Prognosis of patients with ischaemic cardiomyopathy after coronary revascularisation: Relation to viability and improvement in left ventricular ejection fraction

Rizzello, V., Poldermans, D., Biagini, E., Schinkel, A. F. L., Boersma, E., Boccanelli, A, Marwick, T. and Bax, J. J. (2009) Prognosis of patients with ischaemic cardiomyopathy after coronary revascularisation: Relation to viability and improvement in left ventricular ejection fraction. Heart, 95 15: 1273-1277. doi:10.1136/hrt.2008.163972


Author Rizzello, V.
Poldermans, D.
Biagini, E.
Schinkel, A. F. L.
Boersma, E.
Boccanelli, A
Marwick, T.
Bax, J. J.
Title Prognosis of patients with ischaemic cardiomyopathy after coronary revascularisation: Relation to viability and improvement in left ventricular ejection fraction
Journal name Heart   Check publisher's open access policy
ISSN 1355-6037
1468-201X
Publication date 2009-08-01
Sub-type Article (original research)
DOI 10.1136/hrt.2008.163972
Open Access Status DOI
Volume 95
Issue 15
Start page 1273
End page 1277
Total pages 5
Place of publication London, United Kingdom
Publisher BMJ Group
Language eng
Formatted abstract
Background: In patients with ischaemic cardiomyopathy
and viable myocardium, left ventricular ejection fraction
(LVEF) does not always improve after revascularisation.
Whether this may affect prognosis is unclear.
Objective: To evaluate the prognosis of viable patients
with and without improvement of LVEF after coronary
revascularisation.
Methods: Before revascularisation, radionuclide ventriculography
(RNV) and dobutamine stress echocardiography
were performed to assess LVEF and myocardial
viability, respectively. Nine to 12 months after revascularisation,
LVEF improvement was assessed by RNV.
Patients were divided into three groups: group 1, viable
patients with LVEF improvement (n=27); group 2, viable
patients without LVEF improvement (n=15), group 3,
non-viable patients (n=48). Cardiac events were
evaluated during a 4-year follow-up.
Results: After revascularisation, the mean (SD) LVEF
improved from 32 (9)% to 42 (10)% in group 1, but did not
change significantly in group 2 and in group 3, p,0.001
by analysis of variance (ANOVA). Heart failure symptoms
improved in both groups 1 (mean (SD) NYHA class from
3.1 (0.9) to 1.7 (0.7)) and 2 (from 3.2 (0.7) to 1.7 (0.9)),
but not in group 3 (from 2.8 (1.0) to 2.7 (0.5)), p,0.001
by ANOVA. During follow-up, the cardiac event rate was
low (4%) in group 1, intermediate (21%) in group 2 and
high (33%) in group 3 (p=0.01).
Conclusion: The best prognosis after revascularisation
may be expected in those viable patients whose LVEF
improves. Conversely, viable patients without functional
improvement have an intermediate prognosis.
Keyword Position
Emisson
Tomography
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collection: School of Medicine Publications
 
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Created: Thu, 03 Sep 2009, 17:51:13 EST by Mr Andrew Martlew on behalf of Medicine - Princess Alexandra Hospital