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Published on: December 11, 2016
Incremental value of myocardial viability for prediction of long-term prognosis in surgically revascularized patients
Stephen Sawada1, Ashutosh Bapat, Dev Vaz
1Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana 46202, USA. ssawada@iupui.edu
Insights
Myocardial viability, assessed by low-dose score, offers significant long-term prognostic value in patients after coronary artery bypass grafting (CABG) with left ventricular (LV) dysfunction. This viability measure improves outcome prediction beyond clinical factors and rest scores.
Area of Science:
- Cardiology
- Cardiac Surgery
- Echocardiography
Background:
- Coronary artery bypass grafting (CABG) is a common treatment for coronary artery disease (CAD) with left ventricular (LV) dysfunction.
- Predicting long-term outcomes in these patients is crucial for guiding management.
- The role of myocardial viability in prognosis after CABG in LV dysfunction needs further clarification.
Purpose of the Study:
- To evaluate the incremental long-term prognostic value of myocardial viability in surgically revascularized patients with LV dysfunction.
- To determine if myocardial viability assessment adds predictive power beyond established clinical factors and resting wall motion.
Main Methods:
- Dobutamine echocardiography was used to assess myocardial viability in patients with CAD and LV dysfunction (mean ejection fraction 33%).
- 95 patients who underwent CABG were followed for a mean of 4.9 years.
- Multivariate analysis was performed to identify predictors of cardiac death.
Main Results:
- Low-dose wall motion score, reflecting viable myocardium, was the strongest multivariate predictor of cardiac death (p < 0.001).
- The extent of viable myocardium (low-dose score) significantly predicted long-term survival, with better outcomes for extensive viability.
- Low-dose score provided incremental prognostic value to clinical information and rest wall motion scores (p = 0.024).
Conclusions:
- Myocardial viability, specifically assessed by low-dose echocardiography score, is a valuable independent predictor of long-term prognosis in CABG patients with LV dysfunction.
- This assessment of viable myocardium improves risk stratification and can inform clinical decision-making.
- The extent of contractile reserve and ischemia were not predictive of outcome in this cohort.
Objectives:
We assessed the incremental long-term prognostic value of myocardial viability in surgically revascularized (CABG) patients with left ventricular (LV) dysfunction.
Background:
Clinical factors, medical therapy, the degree of LV dysfunction, and stress-induced ischemia may affect the relative prognostic value of myocardial viability.
Methods:
Patients with coronary disease and ventricular dysfunction (mean ejection fraction 33% by echocardiography, 25% by angiography) were studied with dobutamine echocardiography. Follow-up (mean -4.9 years) was obtained in 95 patients (85% triple-vessel disease) who underwent CABG.
Results:
The use of angiotensin-converting enzyme inhibitors, advanced heart failure, rest, low- and peak-dose wall motion scores were univariate predictors of cardiac death. The extent of contractile reserve and ischemia were not predictive. Low-dose score was the strongest multivariate predictor of death (p < 0.001, hazard ratio 6.7). A biphasic response predicted better survival (p = 0.045, hazard ratio 0.5). Five-year survival was better in those with extensive (low-dose score <2.00) versus intermediate (score 2.00 to 2.49) amounts of viable myocardium (p = 0.019). Patients with the least viability (score > or =2.5) had the worst outcome (p = 0.0001 vs. those with low-dose score <2.00; p = 0.05 vs. those with score 2.00 to 2.49). In stepwise multivariate analysis, low-dose score added incremental prognostic value (p = 0.024) to clinical information and rest score.
Conclusions:
Low-dose score, representing the extent of viable myocardium, has incremental prognostic value as a predictor of long-term outcome in CABG patients with LV dysfunction.
