Abstract 13781: Surgical Revascularization of Dysfunctional Myocardium: Should Nonviable Segments be Revascularized?
Introduction: Benefit of revascularization of dysfunctional but viable segments has been reported in numerous clinical trials. However, whether segments without viable myocardium should also been revascularized is still controversial issue.
Aim: To asses the effect of surgical revascularization on left ventricular (LV) systolic function in patients (pts) with viable and nonviable dysfunctional LV segments determined by low-dose dobutamine stress echocardiography (DSE).
Methods: 115 consecutive pts with LV asynergy (at least 4 asynergic segments) scheduled for surgical revascularization were included in the study. The indication for revascularization was made according to angiographic and clinical data. On admission for scheduled surgery all patients underwent detailed echocardiograhic examinations and low-dose DSE. The test was considered positive if ≥4 viable segments were detected. Echocardiography was repeated at 1, 3, 6 and 12 months after surgery.
Results: The mean age, EF and wall motion score index (WMSi) of pts were 59±9 years, 44±9% and 1.82±0.31 respectively. There was no difference between DSE positive and DSE negative pts for any of those parameters (p<0.05 for all). After 12 months, EF increased 11% in pts with viable myocardium vs. 7% in pts without viable segment (p=0.002). Moreover, in pts with viable myocardium, the greatest increase of EF occurred one month after surgery, whereas in those pts with negative DSE EF increased more gradually (p<0.0001 between groups for 1 month vs. preoperative value, Figure), but still improved after 12 months follow-up (p<0.0001 in time for both groups).
Conclusions: It appears that pts without viable myocardium may also benefit from revascularization. The final effect of revascularization should not be assessed soon after surgery, since functional recovery continuously occurs throughout the first year after surgical treatment.
- © 2010 by American Heart Association, Inc.