CLINICAL STUDIES
Myocardial viability during dobutamine echocardiography predicts survival in patients with coronary artery disease and severe left ventricular systolic dysfunction
Imran Afridi, MBBS, FACC*,
Paul A. Grayburn, MD, FACC*,
Julio A. Panza, MD, FACC ,
Jae K. Oh, MD, FACC ,
William A. Zoghbi, MD, FACC and
Thomas H. Marwick, MD, FACC||
* Division of Cardiology University of Texas Southwestern Medical Center, Dallas, Texas, USA
Division of Cardiology, National Institutes of Health, Bethesda, Maryland, USA
Division of Cardiology, Mayo Clinic, Rochester, Minnesota, USA
Division of Cardiology, Baylor College of Medicine, Houston, Texas, USA
|| Division of Cardiology, Cleveland Clinic, Cleveland, Ohio, USA
Manuscript received May 21, 1998;
accepted June 4, 1998.
Address for correspondence: Dr. Imran Afridi, Section of Cardiology (111-A), Veterans Affairs Hospital, 4500 S. Lancaster Road, Dallas, Texas 75216
Afridi{at}ryburn.swmed.edu
Objectives. The purpose of this study was to assess whether the presence or absence of myocardial viability during dobutamine echocardiography (DE) predicts survival in patients with coronary artery disease (CAD) and severe left ventricular (LV) dysfunction.
Background. In patients with CAD, the presence of myocardial viability during DE identifies viable myocardium and predicts recovery of LV systolic function after revascularization. However, there is little data on the relation between myocardial viability and clinical outcome in patients with CAD and severe LV dysfunction.
Methods. We studied 318 patients with CAD and a LV ejection fraction (EF)  35% who underwent DE and were followed for 18 ± 10 months. Patients were classified into four groups. Group I (n = 85) consisted of patients who had evidence of myocardial viability and subsequently underwent revascularization. Group II (n = 119) consisted of patients with myocardial viability who did not undergo revascularization. Group III (n = 30) consisted of patients who did not have myocardial viability and underwent revascularization. Finally, group IV (n = 84) patients lacked myocardial viability and did not undergo revascularization.
Results. The four groups had similar baseline characteristics and rest LVEF. During follow-up there were 51 deaths (16%). The mortality rate was 6% in group I, 20% in group II, 17% in group III and 20% in group IV (p = 0.01, group I vs. other groups).
Conclusions. In patients with CAD and severe LV dysfunction who demonstrated myocardial viability during DE, revascularization improved survival compared with medical therapy.
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Abbreviations and Acronyms
| | CAD | = coronary artery disease | | DE | = dobutamine echocardiography | | EF | = ejection fraction | | LV | = left ventricular |
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