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Myocardial viability on echocardiography predicts long-term survival after revascularization in patients with
1Department of Cardiovascular Medicine, Northwick Park Hospital and Institute of Medical Research, Harrow, United Kingdom.
Insights
Revascularization significantly improves survival in congestive heart failure (CHF) patients with ischemic left ventricular (LV) systolic dysfunction and myocardial viability (MV). This procedure reduces mortality by 93% in patients with at least five viable LV segments.
Area of Science:
- Cardiology
- Cardiovascular Surgery
- Heart Failure Research
Background:
- Limited data exist on the survival benefits of revascularization for congestive heart failure (CHF) caused by ischemic left ventricular (LV) systolic dysfunction.
- Assessing myocardial viability (MV) is crucial for guiding treatment decisions in these patients.
Purpose of the Study:
- To evaluate the impact of revascularization on survival in patients with CHF and ischemic LV systolic dysfunction.
- To determine if the presence and extent of myocardial viability influence the survival benefit of revascularization.
Main Methods:
- 87 patients with CHF and ischemic LV systolic dysfunction (NYHA class II-IV, LVEF <0.35) underwent low-dose dobutamine echocardiography (DE) to assess myocardial viability (MV).
- MV was defined by resting function, improvement with DE, or worsening of function on DE across 12 LV segments.
- Patient outcomes were tracked for a mean of 40 months, with revascularization performed in 37 patients based on clinical criteria.
Main Results:
- Overall, 25% of patients experienced cardiac-related death.
- Revascularization in patients with at least five viable LV segments was associated with a 93% reduction in mortality (CI 22-99%).
- This survival benefit correlated with improvements in NYHA class and LV ejection fraction; patients with less viability or medical management showed higher mortality.
Conclusions:
- Revascularization offers a significant survival advantage for patients with CHF, ischemic LV systolic dysfunction, and substantial myocardial viability.
- These findings suggest that identifying and revascularizing viable myocardium is critical for managing CHF patients with coronary artery disease.
Objectives:
This study was conducted to evaluate the effect of revascularization on survival in patients with congestive heart failure (CHF) due to ischemic left ventricular (LV) systolic dysfunction based on the presence of myocardial viability (MV).
Background:
There are insufficient data regarding the survival benefit of revascularization in patients with CHF due to ischemic LV systolic dysfunction.
Methods:
Follow-up was obtained in 87 consecutive patients with CHF due to ischemic LV systolic dysfunction (New York Heart Association [NYHA] class II-IV; LV ejection fraction <0.35) who underwent low-dose dobutamine echocardiography (DE). MV within each of 12 myocardial segments representing the LV was defined as having either: 1) normal function or mild dyssynergy at rest; 2) severe resting dyssynergy that improved on DE, or 3) worsening of function on DE except in the case of akinesia.
Results:
At a mean follow-up of 40+/-17 months, 37 patients had received revascularization on the basis of clinical grounds, and there were 22 (25%) cardiac-related deaths. Multivariate Cox regression analysis revealed that when patients with at least five segments showing MV underwent revascularization, mortality was reduced by an average of 93% (confidence interval of 22% to 99%), which was associated with improvement in NYHA class as well as LV ejection fraction. Patients with less than five segments showing MV who underwent revascularization (and thus, showing mostly scar), and those with at least 5 segments demonstrating MV who were treated medically, had a much higher mortality.
Conclusions:
Revascularization produces a clear survival benefit in patients with CHF due to ischemic LV systolic dysfunction who have a significant region of the LV demonstrating MV. These data may have wide-ranging implications in the management of patients with coronary artery disease whose main clinical presentation is CHF.