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(Circulation. 1997;96:793-800.)
© 1997 American Heart Association, Inc.
Articles |
Improved Outcome After Coronary Bypass Surgery in Patients With Ischemic Cardiomyopathy and Residual Myocardial Viability
From the Cardiovascular Division, Department of Internal Medicine, University of Virginia Health Sciences Center, Charlottesville, Va.
Correspondence to Dr Michael Ragosta, Cardiovascular Division, Box 158, University of Virginia Health Sciences Center, Charlottesville, VA 22908. E-mail mragosta{at}virginia.edu
Background Although residual myocardial viability in patients with coronary artery disease and extensive regional asynergy is associated with improved ventricular function after coronary bypass surgery, the relationship between viability and clinical outcome after surgery is unclear. We hypothesized that patients with poor ventricular function and predominantly viable myocardium have a better outcome after bypass surgery compared with those with less viability.
Methods and Results Seventy patients with multivessel
coronary artery disease and left ventricular
ejection fractions <40% who underwent preoperative quantitative
201Tl scintigraphy before coronary
bypass surgery were analyzed retrospectively. 201Tl
scintigrams were reviewed blindly, and each segment was assigned a
score based on defect magnitude. Segmental viability scores were summed
and divided by the number of segments visualized to determine a
viability index. The viability index was significantly related to
3-year survival free of cardiac event (cardiac death or heart
transplant) after bypass surgery (P=.011) and was
independent of age, ejection fraction, and number of diseased
coronary vessels. Patients with greater viability (group 1;
viability index >0.67; n=33) were similar to patients with less
viability (group 2; viability index 
0.67; n=37) with respect to age,
comorbidities, and extent of coronary artery disease. There
were 6 cardiac deaths and no heart transplants in group 1 patients and
15 cardiac deaths and two transplants in group 2 patients. Survival
free of cardiac death or transplantation was significantly better in
group 1 patients on Kaplan-Meier analysis
(P=.018).
Conclusions We conclude that resting 201Tl scintigraphy may be useful in preoperative risk stratification for identification of patients more likely to benefit from surgical revascularization.
Key Words: revascularization • cardiomyopathy • ischemia
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D PAGANO, J N TOWNEND, and R S BONSER What is the role of revascularisation in ischaemic heart failure? Heart, January 1, 1999; 81(1): 8 - 9. [Full Text]
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M. F. Di Carli, J. Maddahi, S. Rokhsar, H. R. Schelbert, D. Bianco-Batlles, R. C. Brunken, and B. Fromm LONG-TERM SURVIVAL OF PATIENTS WITH CORONARY ARTERY DISEASE AND LEFT VENTRICULAR DYSFUNCTION: IMPLICATIONS FOR THE ROLE OF MYOCARDIAL VIABILITY ASSESSMENT IN MANAGEMENT DECISIONS J. Thorac. Cardiovasc. Surg., December 1, 1998; 116(6): 997 - 1004. [Abstract] [Full Text] [PDF]
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J. Meluzin, J. Cerny, M. Frelich, F. Stetka, L. Spinarova, J. Popelova, R. Stipal, and on behalf of the Investigators of This Multicenter Prognostic value of the amount of dysfunctional but viable myocardium in revascularized patients with coronary artery disease and left ventricular dysfunction J. Am. Coll. Cardiol., October 1, 1998; 32(4): 912 - 920. [Abstract] [Full Text] [PDF]
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I. Afridi, P. A. Grayburn, J. A. Panza, J. K. Oh, W. A. Zoghbi, and T. H. Marwick Myocardial viability during dobutamine echocardiography predicts survival in patients with coronary artery disease and severe left ventricular systolic dysfunction J. Am. Coll. Cardiol., October 1, 1998; 32(4): 921 - 926. [Abstract] [Full Text] [PDF]
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G. L. Miller, I. L. Kron, and J. T. Cope Viability Assessment Before CABG • Response Circulation, September 29, 1998; 98 (13): 1350 - 1353. [Full Text] [PDF]
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J. E. Udelson Steps Forward in the Assessment of Myocardial Viability in Left Ventricular Dysfunction Circulation, March 10, 1998; 97(9): 833 - 838. [Full Text] [PDF]
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D Pagano, R S Bonser, J N Townend, F Ordoubadi, R Lorenzoni, and P G Camici Predictive value of dobutamine echocardiography and positron emission tomography in identifying hibernating myocardium in patients with postischaemic heart failure Heart, March 1, 1998; 79(3): 281 - 288. [Abstract] [Full Text]
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