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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

View larger version (20K): [in a new window]   Figure 1 Scatter plot showing the individual LVEFs before and after revascularization. Improvement of LVEF occurred over the entire range of LVEFs. The solid line represents the line of identity. LVEF = left ventricular ejection fraction; post: after revascularization; pre = before revascularization. Triangles = improvers; octagons = nonimprovers.

View larger version (30K): [in a new window]   Figure 2 Pie chart demonstrating the distribution of the different responses during dobutamine stress echocardiography.

View larger version (14K): [in a new window]   Figure 3 Receiver operating characteristic curve analysis showing that the cutoff level of four dysfunctional but viable segments yielded the highest sensitivity/specificity to predict functional outcome on a patient basis.

View larger version (16K): [in a new window]   Figure 4 Change in NYHA functional class in the two groups after revascularization. In group A (patients with 4 viable segments) mean NYHA functional class improved from 3.2 to 1.8. In group B (patients with <4 viable segments) the mean NYHA functional class remained unchanged (from 3.1 to 2.8). NYHA = New York Heart Association; post = after revascularization; pre = before revascularization.

View larger version (15K): [in a new window]   Figure 5 Event-free survival curves of the patients in the two groups. The event rate was higher in group B (p = 0.02 vs. group A).