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Updated: Jul 19, 2026
Cardiac Loading using Passive Left Atrial Pressurization and Passive Afterload for Graft Assessment
Published on: August 2, 2024
[Assessment of tissue viability for improvement of the left ventricular function after revascularization]
Radomir Matunović1, Aleksandar Stojanović, Zdravko Mijailović
1Vojnomedicinska akademija, Beograd Klinika za kardiologiju. milaca@verat.net
Insights
Invasive revascularization significantly improves heart function and reduces cardiac deaths in heart failure patients post-myocardial infarction compared to drug therapy alone.
Area of Science:
- Cardiology
- Interventional Cardiology
- Echocardiography
Context:
- Heart failure following myocardial infarction presents a significant clinical challenge.
- Limited efficacy of current drug therapies and invasive revascularization.
- Identifying viable myocardial tissue is crucial for treatment decisions.
Purpose:
- To compare the effectiveness of invasive revascularization (CABG/PTCA) versus conventional drug therapy.
- To evaluate outcomes in patients with heart failure post-myocardial infarction and viable myocardium.
- To assess functional recovery and cardiac events over 12 months.
Summary:
- A prospective study of 66 patients with heart failure post-myocardial infarction and reduced LVEF (<35%).
- 34 patients underwent revascularization (CABG/PTCA); 32 received drug therapy.
- Evaluated LVEF, WMSI, NYHA class, and cardiac death over 12 months.
Impact:
- Revascularization significantly improved LVEF (37.84% vs. 33.14%) and reduced cardiac deaths (8.82% vs. 21.87%).
- Patients undergoing revascularization showed better clinical status and WMSI (1.69 vs. 1.82).
- Invasive procedures offer superior functional recovery and reduced cardiac events in selected patients.
Introduction:
Treatment of patients with heart failure following myocardial infarction is still a clinical challenge. Drug therapy in these patients is limited, and invasive revascularization is not always successful and does not guarantee desired results. The aim of this study was to compare the effectiveness of invasive revascularization procedures (coronary artery bypass grafting - CABG or percutaneous transluminal coronary angioplasty - PTCA) with conventional drug therapy in patients with heart failure after acute myocardial infarction in whom significant portion of viable myocardial tissue was detected during low dose dobutamine stress echocardiography.
Material And Methods:
Using a prospective analysis, we investigated 66 patients with heart failure following myocardial infarction and reduced left ventricular ejection fraction (LVEF <35%). 34 patients underwent revascularization procedures including CABG or PTCA. The other 32 patients received only conventional drug therapy. The patients were followed during 12 months examing LVEF, left ventricular wall motion score index (WMSI), NYHA functional class, and cardiac death.
Results:
After 12 months, patients undergoing revascularization procedures presented with significantly better functional improvement of LVEF (37.84% vs. 33.14%, p<0.05), better clinical status and significantly less cardiac deaths (8.82% vs. 21.87%, p<0.01) in comparison to patients who stayed on drug therapy. After 12 months WMSI was significantly better in patients who underwent interventional therapy (1.69 +/- 07 vs. 1.82 +/- 04, p<0.01).
Conclusion:
After a 12-month follow up period, patients with presence of viable myocardial tissue after myocardial infarction and undergoing revasculkatization procedures presented with better functional recovery and less cardiac events, including cardiac death, in comparison with patients who received only drug therapy.
