Incremental value of myocardial viability for prediction of Long-Term prognosis in surgically revascularized patients with left ventricular dysfunction
Stephen Sawada, MD, FACC* ,*,
Ashutosh Bapat, MD*,
Dev Vaz, MD*,
Juan Weksler, MD*,
Naomi Fineberg, PhD*,
Adam Greene, MD, FACC*,
Irmina Gradus-Pizlo, MD, FACC* and
Harvey Feigenbaum, MD, FACC*
* Department of Medicine of Indiana University School of Medicine, Indianapolis, Indiana, USA
Krannert Institute of Cardiology, Indianapolis, Indiana, USA
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Figure 1 Survival of the three groups of patients with extensive (group 1), intermediate (group 2), and limited (group 3) myocardial viability based on low-dose wall motion scores. The two patients with perioperative deaths are included. Log-rank p values comparing survival among the three groups at five years and for the complete duration of the study are shown at the bottom of the figure. At five years, survival of group 1 was better than group 2, and there was a trend towards improved survival in group 2 compared with group 3. For the complete duration of the study, there was a trend towards improved survival in group 1 versus group 2. Survival of group 3 remained worse than groups 1 and 2.
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Figure 2 Results of stepwise multivariate analysis. Resting wall score added incremental prognostic value to clinical variables. Low-dose score added incremental prognostic value to the combination of clinical variables and rest score. In this step, the inclusion of change in score from rest to low-dose did not improve on the chi-square using low-dose score alone. In the final step, peak-dose score and a biphasic response provided no additional prognostic value. ACEI = angiotensin-converting enzyme inhibitor; CHF = congestive heart failure.
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