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. 1999 Dec;82(6):684–688. doi: 10.1136/hrt.82.6.684

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

D Pagano 1, M Lewis 1, J Townend 1, P Davies 1, P Camici 1, R Bonser 1
PMCID: PMC1729216  PMID: 10573493

Abstract

OBJECTIVE—To assess the impact of revascularisation of viable myocardium on survival in patients with postischaemic heart failure.
METHODS—35 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.
RESULTS—Two 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).
CONCLUSION—Revascularisation 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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Figure 1  .

Figure 1  

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Kaplan-Meier curves showing estimated cardiac event free survival for patients in group 1 (⩾ 8 viable segments) and group 2 (< 8 viable segments).

Figure 2  .

Figure 2  

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Kaplan-Meier curves showing estimated cardiac event free survival for patients with ⩾ 6 viable segments and patients with < 6 viable segments.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Afridi I., Grayburn P. A., Panza J. A., Oh J. K., Zoghbi W. A., Marwick T. H. Myocardial viability during dobutamine echocardiography predicts survival in patients with coronary artery disease and severe left ventricular systolic dysfunction. J Am Coll Cardiol. 1998 Oct;32(4):921–926. doi: 10.1016/s0735-1097(98)00321-0. [DOI] [PubMed] [Google Scholar]
  2. Alderman E. L., Fisher L. D., Litwin P., Kaiser G. C., Myers W. O., Maynard C., Levine F., Schloss M. Results of coronary artery surgery in patients with poor left ventricular function (CASS). Circulation. 1983 Oct;68(4):785–795. doi: 10.1161/01.cir.68.4.785. [DOI] [PubMed] [Google Scholar]
  3. Bland J. M., Altman D. G. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet. 1986 Feb 8;1(8476):307–310. [PubMed] [Google Scholar]
  4. Bonnier H. J., Visser R. F., Klomps H. C., Hoffmann H. J. Comparison of intravenous anisoylated plasminogen streptokinase activator complex and intracoronary streptokinase in acute myocardial infarction. Am J Cardiol. 1988 Jul 1;62(1):25–30. doi: 10.1016/0002-9149(88)91359-8. [DOI] [PubMed] [Google Scholar]
  5. Cohn J. N., Johnson G., Ziesche S., Cobb F., Francis G., Tristani F., Smith R., Dunkman W. B., Loeb H., Wong M. A comparison of enalapril with hydralazine-isosorbide dinitrate in the treatment of chronic congestive heart failure. N Engl J Med. 1991 Aug 1;325(5):303–310. doi: 10.1056/NEJM199108013250502. [DOI] [PubMed] [Google Scholar]
  6. Doi Y. L., Furuno T., Takata J., Yabe T., Chikamori T. Late consequences of Kawasaki disease. Circulation. 1996 Jul 15;94(2):231–232. doi: 10.1161/01.cir.94.2.231. [DOI] [PubMed] [Google Scholar]
  7. Kaul S. There may be more to myocardial viability than meets the eye. Circulation. 1995 Nov 15;92(10):2790–2793. doi: 10.1161/01.cir.92.10.2790. [DOI] [PubMed] [Google Scholar]
  8. Marinho N. V., Keogh B. E., Costa D. C., Lammerstma A. A., Ell P. J., Camici P. G. Pathophysiology of chronic left ventricular dysfunction. New insights from the measurement of absolute myocardial blood flow and glucose utilization. Circulation. 1996 Feb 15;93(4):737–744. doi: 10.1161/01.cir.93.4.737. [DOI] [PubMed] [Google Scholar]
  9. Pagano D., Bonser R. S., Townend J. N., Ordoubadi F., Lorenzoni R., Camici P. G. Predictive value of dobutamine echocardiography and positron emission tomography in identifying hibernating myocardium in patients with postischaemic heart failure. Heart. 1998 Mar;79(3):281–288. doi: 10.1136/hrt.79.3.281. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Pagano D., Townend J. N., Littler W. A., Horton R., Camici P. G., Bonser R. S. Coronary artery bypass surgery as treatment for ischemic heart failure: the predictive value of viability assessment with quantitative positron emission tomography for symptomatic and functional outcome. J Thorac Cardiovasc Surg. 1998 Apr;115(4):791–799. doi: 10.1016/S0022-5223(98)70357-5. [DOI] [PubMed] [Google Scholar]
  11. Pagley P. R., Beller G. A., Watson D. D., Gimple L. W., Ragosta M. Improved outcome after coronary bypass surgery in patients with ischemic cardiomyopathy and residual myocardial viability. Circulation. 1997 Aug 5;96(3):793–800. doi: 10.1161/01.cir.96.3.793. [DOI] [PubMed] [Google Scholar]
  12. Rahimtoola S. H. The hibernating myocardium. Am Heart J. 1989 Jan;117(1):211–221. doi: 10.1016/0002-8703(89)90685-6. [DOI] [PubMed] [Google Scholar]
  13. Roth A., Herling M., Vishlitzki V. The impact of 'Shahal' (a new cardiac emergency service) on subscribers' requests for medical assistance: characteristics and distribution of calls. Eur Heart J. 1995 Jan;16(1):129–133. doi: 10.1093/eurheartj/16.1.129. [DOI] [PubMed] [Google Scholar]
  14. Segar D. S., Brown S. E., Sawada S. G., Ryan T., Feigenbaum H. Dobutamine stress echocardiography: correlation with coronary lesion severity as determined by quantitative angiography. J Am Coll Cardiol. 1992 May;19(6):1197–1202. doi: 10.1016/0735-1097(92)90324-g. [DOI] [PubMed] [Google Scholar]
  15. Teerlink J. R., Goldhaber S. Z., Pfeffer M. A. An overview of contemporary etiologies of congestive heart failure. Am Heart J. 1991 Jun;121(6 Pt 1):1852–1853. doi: 10.1016/0002-8703(91)90072-p. [DOI] [PubMed] [Google Scholar]
  16. Townend J. N., Littler W. A. Angiotensin converting enzyme inhibitors in heart failure: how good are they? Br Heart J. 1993 May;69(5):373–375. doi: 10.1136/hrt.69.5.373. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Townend J. N., Pagano D., Allen S. M., Jordan P., Davies M. K., Littler W. A., Bonser R. S. Results of surgical revascularization in ischaemic heart failure without angina. Eur J Cardiothorac Surg. 1995;9(9):507–514. doi: 10.1016/s1010-7940(95)80051-4. [DOI] [PubMed] [Google Scholar]
  18. Wasserman K., Whipp B. J., Koyl S. N., Beaver W. L. Anaerobic threshold and respiratory gas exchange during exercise. J Appl Physiol. 1973 Aug;35(2):236–243. doi: 10.1152/jappl.1973.35.2.236. [DOI] [PubMed] [Google Scholar]

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