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Myocardial viability assessment in ischemic cardiomyopathy: benefits of coronary revascularization
G D Dreyfus1, D Duboc, A Blasco
1Department of Cardio-Vascular Surgery and Transplantation, Hôpital Foch, Paris V University, Suresnes, France.
Insights
For patients with ischemic heart disease, coronary artery bypass grafting is a viable alternative to heart transplantation when myocardial viability is present. This approach shows improved ejection fraction and low operative mortality.
Area of Science:
- Cardiology
- Cardiac Surgery
- Nuclear Cardiology
Background:
- Ischemic heart disease, congestive heart failure, and low ejection fraction often lead to referrals for orthotopic heart transplantation.
- Myocardial viability assessment can guide treatment decisions in these complex cardiac patients.
Purpose of the Study:
- To prospectively evaluate the efficacy of coronary artery bypass grafting (CABG) versus orthotopic heart transplantation (OHT) based on myocardial viability.
- To assess outcomes in patients with ischemic heart disease undergoing CABG after viability testing.
Main Methods:
- Prospective study of 50 patients referred for OHT between January 1990 and June 1992.
- Myocardial viability assessed by thallium scintigraphy and positron emission tomography.
- Regional left ventricular function evaluated using gated blood pool single-photon emission computed tomography (SPECT).
- Full hemodynamic evaluation performed.
Main Results:
- 46 patients with myocardial viability underwent CABG; 45 were male, mean age 58 years.
- All patients had congestive heart failure; dyspnea was the main symptom (80%).
- Operative mortality for CABG was 2.17% (1/46).
- Mean ejection fraction improved from 0.23 to 0.39 post-CABG.
- Long-term survivors (40/46) were in New York Heart Association class II.
Conclusions:
- Coronary artery bypass grafting is a safe and effective alternative to heart transplantation for selected patients with ischemic heart disease and viable myocardium.
- Myocardial viability assessment is crucial for optimizing treatment strategies, improving cardiac function, and reducing mortality.
Abstract:
Patients with ischemic heart disease, congestive heart failure, and low ejection fraction are usually referred for orthotopic heart transplantation. Based on results of myocardial viability assessment, we have prospectively used either coronary artery bypass grafting or orthotopic heart transplantation. From January 1990 to June 1992, among 50 patients initially referred for heart transplantation, 46 showing myocardial viability underwent bypass grafting. Forty-five of these 46 patients were men, and the mean age was 58 +/- 12 years (range, 40 to 70 years). Congestive heart failure was present in all patients, and dyspnea was the main symptom in 80% (37/46). Patients were selected according to three criteria. (1) Myocardial viability was primarily assessed by thallium scintigraphy for up to 24 hours (28/46 patients). When results were negative, patients underwent positron emission tomography (20/46 patients). (2) Regional left ventricular function was assessed using gated blood pool single-photon emission computed tomography combined with (3) full hemodynamic evaluation. Results were as follows: end-diastolic volume, 129 +/- 35 mL/m2; ejection fraction, 0.23 +/- 0.06; cardiac index, 2.4 +/- 0.62 L.min-1.m-2; mean pulmonary artery pressure, 26 +/- 0.90 mm Hg; and mean pulmonary capillary wedge pressure, 16 +/- 1.10 mm Hg. Operative mortality was 2.17% (1/46). During follow-up (mean duration, 18 months), there were three late cardiac-related deaths (arrhythmias) and two noncardiac-related deaths. The 40 long-term survivors are in New York Heart Association class II. Angiography (15 patients) or gated blood pool single photon emission tomography (32) showed improvement in mean ejection fraction to 0.39 +/- 0.13 (range, 0.22 to 0.46).(ABSTRACT TRUNCATED AT 250 WORDS)