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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