(Circulation. 1999;100:1298-1304.)
© 1999 American Heart Association, Inc.
Clinical Investigation and Reports |
Failure to Improve Left Ventricular Function After Coronary Revascularization for Ischemic Cardiomyopathy Is Not Associated With Worse Outcome
From The Department of Internal Medicine, Section of Cardiovascular Medicine (H.S., B.G.A., C.A.M., F.J.Th.W), and The Department of Surgery, Section of Cardiothoracic Surgery (J.A.E.), Yale University School of Medicine, and The Center for Outcomes Research and Evaluation (J.A.M.), Yale-New Haven Hospital, New Haven, Conn.
Correspondence to Frans J.Th. Wackers, MD, Yale University School of Medicine, Cardiovascular Nuclear Imaging Laboratory, 333 Cedar ST TE-2 PO Box 208042, New Haven, CT 06520-8042. E-mail frans.wackers{at}diagrad.med.yale.edu
Background—Preoperative identification of viable myocardium in patients with ischemic cardiomyopathy is considered important because CABG can result in recovery of left ventricular (LV) function. However, the hypothesis that lack of improvement of LV function after CABG is associated with poorer patient outcome is untested.
Methods and Results—Outcome was compared in patients with
ischemic LV dysfunction (LVEF 
0.30) with and without
improvement in LVEF after CABG. Of 135 consecutive patients, 128 (95%)
survived CABG and 104 (77%) had pre- and post-CABG LVEF assessment. Of
these 104 patients, 68 (65%) had >0.05 increase in LVEF (group A) and
36 (35%) had no significant change, or 0.05 decrease in LVEF (group
B) compared with pre-CABG LVEF. No significant differences existed in
age, gender, comorbidities, baseline symptoms, baseline LVEF, or
intraoperative variables between groups A and B. Group A increased
LVEF from 0.24±0.05 to 0.39±0.1 (P<0.005). In Group
B, LVEF did not change significantly postoperatively, 0.24±0.05 to
0.23±0.06 (P=NS). Postoperative improvement in angina
and heart failure scores were similar between the 2 groups. Survival
free of cardiac death was similar for both groups (93% in group A and
94% in group B, P=NS) at a mean follow-up of 32±23
months.
Conclusions—Lack of improvement of global LVEF after CABG is not associated with poorer outcome compared with that of patients with improved LVEF, presumably because effective revascularization of ischemic myocardium, even without improvement in ventricular function, protects against future infarction and death.
Key Words: ischemia • cardiomyopathy • revascularization • survival
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