CLINICAL STUDIES
Myocardial viability on echocardiography predicts long-term survival after revascularization in patients with ischemic congestive heart failure
Roxy Senior, MD, DM, FRCPa,
Sanjiv Kaul, MD, FACC* and
Avijit Lahiri, MD, MRCP, FACCa
a Department of Cardiovascular Medicine, Northwick Park and St. Mark’s Hospitals and Institute of Medical Research, Harrow, United Kingdom
* Cardiovascular Division, University of Virginia, Charlottesville, Virginia, USA
Manuscript received July 31, 1998;
revised manuscript received January 25, 1999,
accepted February 15, 1999.
Reprint requests and correspondence: Dr. Avijit Lahiri, Department of Cardiology, Northwick Park Hospital, Harrow, Middlesex HA1 3UJ, United Kingdom
nphcardicac{at}compuserve.com
OBJECTIVES
This study was conducted to evaluate the effect of revascularization on survival in patients with congestive heart failure (CHF) due to ischemic left ventricular (LV) systolic dysfunction based on the presence of myocardial viability (MV).
BACKGROUND
There are insufficient data regarding the survival benefit of revascularization in patients with CHF due to ischemic LV systolic dysfunction.
METHODS
Follow-up was obtained in 87 consecutive patients with CHF due to ischemic LV systolic dysfunction (New York Heart Association [NYHA] class II-IV; LV ejection fraction <0.35) who underwent low-dose dobutamine echocardiography (DE). MV within each of 12 myocardial segments representing the LV was defined as having either: 1) normal function or mild dyssynergy at rest; 2) severe resting dyssynergy that improved on DE, or 3) worsening of function on DE except in the case of akinesia.
RESULTS
At a mean follow-up of 40 ± 17 months, 37 patients had received revascularization on the basis of clinical grounds, and there were 22 (25%) cardiac-related deaths. Multivariate Cox regression analysis revealed that when patients with at least five segments showing MV underwent revascularization, mortality was reduced by an average of 93% (confidence interval of 22% to 99%), which was associated with improvement in NYHA class as well as LV ejection fraction. Patients with less than five segments showing MV who underwent revascularization (and thus, showing mostly scar), and those with at least 5 segments demonstrating MV who were treated medically, had a much higher mortality.
CONCLUSIONS
Revascularization produces a clear survival benefit in patients with CHF due to ischemic LV systolic dysfunction who have a significant region of the LV demonstrating MV. These data may have wide-ranging implications in the management of patients with coronary artery disease whose main clinical presentation is CHF.
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Abbreviations and Acronyms
| | ACE | = angiotensin converting enzyme | | CAD | = coronary artery disease | | CHF | = congestive heart failure | | DE | = dobutamine echocardiography | | ECG | = electrocardiography | | LV | = left ventricle; left ventricular | | NYHA | = New York Heart Association | | MV | = myocardial viability | | SWT | = systolic wall thickening |
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