Heart 1999;82:684-688 ( December )

Coronary revascularisation for postischaemic heart failure: how myocardial viability affects survival

D Pagano^a, M E Lewis^a, J N Townend^b, P Davies^c, P G Camici^d, R S Bonser^a

^a Cardiothoracic Surgical Unit, Queen Elizabeth Hospital, Edgbaston, Birmingham B15 2TH, UK, ^b University Department of Cardiovascular Medicine, Birmingham, UK, ^c School of Mathematics and Statistics, Birmingham, UK, ^d MRC Cyclotron Unit, Imperial College School of Medicine, Hammersmith Hospital, London, UK

Correspondence to: Dr Bonser. email: r.s.bonser{at}bham.ac.uk

Accepted for publication 5 July 1999

OBJECTIVETo assess the impact of revascularisation of viable myocardium on survival in patients with postischaemic heart failure.
METHODS35 patients (mean (SD) age 58 (7) years) with severe heart failure (New York Heart Association (NYHA) functional class  III), mean left ventricular ejection fraction (LVEF) 24 (7)% (range 10-35%), and limited exercise capacity (peak oxygen consumption (VO₂) 15 (4) ml/kg/min) were studied. 21/35 patients had no angina. Myocardial viability was assessed with quantitative positron emission tomography and the glucose analogue ¹⁸F-fluorodeoxyglucose (FDG) (viable segment = FDG uptake  0.25 µmol/min/g) in all patients before coronary artery bypass grafting. Patients were divided into two groups: group 1,  8 viable dysfunctional segments (mean 12 (2), range 8-15); and group 2, < 8 viable dysfunctional segments (mean 3.5 (3), range 0-7). The two groups were comparable for age, sex, NYHA class, LVEF, and peak VO₂.
RESULTSTwo patients died perioperatively and seven patients died during follow up (mean 33 (14) months). All deaths were from cardiac causes. Kaplan-Meyer survival analysis showed 86% survival for group 1 patients versus 57% for group 2 (p = 0.03). Analysis by Cox proportional hazard model revealed three independent factors for cardiac event free survival: presence of  8 viable segments (p = 0.006); preoperative LVEF (p = 0.002); and patient age (p = 0.01).
CONCLUSIONRevascularisation for postischaemic heart failure can be associated with good survival, which is critically dependent upon the amount of viable myocardium.


Keywords: heart failure; myocardial viability; hibernating myocardium; survival

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© 1999 by Heart
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