93(2):
221 - 225.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
V Rizzello, D Poldermans, A F L Schinkel, E Biagini, E Boersma, A Elhendy, F B Sozzi, A Maat, F Crea, J R T C Roelandt, et al.
Long term prognostic value of myocardial viability and ischaemia during dobutamine stress echocardiography in patients with ischaemic cardiomyopathy undergoing coronary revascularisation
Heart,
February 1, 2006;
92(2):
239 - 244.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
T.-H. Park, S. F. Nagueh, D. S. Khoury, H. A. Kopelen, S. Akrivakis, K. Nasser, G. Ren, and N. G. Frangogiannis
Impact of myocardial structure and function postinfarction on diastolic strain measurements: implications for assessment of myocardial viability
Am J Physiol Heart Circ Physiol,
February 1, 2006;
290(2):
H724 - H731.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
V. Bodi, J. Sanchis, M. P. Lopez-Lereu, A. Losada, J. Nunez, M. Pellicer, V. Bertomeu, F. J. Chorro, and A. Llacer
Usefulness of a Comprehensive Cardiovascular Magnetic Resonance Imaging Assessment for Predicting Recovery of Left Ventricular Wall Motion in the Setting of Myocardial Stunning
J. Am. Coll. Cardiol.,
November 1, 2005;
46(9):
1747 - 1752.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R Senior, M Monaghan, H Becher, J Mayet, and P Nihoyannopoulos
Stress echocardiography for the diagnosis and risk stratification of patients with suspected or known coronary artery disease: a critical appraisal. Supported by the British Society of Echocardiography
Heart,
April 1, 2005;
91(4):
427 - 436.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
V. Rizzello, D. Poldermans, E. Boersma, E. Biagini, A. F.L. Schinkel, B. Krenning, A. Elhendy, E. C. Vourvouri, F. B. Sozzi, A. Maat, et al.
Opposite Patterns of Left Ventricular Remodeling After Coronary Revascularization in Patients With Ischemic Cardiomyopathy: Role of Myocardial Viability
Circulation,
October 19, 2004;
110(16):
2383 - 2388.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J J Bax, E E van der Wall, and M Harbinson
Radionuclide techniques for the assessment of myocardial viability and hibernation
Heart,
August 1, 2004;
90(suppl_5):
v26 - v33.
[Full Text]
[PDF]
|
|
|
|
|
|
|
S.R. Underwood, J. J Bax, J. v. Dahl, M. Y Henein, A. C van Rossum, E. R Schwarz, J.-L. Vanoverschelde, E. E.v. d. Wall, and W. Wijns
Imaging techniques for the assessment of myocardial hibernation: Report of a Study Group of the European Society of Cardiology
Eur. Heart J.,
May 2, 2004;
25(10):
815 - 836.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
K. Shan, G. Constantine, M. Sivananthan, and S. D. Flamm
Role of Cardiac Magnetic Resonance Imaging in the Assessment of Myocardial Viability
Circulation,
March 23, 2004;
109(11):
1328 - 1334.
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Pitt, D. Dutka, D. Pagano, P. Camici, and R. Bonser
The natural history of myocardium awaiting revascularisation in patients with impaired left ventricular function
Eur. Heart J.,
March 2, 2004;
25(6):
500 - 507.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. Sawada, A. Bapat, D. Vaz, J. Weksler, N. Fineberg, A. Greene, I. Gradus-Pizlo, and H. Feigenbaum
Incremental value of myocardial viability for prediction of Long-Term prognosis in surgically revascularized patients with left ventricular dysfunction
J. Am. Coll. Cardiol.,
December 17, 2003;
42(12):
2099 - 2105.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
B. P. Griffith
Surgical treatment of congestive heart failure: evolving options
Ann. Thorac. Surg.,
December 1, 2003;
76(6):
S2254 - 2259.
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. D. Cheitlin, W. F. Armstrong, G. P. Aurigemma, G. A. Beller, F. Z. Bierman, J. L. Davis, P. S. Douglas, D. P. Faxon, L. D. Gillam, T. R. Kimball, et al.
ACC/AHA/ASE 2003 guideline update for the clinical application of echocardiography: summary article: a report of the American college of cardiology/American heart association task force on practice guidelines (ACC/AHA/ASE committee to update the 1997 guidelines for the clinical application of echocardiography)
J. Am. Coll. Cardiol.,
September 3, 2003;
42(5):
954 - 970.
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. D. Cheitlin, W. F. Armstrong, G. P. Aurigemma, G. A. Beller, F. Z. Bierman, J. L. Davis, P. S. Douglas, D. P. Faxon, L. D. Gillam, T. R. Kimball, et al.
ACC/AHA/ASE 2003 Guideline Update for the Clinical Application of Echocardiography: Summary Article: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/ASE Committee to Update the 1997 Guidelines for the Clinical Application of Echocardiography)
Circulation,
September 2, 2003;
108(9):
1146 - 1162.
[Full Text]
[PDF]
|
|
|
|
|
|
|
G. I.W. Galasko and A. Lahiri
The non-invasive assessment of hibernating myocardium in ischaemic cardiomyopathy--a myriad of techniques
Eur J Heart Fail,
June 1, 2003;
5(3):
217 - 227.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
F. C. Visser
Prediction of Surgical Treatment Effect by Preoperative Imaging:Present and Future Perspectives
Seminars in Cardiothoracic and Vascular Anesthesia,
March 1, 2003;
7(1):
31 - 36.
[PDF]
|
|
|
|
|
|
|
C. A. Visser and F. Nijland
Current Status of Echocardiography for Detection of Myocardial Ischemia and Viability
Seminars in Cardiothoracic and Vascular Anesthesia,
March 1, 2003;
7(1):
41 - 43.
[PDF]
|
|
|
|
|
|
|
J. Meluzin, J. Cerny, L. Spinarova, J. Toman, L. Groch, F. Stetka, M. Frelich, P. Hude, J. Krejci, L. Rambouskova, et al.
Prognosis of patients with chronic coronary artery disease and severe left ventricular dysfunction. The importance of myocardial viability
Eur J Heart Fail,
January 1, 2003;
5(1):
85 - 93.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
T. H Marwick
Stress echocardiography
Heart,
January 1, 2003;
89(1):
113 - 118.
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. A. Fox, V. Formanek, A. Friedrich, and S. K. Shernan
Intraoperative Echocardiography
Card. Surg. Adult,
January 1, 2003;
2(2003):
283 - 314.
[Full Text]
|
|
|
|
|
|
|
P. B. Jacklin, S. F. Barrington, J. C. Roxburgh, G. Jackson, D. Sariklis, P. A. West, and M. N. Maisey
Cost-effectiveness of preoperative positron emission tomography in ischemic heart disease
Ann. Thorac. Surg.,
May 1, 2002;
73(5):
1403 - 1409.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
K. C. Allman, L. J. Shaw, R. Hachamovitch, and J. E. Udelson
Myocardial viability testing and impact of revascularization on prognosis in patients with coronary artery disease and left ventricular dysfunction: a meta-analysis
J. Am. Coll. Cardiol.,
April 3, 2002;
39(7):
1151 - 1158.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Chello, P. Mastroroberto, F. Perticone, F. Cirillo, E. Bevacqua, S. Olivito, and E. Covino
Plasma levels of atrial and brain natriuretic peptides as indicators of recovery of left ventricular systolic function after coronary artery bypass
Eur. J. Cardiothorac. Surg.,
July 1, 2001;
20(1):
140 - 146.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R Sicari, A Ripoli, E Picano, A.C Borges, A Varga, W Mathias, L Cortigiani, R Bigi, J Heyman, S Polimeno, et al.
The prognostic value of myocardial viability recognized by low dose dipyridamole echocardiography in patients with chronic ischaemic left ventricular dysfunction
Eur. Heart J.,
May 2, 2001;
22(10):
837 - 844.
[Abstract]
[PDF]
|
|
|
|
|
|
|
Y. Yong, S. F. Nagueh, S. Shimoni, K. Shan, Z.-X. He, M. J. Reardon, G. V. Letsou, J. F. Howell, M. S. Verani, M. A. Quinones, et al.
Deceleration Time in Ischemic Cardiomyopathy : Relation to Echocardiographic and Scintigraphic Indices of Myocardial Viability and Functional Recovery After Revascularization
Circulation,
March 6, 2001;
103(9):
1232 - 1237.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
H.-M. J. Siebelink, P. K. Blanksma, H. J. G. M. Crijns, J. J. Bax, A. J. van Boven, T. Kingma, D. A. Piers, J. Pruim, P. L. Jager, W. Vaalburg, et al.
No difference in cardiac event-free survival between positron emission tomography-guided and single-photon emission computed tomography-guided patient management: A prospective, randomized comparison of patients with suspicion of jeopardized myocardium
J. Am. Coll. Cardiol.,
January 1, 2001;
37(1):
81 - 88.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
G. A. Beller
Noninvasive Assessment of Myocardial Viability
N. Engl. J. Med.,
November 16, 2000;
343(20):
1487 - 1490.
[Full Text]
|
|
|
|
|
|
|
R. Sciagra, M. Pellegri, A. Pupi, L. Bolognese, G. Bisi, V. Carnovale, and G. M. Santoro
Prognostic implications of Tc-99m sestamibi viability imaging and subsequent therapeutic strategy in patients with chronic coronary artery disease and left ventricular dysfunction
J. Am. Coll. Cardiol.,
September 1, 2000;
36(3):
739 - 745.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
E. Stahle
Patients with ischaemic heart disease and severe left ventricular dysfunction -- who should not be revascularized?
Eur. Heart J.,
January 2, 2000;
21(2):
101 - 103.
[PDF]
|
|
|
|
|
|
|
A. Pasquet, M.S. Lauer, M.J. Williams, M.-A. Secknus, B. Lytle, and T.H. Marwick
Prediction of global left ventricular function after bypass surgery in patients with severe left ventricular dysfunction. Impact of pre-operative myocardial function, perfusion, and metabolism
Eur. Heart J.,
January 2, 2000;
21(2):
125 - 136.
[Abstract]
[PDF]
|
|
|
|
|
|
|
T. Sharir, D. S. Berman, H. C. Lewin, J. D. Friedman, I. Cohen, R. Miranda, R. D. Agafitei, and G. Germano
Incremental Prognostic Value of Rest-Redistribution 201Tl Single-Photon Emission Computed Tomography
Circulation,
November 9, 1999;
100(19):
1964 - 1970.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
K. A. Eagle, R. A. Guyton, R. Davidoff, G. A. Ewy, J. Fonger, T. J. Gardner, J. P. Gott, H. C. Herrmann, R. A. Marlow, W. C. Nugent, et al.
ACC/AHA guidelines for coronary artery bypass graft surgery: A report of the American College of Cardiology/ American Heart Association task force on Practice Guidelines (Committee to revise the 1991 Guidelines for Coronary Artery Bypass Graft Surgery)
J. Am. Coll. Cardiol.,
October 1, 1999;
34(4):
1262 - 1347.
[Full Text]
[PDF]
|
|
|
|
|
|
|
H. Samady, J. A. Elefteriades, B. G. Abbott, J. A. Mattera, C. A. McPherson, and F. J. Th. Wackers
Failure to Improve Left Ventricular Function After Coronary Revascularization for Ischemic Cardiomyopathy Is Not Associated With Worse Outcome
Circulation,
September 21, 1999;
100(12):
1298 - 1304.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. J. Bax, D. Poldermans, A. Elhendy, J. H. Cornel, E. Boersma, R. Rambaldi, J. R. T. C. Roelandt, and P. M. Fioretti
Improvement of left ventricular ejection fraction, heart failure symptoms and prognosis after revascularization in patients with chronic coronary artery disease and viable myocardium detected by dobutamine stress echocardiography
J. Am. Coll. Cardiol.,
July 1, 1999;
34(1):
163 - 169.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. Senior, S. Kaul, and A. Lahiri
Myocardial viability on echocardiography predicts long-term survival after revascularization in patients with ischemic congestive heart failure
J. Am. Coll. Cardiol.,
June 1, 1999;
33(7):
1848 - 1854.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
