Related Experiment Videos
The beneficial effect of revascularization on jeopardized myocardium: reverse remodeling and improved long-term
Jacopo Dalle Mule1, Jeroen J Bax, Bartolo Zingone
1Unità Operativa di Cardiologia, Ospedale di Pieve di Cadore, ASL 1 Belluno, Italy.
Insights
Patients with significant jeopardized myocardium (heart muscle) benefit from revascularization, showing improved heart function, reduced heart size, and better long-term outcomes. Those with less jeopardized myocardium do not improve and have worse prognosis.
Area of Science:
- Cardiology
- Cardiovascular Imaging
- Interventional Cardiology
Background:
- Assessing myocardial viability and ischemia before revascularization is crucial for predicting outcomes.
- Revascularization aims to restore blood flow to ischemic or infarcted heart muscle.
- Systolic performance, ventricular remodeling, and long-term prognosis are key indicators of cardiac health post-intervention.
Purpose of the Study:
- To evaluate the impact of pre-revascularization myocardial viability and ischemia on post-procedural systolic function.
- To assess the effect of viability/ischemia on left ventricular remodeling and symptoms.
- To determine the influence of jeopardized myocardium on long-term prognosis after revascularization.
Main Methods:
- Thallium-201 imaging was used to identify stress-induced ischemia and myocardial viability in 50 patients.
- Left ventricular ejection fraction (LVEF), LV end-systolic volume index (LVESVI), and LV end-diastolic volume index (LVEDVI) were measured before and 3 months post-revascularization.
- Graft/vessel patency was confirmed, and long-term follow-up (up to 3 years) included New York Heart Association (NYHA) class and hard clinical events.
Main Results:
- Patients with >= 5 jeopardized segments showed significant LVEF improvement (35% to 43%), reverse remodeling (decreased LVESVI and LVEDVI), improved NYHA class, and a 0% event rate.
- Conversely, patients with <5 jeopardized segments had no LVEF improvement, ongoing adverse remodeling (increased LVESVI and LVEDVI), no NYHA class improvement, and a 29% event rate.
Conclusions:
- Revascularization significantly benefits patients with substantial jeopardized myocardium.
- Pre-procedural assessment of myocardial viability is critical for patient selection and outcome prediction.
- Identifying patients with significant myocardial viability undergoing revascularization leads to improved cardiac function, reverse remodeling, and favorable long-term prognosis.
Objectives:
To evaluate the impact of viability/ischemia before revascularization on improvement in systolic performance, reverse remodeling, symptoms and long-term prognosis post-revascularization.
Methods:
Fifty patients underwent thallium-201 imaging before revascularization to assess stress-induced ischemia and viability ('jeopardized myocardium'). Left ventricular (LV) ejection fraction (EF), LV end-systolic volume index (LVESVI) and LV end-diastolic volume index (LVEDVI) were determined before and 3 months post-revascularization. Graft/vessel patency was controlled by repeat angiography. Long-term follow-up data (New York Heart Association (NYHA) class, hard events) were acquired up to 3 years.
Results:
Patients with > or = 5 jeopardized segments on thallium-201 imaging demonstrated improvement of LVEF at 3 months (from 35+/-6 to 43+/-6%, P<0.001), with reverse remodeling (LVESVI decreased from 68+/-16 to 52+/-14 ml/m(2), P<0.001; LVEDVI decreased from 103+/-21 to 91+/-18 ml/m(2), P<0.001), and improved in NYHA class with excellent long-term prognosis (0% event rate). Conversely, patients with <5 jeopardized segments failed to improve in LVEF (34+/-4 vs. 33+/-7%, NS), and exhibited ongoing remodeling (LVESVI increased from 70+/-14 to 78+/-23 ml/m(2), P<0.001; LVEDVI increased from 106+/-19 to 116+/-25 ml/m(2), P<0.001), without improvement in NYHA class, and worse long-term prognosis (29% event rate).
Conclusion:
Patients with jeopardized myocardium benefit from revascularization with improvement in LVEF, reverse remodeling, improvement in NYHA class and favorable long-term prognosis.