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Revascularization of residual viable myocardium improves left ventricular dysfunction in patients after myocardial
W Benzer1, H Fritzsche, M Kargl
1Department of Interventional Cardiology, Landeskrankenhaus, Feldkirch, Austria. wbenzer@cable.vol.at
Insights
Revascularization improves left ventricular function in heart attack patients with viable myocardium. Testing for residual viability is crucial for recommending treatment and improving outcomes.
Area of Science:
- Cardiology
- Cardiovascular Imaging
- Interventional Cardiology
Background:
- Left ventricular function significantly impacts patient prognosis after myocardial infarction.
- Approximately 50% of infarct-related segments retain viable myocardium.
- Residual myocardial viability influences the effectiveness of interventions.
Purpose of the Study:
- To test if revascularization of infarct-related segments with residual viability improves left ventricular function.
- To assess changes in regional and global left ventricular ejection fraction post-revascularization.
Main Methods:
- Identified residual viable myocardium using exercise-redistribution-reinjection thallium scintigraphy (SPECT imaging).
- Measured regional and global left ventricular ejection fraction (LVEF) at rest and during exercise using radionuclide ventriculography.
- Performed revascularization of the infarct-related artery in patients with viable myocardium.
Main Results:
- Significant improvements observed in LVEF at rest and during exercise post-revascularization.
- Regional LVEF at rest increased from 32% to 41% (p=0.03).
- Global LVEF during exercise increased from 38% to 49% (p=0.02).
Conclusions:
- Revascularization of infarct-related segments with residual myocardial viability significantly enhances regional and global left ventricular function.
- Testing for myocardial viability is recommended to guide revascularization decisions.
- Improved left ventricular function post-revascularization suggests a positive impact on patient outcomes.
Abstract:
The symptoms and prognosis of patients after myocardial infarction are essentially influenced by left ventricular function. About 50% of infarct related segments contain partly viable myocardium. The aim of this study was to test the hypothesis that regional and global left ventricular function can be improved by revascularization of infarct related segments with residual myocardial viability. In 15 of 30 consecutive patients, residual viable myocardium was found in the affected segment within 2.2 +/- 1.6 months after AMI. Myocardial viability was estimated by exercise-redistribution-reinjection thallium scintigraphy (SPECT imaging). Rest and exercise radionuclide ventriculography was performed to measure regional and global left ventricular ejection fraction before and after revascularization of the infarct related artery. 10 +/- 3 months after revascularization we observed a significant increase in the regional left ventricular ejection fraction at rest (from 32 +/- 16% to 41 +/- 19%; p = 0.03), global left ventricular ejection fraction at rest (from 38 +/- 12% to 46 +/- 11%; p = 0.01), regional LV ejection fraction during exercise (from 34 +/- 16% to 46 +/- 20%; p = 0.01), and global left ventricular ejection fraction during exercise (from 38 +/- 14% to 49 +/- 14%; p = 0.02). The results show that after revascularization of infarct related segments with residual myocardial viability, the regional and global left ventricular ejection fraction may be significantly improved, both at rest and during exercise. Thus infarct related segments should be tested for residual viability. In its presence revascularization is recommended, as the left ventricular function may be markedly improved.