JACC
HOME SUBSCRIPTIONS CURRENT ISSUE PAST ISSUES CARDIOSOURCE SEARCH HELP FEEDBACK
 QUICK SEARCH:   [advanced]


     


J Am Coll Cardiol, 1999; 33:750-758
© 1999 by the American College of Cardiology Foundation
This Article
Right arrow Figures Only
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Marwick, T. H.
Right arrow Articles by Lytle, B. W.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Marwick, T. H.
Right arrow Articles by Lytle, B. W.

CLINICAL STUDIES

Functional status and quality of life in patients with heart failure undergoing coronary bypass surgery after assessment of myocardial viability

Thomas H. Marwick, MD, PhD, FACCa, Charis Zuchowski, BSa, Michael S. Lauer, MD, FACCa, Maria-Anna Secknus, MDa, M. John Williams, MDa and Bruce W. Lytle, MD, FACCa

a Department of Cardiology, Cleveland Clinic Foundation, Cleveland, Ohio, USA

Manuscript received June 4, 1998; revised manuscript received September 23, 1998, accepted November 18, 1998.

Reprint requests and correspondence: Dr. T. Marwick, University Department of Medicine, Princess Alexandra Hospital, Ipswich Road, Brisbane, Qld 4102, Australia
tmarwick{at}medicine.pa.uq.edu.au

OBJECTIVES

The aim of this study was to evaluate whether preoperative clinical and test data could be used to predict the effects of myocardial revascularization on functional status and quality of life in patients with heart failure and ischemic LV dysfunction.

BACKGROUND

Revascularization of viable myocardial segments has been shown to improve regional and global LV function. The effects of revascularization on exercise capacity and quality of life (QOL) are not well defined.

METHODS

Sixty three patients (51 men, age 66 ± 9 years) with moderate or worse LV dysfunction (LVEF 0.28 ± 0.07) and symptomatic heart failure were studied before and after coronary artery bypass surgery. All patients underwent preoperative positron emission tomography (PET) using FDG and Rb-82 before and after dipyridamole stress; the extent of viable myocardium by PET was defined by the number of segments with metabolism-perfusion mismatch or ischemia. Dobutamine echocardiography (DbE) was performed in 47 patients; viability was defined by augmentation at low dose or the development of new or worsening wall motion abnormalities. Functional class, exercise testing and a QOL score (Nottingham Health Profile) were obtained at baseline and follow-up.

RESULTS

Patients had wall motion abnormalities in 83 ± 18% of LV segments. A mismatch pattern was identified in 12 ± 15% of LV segments, and PET evidence of viability was detected in 30 ± 21% of the LV. Viability was reported in 43 ± 18% of the LV by DbE. The difference between pre- and postoperative exercise capacity ranged from a reduction of 2.8 to an augmentation of 5.2 METS. The degree of improvement of exercise capacity correlated with the extent of viability by PET (r = 0.54, p = 0.0001) but not the extent of viable myocardium by DbE (r = 0.02, p = 0.92). The area under the ROC curve for PET (0.76) exceeded that for DbE (0.66). In a multiple linear regression, the extent of viability by PET and nitrate use were the only independent predictors of improvement of exercise capacity (model r = 0.63, p = 0.0001). Change in Functional Class correlated weakly with the change in exercise capacity (r = 0.25), extent of viable myocardium by PET (r = 0.23) and extent of viability by DbE (r = 0.31). Four components of the quality of life score (energy, pain, emotion and mobility status) significantly improved over follow-up, but no correlations could be identified between quality of life scores and the results of preoperative testing or changes in exercise capacity.

CONCLUSIONS

In patients with LV dysfunction, improvement of exercise capacity correlates with the extent of viable myocardium. Quality of life improves in most patients undergoing revascularization. However, its measurement by this index does not correlate with changes in other parameters nor is it readily predictable.

Abbreviations and Acronyms
  CABG = coronary artery bypass surgery
  CHF = congestive heart failure
  DbE = dobutamine echocardiography
  FDG = fluorodeoxyglucose
  LV = left ventricular
  mCi = milliCuries
  METS = metabolic equivalents
  ROC = receiver operating characteristic
  PET = positron emission tomography
  QOL = quality of life




This article has been cited by other articles:


Home page
Eur J EchocardiogrHome page
R. Sicari, P. Nihoyannopoulos, A. Evangelista, J. Kasprzak, P. Lancellotti, D. Poldermans, J.-U. Voigt, J. L. Zamorano, and on behalf of the European Association of Echocardi
Stress echocardiography expert consensus statement: European Association of Echocardiography (EAE) (a registered branch of the ESC)
Eur J Echocardiogr, July 1, 2008; 9(4): 415 - 437.
[Abstract] [Full Text] [PDF]


Home page
Card Surg AdultHome page
M. T. Spoor and S. F. Bolling
Nontransplant Surgical Options for Heart Failure
Card. Surg. Adult, January 1, 2008; 3(2008): 1639 - 1648.
[Full Text]


Home page
JNMHome page
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]


Home page
CirculationHome page
M. F. Di Carli and R. Hachamovitch
New Technology for Noninvasive Evaluation of Coronary Artery Disease
Circulation, March 20, 2007; 115(11): 1464 - 1480.
[Full Text] [PDF]


Home page
JNMHome page
C. Brogsitter, T. Gruning, R. Weise, P. Wielepp, O. Lindner, R. Korfer, and W. Burchert
18F-FDG PET for Detecting Myocardial Viability: Validation of 3D Data Acquisition
J. Nucl. Med., January 1, 2005; 46(1): 19 - 24.
[Abstract] [Full Text] [PDF]


Home page
J Am Coll CardiolHome page
D. S. Bach
Viability, prognosis, revascularization, and pascal
J. Am. Coll. Cardiol., December 17, 2003; 42(12): 2106 - 2108.
[Full Text] [PDF]


Home page
J. Thorac. Cardiovasc. Surg.Home page
P. J. Shah, D. L. Hare, J. S. Raman, I. Gordon, R. K. Chan, J. D. Horowitz, A. Rosalion, and B. F. Buxton
Survival after myocardial revascularization for ischemic cardiomyopathy: A prospective ten-year follow-up study
J. Thorac. Cardiovasc. Surg., November 1, 2003; 126(5): 1320 - 1327.
[Abstract] [Full Text] [PDF]


Home page
JNMHome page
W. J. Kang, D. S. Lee, J. C. Paeng, K.-B. Kim, J.-K. Chung, and M. C. Lee
Prognostic Value of Rest 201Tl-Dipyridamole Stress 99mTc-Sestamibi Gated SPECT for Predicting Patient-Based Clinical Outcomes After Bypass Surgery in Patients with Ischemic Left Ventricular Dysfunction
J. Nucl. Med., November 1, 2003; 44(11): 1735 - 1740.
[Abstract] [Full Text] [PDF]


Home page
JNMHome page
A. F.L. Schinkel, J. J. Bax, R. van Domburg, A. Elhendy, R. Valkema, E. C. Vourvouri, F. B. Sozzi, J. R.T.C. Roelandt, and D. Poldermans
Dobutamine-Induced Contractile Reserve in Stunned, Hibernating, and Scarred Myocardium in Patients with Ischemic Cardiomyopathy
J. Nucl. Med., February 1, 2003; 44(2): 127 - 133.
[Abstract] [Full Text] [PDF]


Home page
Card Surg AdultHome page
V. Badhwar and S. F. Bolling
Nontransplant Surgical Options for Heart Failure
Card. Surg. Adult, January 1, 2003; 2(2003): 1515 - 1526.
[Full Text]


Home page
ICVTSHome page
A. Gimelli, J. A. M. Neto, C. Marcassa, P. Ferrazzi, M. Glauber, and P. Marzullo
Beneficial effects of coronary revascularization in patients with ischaemic left ventricular dysfunction with and without anginal symptoms
Interactive CardioVascular and Thoracic Surgery, September 1, 2002; 1(1): 9 - 15.
[Abstract] [Full Text] [PDF]


Home page
J Am Coll CardiolHome page
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]


Home page
J Am Coll CardiolHome page
R. O. Bonow
Myocardial viability and prognosis in patients with ischemic left ventricular dysfunction
J. Am. Coll. Cardiol., April 3, 2002; 39(7): 1159 - 1162.
[Full Text] [PDF]


Home page
J Am Coll CardiolHome page
M. C. Corretti, T. J. Anderson, E. J. Benjamin, D. Celermajer, F. Charbonneau, M. A. Creager, J. Deanfield, H. Drexler, M. Gerhard-Herman, D. Herrington, et al.
Guidelines for the ultrasound assessment of endothelial-dependent flow-mediated vasodilation of the brachial artery: A report of the International Brachial Artery Reactivity Task Force
J. Am. Coll. Cardiol., January 16, 2002; 39(2): 257 - 265.
[Abstract] [Full Text] [PDF]


Home page
J. Thorac. Cardiovasc. Surg.Home page
G. B. Luciani, G. Montalbano, G. Casali, and A. Mazzucco
Predicting long-term functional results after myocardial revascularization in ischemic cardiomyopathy
J. Thorac. Cardiovasc. Surg., September 1, 2000; 120(3): 478 - 489.
[Abstract] [Full Text] [PDF]


Home page
CirculationHome page
G. A. Beller and B. L. Zaret
Contributions of Nuclear Cardiology to Diagnosis and Prognosis of Patients With Coronary Artery Disease
Circulation, March 28, 2000; 101(12): 1465 - 1478.
[Full Text] [PDF]




HOME SUBSCRIPTIONS CURRENT ISSUE PAST ISSUES CARDIOSOURCE SEARCH HELP FEEDBACK
Copyright © 1999 by the American College of Cardiology Foundation.