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Myocardial viability testing and impact of revascularization on prognosis in patients with coronary artery disease and left ventricular dysfunction: a meta-analysis

Kevin C. Allman, MB, BS, FRACP, FACC^*,*, Leslee J. Shaw, PhD, Rory Hachamovitch, MD, FACC and James E. Udelson, MD, FACC

^* Concord Hospital, Concord NSW, Australia
Atlanta Cardiovascular Research Institute, Atlanta, Georgia, USA
Tufts University School of Medicine/New England Medical Center Hospitals, Boston, Massachusetts, USA

View larger version (21K): [in a new window]   Figure 1 (a) Death rates for patients with and without myocardial viability treated by revascularization or medical therapy. There is 79.6% reduction in mortality for patients with viability treated by revascularization (p < 0.0001). In patients without myocardial viability, there was no significant difference in mortality with revascularization versus medical therapy. (b) Same data as (a) with comparisons based on treatment strategy in patients with and without viability. Annual mortality was lower in revascularized patients when viability was present versus absent (3.2% vs. 7.7%, p < 0.0001). Annual mortality was significantly higher in medically treated patients when viability was present versus absent (16% vs. 6.2%, p = 0.001). Revasc. = revascularization.

View larger version (14K): [in a new window]   Figure 2 Relation between left ventricular ejection fraction (EF) and predicted change in mortality for patients with viable (circles) versus nonviable (triangles) myocardium based on the results of meta-regression. This demonstrates increasing potential for improved survival with lower left ventricular EF in patients with viable myocardium, p < 0.0001 (broken plot line), but not in those without viability, p = 0.11 (continuous line).

View larger version (15K): [in a new window]   Figure 3 Decrease in mortality with revascularization of viable myocardium for each testing technique shown as mean value with 95% confidence limits. Note wide confidence limits, especially for thallium and echocardiography. No measurable differences in test performance were observed. EF = ejection fraction; FDG = F-18 fluorodeoxyglucose.