Improvement of left ventricular ejection fraction, heart failure symptoms and prognosis after revascularization in patients with chronic coronary artery disease and viable myocardium detected by dobutamine stress echocardiography.
OBJECTIVE
This study was designed to address, in patients with severe ischemic left ventricular dysfunction, whether dobutamine stress echocardiography (DSE) can predict improvement of left ventricular ejection fraction (LVEF), functional status and long-term prognosis after revascularization.


BACKGROUND
Dobutamine stress echocardiography can predict improvement of wall motion after revascularization. The relation between viability, improvement of function, improvement of heart failure symptoms and long-term prognosis has not been studied.


METHODS
We studied 68 patients with DSE before revascularization; 62 patients underwent resting echocardiography/radionuclide ventriculography before and three months after revascularization. Long-term follow-up data (New York Heart Association [NYHA] functional class, Canadian Cardiovascular Society [CCS] classification and events) were acquired up to two years.


RESULTS
Patients with > or =4 viable segments on DSE (group A, n = 22) improved in LVEF at three months (from 27+/-6% to 33+/-7%, p < 0.01), in NYHA functional class (from 3.2+/-0.7 to 1.6+/-0.5, p < 0.01) and in CCS classification (from 2.9+/-0.3 to 1.2+/-0.4, p < 0.01); in patients with <4 viable segments (group B, n = 40) LVEF and NYHA functional class did not improve, whereas CCS classification improved significantly (from 3.0+/-0.8 to 1.3+/-0.5, p < 0.01). A higher event rate was observed at long-term follow-up in group B versus group A (47% vs. 17%, p < 0.05).


CONCLUSIONS
Patients with substantial viability on DSE demonstrated improvement in LVEF and NYHA functional class after revascularization; viability was also associated with a favorable prognosis after revascularization.
Department of Cardiology, University Hospital Leiden, The Netherlands. Bax@cardio.azl.nl
J J
JJ
Bax
D
D
Poldermans
A
A
Elhendy
J H
JH
Cornel
E
E
Boersma
R
R
Rambaldi
J R
JR
Roelandt
P M
PM
Fioretti
D000368:Aged; D002316:Cardiotonic Agents / Q000627:therapeutic use*; D002908:Chronic Disease; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy*; D004280:Dobutamine; D005080:Exercise Test; D005260:Female; D006333:Heart Failure / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D012372:ROC Curve; D013318:Stroke Volume; D016896:Treatment Outcome; D014463:Ultrasonography; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology*
D002316:Cardiotonic Agents; D004280:Dobutamine