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Prognosis of Patients With Ischemic Cardiomyopathy after Coronary Revascularization: Relation to Viability and Improvement in LVEF
  1. Vittoria Rizzello (vittoria.rizzello{at}gmail.com)
  1. Department of Cardiovascular Disease, San Giovanni-Addolorata Hospital, Rome, Italy
    1. Don Poldermans
    1. Thorax Center Rotterdam, Netherlands
      1. Elena Biagini
      1. Thorax Center Rotterdam, Netherlands
        1. Arend Schinkel
        1. Thorax Center Rotterdam, Netherlands
          1. Eric Boersma
          1. Thorax Center Rotterdam, Netherlands
            1. Tom Marwick
            1. Department of Medicine University of Queensland, Princess Alexandra Hospital, Brisbane, Australia
              1. Alessandro Boccanelli
              1. Department of Cardiovascular Disease, San Giovanni-Addolorata Hospital, Rome, Italy
                1. Jos Roelandt
                1. Thorax Center Rotterdam, Netherlands
                  1. Jeroen Bax
                  1. Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands

                    Abstract

                    Objective: To evaluate the prognosis of viable patients with and without improvement of left ventricular ejection fraction (LVEF) after coronary revascularization.

                    Background: In patients with ischemic cardiomyopathy and viable myocardium, LVEF does not always improve after revascularization. Whether this may affect prognosis is unclear.

                    Methods: Before revascularization, radionuclide ventriculography (RNV) and dobutamine stress echocardiography (DSE) were performed to assess LVEF and myocardial viability, respectively. Nine to 12 months after revascularization, LVEF improvement was assessed by RNV. Patients were divided into 3 groups: Group 1, viable patients with LVEF improvement (n=27); Group 2, viable patients without LVEF improvement (n=15), Group 3, nonviable patients (n=48). Cardiac events were evaluated during a 4 years follow-up.

                    Results: After revascularization, the LVEF improved from 32 ± 9% to 42 ±10% in Group 1, but did not change significantly in Group 2 and in Group 3, P < 0.001 by ANOVA. Heart failure symptoms improved both in Groups 1 (NYHA class from 3.1 ±0.9 to 1.7 ±0.7) and 2 (from 3.2 ± 0.7 to 1.7 ±0.9), but not in Group 3 (from 2.8 ±1.0 to 2.7 ± 0.5), P < 0.001 by ANOVA. During the follow-up, the cardiac event rate was low (4%) in Group 1, intermediate (21%) in Group 2 and high (33%) in Group 3 (P = 0.01).

                    Conclusion: The best prognosis after revascularization may be expected in those viable patients who improve in LVEF. Conversely, viable patients without functional improvement have an intermediate prognosis.

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