Coronary revascularization and recovery of function: the ultimate target

Recovery of contraction in the akinetic segments represents an important target of coronary revascularization, and the preoperative recognition of viable dyssynergic (hibernating) myocardium is a crucial point in the preoperative investigation of patients with chronically depressed left ventricular function. Dobutamine-echocardiography was utilized in 14 patients to study the contractile reserve retained by viable segments. Redistribution of thallium-201 after rest injection was also used to assess the viability of these areas. The wall motion response to dobutamine infusion predicted immediate postoperative improvement in 85 of 93 segments (sensitivity 91%) and identified 25 of 32 segments which did not exhibit early postoperative improvement (specificity 78%). Rest-redistribution of thallium-201 demonstrated high sensitivity (93%) but low specificity (44%) for predicting the early recovery of regional wall motion. When late recovery was also considered, the specificity of this method increased to 64%. Recovery of function following coronary revascularization can be predicted in patients in whom hibernating myocardium is recognized preoperatively.