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Coronary revascularization in the treatment of moderate and severe postischemic left ventricular dysfunction

F Fath-Ordoubadi1, D Pagano, N V Marinho

  • 1MRC Cyclotron Unit, Imperial College School of Medicine, Hammersmith Hospital, London, United Kingdom.

The American Journal of Cardiology
|July 22, 1998
PubMed

Insights

Coronary revascularization significantly improves left ventricular (LV) function in patients with severe LV dysfunction and viable myocardium. The severity of LV dysfunction impacts the accuracy of positron emission tomography (PET) in predicting myocardial viability.

Area of Science:

  • Cardiology
  • Nuclear Medicine
  • Cardiovascular Surgery

Background:

  • Chronic postischemic left ventricular (LV) dysfunction can improve after coronary revascularization, a phenomenon known as hibernating myocardium.
  • The relationship between the severity of LV dysfunction and functional outcomes post-revascularization, as well as the accuracy of viability tests, remains unclear.

Purpose of the Study:

  • To investigate whether the severity of left ventricular (LV) dysfunction influences functional recovery after coronary revascularization.
  • To assess the impact of LV dysfunction severity on the predictive accuracy of (18F)2-fluoro-2-deoxy-D-glucose (FDG) positron emission tomography (PET) for myocardial viability.

Main Methods:

  • Studied 47 patients with coronary artery disease and chronic LV dysfunction.
  • Assessed myocardial viability using FDG-PET during a hyperinsulinemic clamp before coronary artery bypass grafting (CABG).
  • Evaluated global and regional LV function (ejection fraction and wall motion score) before and 4-6 months after CABG.
  • Divided patients into moderate (EF > 30%) and severe (EF ≤ 30%) LV dysfunction groups.

Main Results:

  • Patients with severe LV dysfunction (Group 1) showed significant improvement in ejection fraction (EF) and wall motion score (WMS) post-CABG (p < 0.0001).
  • Patients with moderate LV dysfunction (Group 2) had no significant change in EF post-CABG, although WMS tended to improve (p = 0.09).
  • Severe dysfunction group had a higher proportion of dysfunctional segments and higher FDG uptake, indicating more hibernating myocardium.
  • Baseline EF affected PET's predictive accuracy: highest positive predictive accuracy in Group 2, highest negative predictive accuracy in Group 1.

Conclusions:

  • Coronary revascularization offers the greatest potential benefit for patients with severe LV dysfunction, provided there is evidence of myocardial viability.
  • The degree of left ventricular dysfunction significantly influences the predictive accuracy of myocardial viability studies like FDG-PET.

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