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Relationship between myocardial viability and improvement in left ventricular function and heart failure symptoms
I Peovska1, J Maksimovic, M Vavlukis
1Heart Diseases Institute, Clinical Centre, Skopje, R. Macedonia. irenapeovska@yahoo.com
Insights
Assessing myocardial viability before coronary artery bypass surgery (CABG) predicts improved left ventricular (LV) function and heart failure symptom relief. Substantial viability indicates better outcomes after revascularization.
Area of Science:
- Cardiology
- Nuclear Medicine
- Cardiac Surgery
Background:
- Myocardial viability assessment is crucial for predicting outcomes after coronary artery bypass surgery (CABG).
- The association between myocardial viability and heart failure symptom improvement post-revascularization requires further clarification.
Purpose of the Study:
- To establish the relationship between the extent of viable myocardium and left ventricular (LV) function improvement post-CABG.
- To determine if preoperative viability testing predicts heart failure symptom improvement after revascularization.
Main Methods:
- Eighty-five patients with ischemic cardiomyopathy underwent Tc-99m sestamibi myocardial perfusion SPECT (MPI) for viability assessment.
- LV function and heart failure symptoms (NYHA criteria) were evaluated pre- and post-revascularization (16 ± 6 months).
- Quantitative analysis used a 17-segment LV model and Bull's eye plots for MPI.
Main Results:
- A direct correlation (r=0.79, P<0.01) was found between the number of viable segments and LV ejection fraction (LVEF) improvement.
- Four or more viable segments (≥24% of LV) predicted LVEF improvement with 83% sensitivity and 79% specificity.
- Presence of ≥4 viable segments predicted heart failure symptom improvement (PPV 79%, NPV 74%).
Conclusions:
- Substantial myocardial viability (≥4 segments, 24% LV) on gated SPECT MPI strongly correlates with improved LVEF and heart failure symptoms post-CABG.
- Preoperative viability assessment is valuable for predicting functional recovery and symptom relief in patients undergoing revascularization for ischemic heart failure.
Background:
The evaluation of myocardial viability is an important preoperative parameter, predictive of improvement in regional and global left ventricular (LV) function after coronary artery bypass surgery (CABG). However, whether the presence of viability is also associated with relief of heart failure symptoms after revascularization is not always certain. The aims of the study were to define the relationship between extent of viable myocardium and improvement in LV function after CABG and to determine whether preoperative viability testing can predict improvement in heart failure symptoms.
Methods:
Eighty-five consecutive patients with ischemic cardiomyopathy (mean LVEF 35%) undergoing surgical revascularization were studied with a Tc-99m sestamibi one-day rest/nitrate enhanced myocardial perfusion SPECT imaging (MPI) to assess viability. Regional and global function were measured before and 16 -/+ 6 months after revascularization. We have used the Bull's eye quantitative analysis of MPI scans and 17 segment model of LV function and perfusion evaluation. Heart failure symptoms were graded according to the New York Heart Association (NYHA) criteria, before and 16 -/+ 6 months after revascularization.
Results:
The number of viable segments per patient was directly related to the improvement in LVEF after revascularization (r 0.79, P < 0.01). Patients with > 4 viable segments representing 24% of the left ventricle yielded the sensitivity of 83% and specificity of 79% respectively for predicting improvement in LVEF. Furthermore, the presence of four or more viable segments predicted improvement in heart failure symptoms after revascularization, with positive and negative predictive values of 79% and 74%, respectively.
Conclusion:
The presence of substantial viability (four or more viable segments, 24% of the left ventricle) on myocardial perfusion gated SPECT imaging in patients with ischemic heart failure before CABG surgery has significant correlation with the improvement in LVEF and heart failure symptoms postoperatively.
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