CLINICAL STUDIES
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
Jeroen J. Bax, MD*,
Don Poldermans, MD ,
Abdou Elhendy, MD,
Jan H. Cornel, MD ,
Eric Boersma, PhD ,
Riccardo Rambaldi, MD,
Jos R. T. C. Roelandt, MD, FACC and
Paolo M. Fioretti, MD, FACC||
* Department of Cardiology, University Hospital Leiden, Leiden, The Netherlands
Department of Cardiology, ThoraxCenter Rotterdam, Rotterdam, The Netherlands
Department of Cardiology, Medical Center Alkmaar, Alkmaar, The Netherlands
Department of Clinical Epidemiology/Statistics, University Hospital Rotterdam, Rotterdam, The Netherlands
|| Department of Cardiology, Medical Center Udine, Udine, Italy
Manuscript received August 6, 1998;
revised manuscript received February 4, 1999,
accepted March 15, 1999.
Reprint requests and correspondence: Dr. Jeroen J. Bax, Department of Cardiology, University Hospital Leiden, Rijnsburgerweg 10, 2333 AA Leiden, The Netherlands
Bax{at}cardio.azl.nl
OBJECTIVES
This study was designed to address, in patients with severe ischemic left ventricular dysfunction, whether dobutamine stress echocardiography (DSE) can predict improvement of left ventricular ejection fraction (LVEF), functional status and long-term prognosis after revascularization.
BACKGROUND
Dobutamine stress echocardiography can predict improvement of wall motion after revascularization. The relation between viability, improvement of function, improvement of heart failure symptoms and long-term prognosis has not been studied.
METHODS
We studied 68 patients with DSE before revascularization; 62 patients underwent resting echocardiography/radionuclide ventriculography before and three months after revascularization. Long-term follow-up data (New York Heart Association [NYHA] functional class, Canadian Cardiovascular Society [CCS] classification and events) were acquired up to two years.
RESULTS
Patients with  4 viable segments on DSE (group A, n = 22) improved in LVEF at three months (from 27 ± 6% to 33 ± 7%, p < 0.01), in NYHA functional class (from 3.2 ± 0.7 to 1.6 ± 0.5, p < 0.01) and in CCS classification (from 2.9 ± 0.3 to 1.2 ± 0.4, p < 0.01); in patients with <4 viable segments (group B, n = 40) LVEF and NYHA functional class did not improve, whereas CCS classification improved significantly (from 3.0 ± 0.8 to 1.3 ± 0.5, p < 0.01). A higher event rate was observed at long-term follow-up in group B versus group A (47% vs. 17%, p < 0.05).
CONCLUSIONS
Patients with substantial viability on DSE demonstrated improvement in LVEF and NYHA functional class after revascularization; viability was also associated with a favorable prognosis after revascularization.
|
Abbreviations and Acronyms
| | CABG | = coronary artery bypass grafting | | CCS | = Canadian Cardiovascular Society | | CI | = confidence interval | | DSE | = dobutamine stress echocardiography | | LV | = left ventricular | | LVEF | = left ventricular ejection fraction | | NYHA | = New York Heart Association | | RNV | = radionuclide ventriculography | | ROC | = receiver operating characteristic |
|
This article has been cited by other articles:
|
|
|
|
 
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--Executive Summary: European Association of Echocardiography (EAE) (a registered branch of the ESC)
Eur. Heart J.,
November 11, 2008;
(2008)
ehn492v1.
[Full Text]
[PDF]
|
|
|
|
|
|
|
G. Bajraktari, A. Duncan, J. Pepper, and M. Henein
Prolonged total isovolumic time predicts cardiac events following coronary artery bypass surgery
Eur J Echocardiogr,
November 1, 2008;
9(6):
779 - 783.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. H. Mandegar, M. A. Yousefnia, F. Roshanali, H. Rayatzadeh, and F. Alaeddini
Interaction between two predictors of functional outcome after revascularization in ischemic cardiomyopathy: left ventricular volume and amount of viable myocardium.
J. Thorac. Cardiovasc. Surg.,
October 1, 2008;
136(4):
930 - 936.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. Chan, F. Khafagi, A. A. Young, B. R. Cowan, C. Thompson, and T. H. Marwick
Impact of coronary revascularization and transmural extent of scar on regional left ventricular remodelling
Eur. Heart J.,
July 1, 2008;
29(13):
1608 - 1617.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
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]
|
|
|
|
|
|
|
H. S. Lim, G. Y.H. Lip, and H.-F. Tse
Implantable cardioverter defibrillator following acute myocardial infarction: the '48-hour' and '40-day' rule
Europace,
May 1, 2008;
10(5):
536 - 539.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Becker, A. Lenzen, C. Ocklenburg, K. Stempel, H. Kuhl, M. Neizel, M. Katoh, R. Kramann, J. Wildberger, M. Kelm, et al.
Myocardial Deformation Imaging Based on Ultrasonic Pixel Tracking to Identify Reversible Myocardial Dysfunction
J. Am. Coll. Cardiol.,
April 15, 2008;
51(15):
1473 - 1481.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. G. Camici, S. K. Prasad, and O. E. Rimoldi
Stunning, Hibernation, and Assessment of Myocardial Viability
Circulation,
January 1, 2008;
117(1):
103 - 114.
[Full Text]
[PDF]
|
|
|
|
|
|
|
E. Seyfeli, A. Abaci, M. Kula, R. Topsakal, N. K. Eryol, H. Arinc, I. Ozdogru, and A. Ergin
Myocardial Blush Grade: To Evaluate Myocardial Viability in Patients With Acute Myocardial Infarction
Angiology,
November 1, 2007;
58(5):
556 - 560.
[Abstract]
[PDF]
|
|
|
|
|
|
|
G. Kitsios and E. Zintzaras
Genetic Variation associated with Ischemic Heart Failure: A HuGE Review and Meta-Analysis
Am. J. Epidemiol.,
September 15, 2007;
166(6):
619 - 633.
[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]
|
|
|
|
|
|
|
M. Penicka, P. Tousek, B. De Bruyne, W. Wijns, O. Lang, J. Madaric, M. Vanderheyden, J. Tintera, M. Maly, P. Widimsky, et al.
Myocardial positive pre-ejection velocity accurately detects presence of viable myocardium, predicts recovery of left ventricular function and bears a prognostic value after surgical revascularization
Eur. Heart J.,
June 1, 2007;
28(11):
1366 - 1373.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
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]
|
|
|
|
|
|
|
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]
|
|
|
|
|
|
|
J. Lipiecki, N. Durel, and J. Ponsonnaille
Which patients with ischaemic heart disease could benefit from cell replacement therapy?
Eur. Heart J. Suppl.,
December 1, 2006;
8(suppl_H):
H3 - H7.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Di Mauro, G. Di Giammarco, G. Vitolla, M. Contini, A. L. Iaco, A. Bivona, L. Weltert, and A. M. Calafiore
Impact of No-to-Moderate Mitral Regurgitation on Late Results After Isolated Coronary Artery Bypass Grafting in Patients With Ischemic Cardiomyopathy
Ann. Thorac. Surg.,
June 1, 2006;
81(6):
2128 - 2134.
[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]
|
|
|
|
|
|
|
A. Desideri, L. Cortigiani, A. I. Christen, S. Coscarelli, D. Gregori, P. Zanco, R. Komorovsky, and J. J. Bax
The Extent of Perfusion-F18-Fluorodeoxyglucose Positron Emission Tomography Mismatch Determines Mortality in Medically Treated Patients With Chronic Ischemic Left Ventricular Dysfunction
J. Am. Coll. Cardiol.,
October 4, 2005;
46(7):
1264 - 1269.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
V Rizzello, D Poldermans, E Biagini, A F L Schinkel, R van Domburg, A Elhendy, E C Vourvouri, M Bountioukos, A Lombardo, B Krenning, et al.
Improvement of stress LVEF rather than rest LVEF after coronary revascularisation in patients with ischaemic cardiomyopathy and viable myocardium
Heart,
March 1, 2005;
91(3):
319 - 323.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. F L Schinkel, J. J Bax, and D. Poldermans
Clinical assessment of myocardial hibernation
Heart,
January 1, 2005;
91(1):
111 - 117.
[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]
|
|
|
|
|
|
|
A. Duncan, D. Francis, D. Gibson, J. Pepper, and M. Henein
Electromechanical left ventricular resynchronisation by coronary artery bypass surgery
Eur. J. Cardiothorac. Surg.,
October 1, 2004;
26(4):
711 - 719.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. B. Selvanayagam, A. Kardos, J. M. Francis, F. Wiesmann, S. E. Petersen, D. P. Taggart, and S. Neubauer
Value of Delayed-Enhancement Cardiovascular Magnetic Resonance Imaging in Predicting Myocardial Viability After Surgical Revascularization
Circulation,
September 21, 2004;
110(12):
1535 - 1541.
[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]
|
|
|
|
|
|
|
E. Biagini, T. W. Galema, A. F. L. Schinkel, W. B. Vletter, J. R. T. C. Roelandt, and F. J. Ten Cate
Myocardial wall thickness predicts recovery of contractile function after primary coronary intervention for acute myocardial infarction
J. Am. Coll. Cardiol.,
April 21, 2004;
43(8):
1489 - 1493.
[Abstract]
[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]
|
|
|
|
|
|
|
A. F. L. Schinkel, D. Poldermans, V. Rizzello, J.-L. J. Vanoverschelde, A. Elhendy, E. Boersma, J. R.T.C. Roelandt, and J. J. Bax
Why do patients with ischemic cardiomyopathy and a substantial amount of viable myocardium not always recover in function after revascularization?
J. Thorac. Cardiovasc. Surg.,
February 1, 2004;
127(2):
385 - 390.
[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]
|
|
|
|
|
|
|
D. S. Bach
Viability, prognosis, revascularization, and pascal
J. Am. Coll. Cardiol.,
December 17, 2003;
42(12):
2106 - 2108.
[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]
|
|
|
|
|
|
|
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]
|
|
|
|
|
|
|
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]
|
|
|
|
|
|
|
M Bountioukos, A F L Schinkel, J J Bax, V Rizzello, R Rambaldi, E C Vourvouri, J R T C Roelandt, and D Poldermans
Quantification of regional left ventricular function in Q wave and non-Q wave dysfunctional regions by tissue Doppler imaging in patients with ischaemic cardiomyopathy
Heart,
November 1, 2003;
89(11):
1322 - 1326.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. J. Bax, A. F.L. Schinkel, E. Boersma, V. Rizzello, A. Elhendy, A. Maat, J. R.T.C. Roelandt, E. E. van der Wall, and D. Poldermans
Early Versus Delayed Revascularization in Patients With Ischemic Cardiomyopathy and Substantial Viability: Impact on Outcome
Circulation,
September 9, 2003;
108(90101):
II-39 - 42.
[Abstract]
[Full Text]
[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. A. Fox, V. Formanek, A. Friedrich, and S. K. Shernan
Intraoperative Echocardiography
Card. Surg. Adult,
January 1, 2003;
2(2003):
283 - 314.
[Full Text]
|
|
|
|
|
|
|
M. F. Di Carli, R. Hachamovitch, and D. S. Berman
The art and science of predicting postrevascularization improvement in left ventricular (LV) function in patients with severely depressed LV function
J. Am. Coll. Cardiol.,
November 20, 2002;
40(10):
1744 - 1747.
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. D. Mule, J. J. Bax, B. Zingone, F. Martinelli, C. Burelli, A. Stefania, L. DiSipio, and G. Soravia
The beneficial effect of revascularization on jeopardized myocardium: reverse remodeling and improved long-term prognosis
Eur. J. Cardiothorac. Surg.,
September 1, 2002;
22(3):
426 - 430.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A F L Schinkel, J J Bax, F B Sozzi, E Boersma, R Valkema, A Elhendy, J R T C Roelandt, and D Poldermans
Prevalence of myocardial viability assessed by single photon emission computed tomography in patients with chronic ischaemic left ventricular dysfunction
Heart,
August 1, 2002;
88(2):
125 - 130.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. F.M van den Heuvel, J. J Bax, P. K Blanksma, W. Vaalburg, H. J.G.M Crijns, and D. J van Veldhuisen
Abnormalities in myocardial contractility, metabolism and perfusion reserve in non-stenotic coronary segments in heart failure patients
Cardiovasc Res,
July 1, 2002;
55(1):
97 - 103.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. J. Bax, J. Maddahi, D. Poldermans, A. Elhendy, J. H. Cornel, E. Boersma, J. R.T.C. Roelandt, and P. M. Fioretti
Sequential 201Tl Imaging and Dobutamine Echocardiography to Enhance Accuracy of Predicting Improved Left Ventricular Ejection Fraction After Revascularization
J. Nucl. Med.,
June 1, 2002;
43(6):
795 - 802.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
I. Matsunari, J. Taki, and N. Tonami
Sequential Strategy Using Multimodality Viability Tests: Does It Work?
J. Nucl. Med.,
June 1, 2002;
43(6):
803 - 805.
[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]
|
|
|
|
|
|
|
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]
|
|
|
|
|
|
|
R. Sciagra, S. Sestini, L. Bolognese, G. Cerisano, P. Buonamici, and A. Pupi
Comparison of Dobutamine Echocardiography and 99mTc-Sestamibi Tomography for Prediction of Left Ventricular Ejection Fraction Outcome After Acute Myocardial Infarction Treated with Successful Primary Coronary Angioplasty
J. Nucl. Med.,
January 1, 2002;
43(1):
8 - 14.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
F B Sozzi, D Poldermans, J J Bax, A Elhendy, E C Vourvouri, R Valkema, J De Sutter, A F L Schinkel, A Borghetti, and J R T C Roelandt
Improved identification of viable myocardium using second harmonic imaging during dobutamine stress echocardiography
Heart,
December 1, 2001;
86(6):
672 - 678.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J.J. Bax, A. Elhendy, E. Boersma, and D. Poldermans
Evaluation of patients with chronic ischaemic left ventricular dysfunction - assessment of tissue viability
Eur. Heart J. Suppl.,
September 1, 2001;
3(suppl_F):
F11 - F14.
[Abstract]
[PDF]
|
|
|
|
|
|
|
J. E. Udelson
Testing our tests: surrogate end points versus driving patient management and outcomes
J. Am. Coll. Cardiol.,
January 1, 2001;
37(1):
89 - 92.
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. J. Bax, F. C. Visser, D. Poldermans, A. Elhendy, J. H. Cornel, E. Boersma, R. Valkema, A. van Lingen, P. M. Fioretti, and C. A. Visser
Relationship Between Preoperative Viability and Postoperative Improvement in LVEF and Heart Failure Symptoms
J. Nucl. Med.,
January 1, 2001;
42(1):
79 - 86.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Tawakol and H. Gewirtz
Does CABG Improve Left Ventricular Ejection Fraction in Patients with Ischemic Cardiomyopathy, and Does It Matter?
J. Nucl. Med.,
January 1, 2001;
42(1):
87 - 0.
[Full Text]
[PDF]
|
|
|
|
|
|
|
R Schulz and G Heusch
Hibernating myocardium
Heart,
December 1, 2000 | |
