title: The prognostic value of myocardial viability recognized by low dose dipyridamole echocardiography in patients with chronic ischaemic left ventricular dysfunction.
abstract: OBJECTIVE
  The aim of this study was to assess the prognostic value of myocardial viability recognized as a contractile response to vasodilator stimulation in patients with left ventricular dysfunction in a large scale, prospective, multicentre, observational study.
  
  
  RESULTS
  Three hundred and seven patients (mean age 60 +/- 10 years) with angiographically proven coronary artery disease, previous (>3 months) myocardial infarction and severe left ventricular dysfunction (ejection fraction <35%; mean ejection fraction: 28 +/- 7%) were enrolled in the study. Each patient underwent low dose dipyridamole echo (0.28 mg x kg(-1) in 4 min). Myocardial viability was identified as an improvement of >0.20 in the wall motion score index. By selection, all patients were followed up for a median of 36 months. One-hundred and twenty-four were revascularized either by coronary artery bypass grafting (n=83) or coronary angioplasty (n=41). The only end-point analysed was cardiac death. In the revascularized group, cardiac death occurred in one of the 41 patients with and in 16 of the 83 patients without a viable myocardium (2.4% vs 19.3%, P<0.01). Outcome, as estimated by Kaplan-Meier survival, was better for patients with, compared to patients without, a viable myocardium, who underwent coronary revascularization (97.6 vs 77.4%, P=0.01). Using a Cox proportional hazards model, the presence of myocardial viability was shown to exert a protective effect on survival (chi-square 4.6, hazard ratio 0.1, 95% CI 0.01-0.8, P<0.03). The survival rate in medically treated patients was lower than in revascularized patients irrespective of the presence of a viable myocardium (79.7% vs 86.2, P=ns).
  
  
  CONCLUSIONS
  In severe left ventricular ischaemic dysfunction, myocardial viability, as assessed by low dose dipyridamole echo, is associated with improved survival in revascularized patients.
authors.affiliation: CNR Institute of Clinical Physiology, Pisa, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Sicari
authors.forename: A
authors.initials: A
authors.lastname: Ripoli
authors.forename: E
authors.initials: E
authors.lastname: Picano
authors.forename: A C
authors.initials: AC
authors.lastname: Borges
authors.forename: A
authors.initials: A
authors.lastname: Varga
authors.forename: W
authors.initials: W
authors.lastname: Mathias
authors.forename: L
authors.initials: L
authors.lastname: Cortigiani
authors.forename: R
authors.initials: R
authors.lastname: Bigi
authors.forename: J
authors.initials: J
authors.lastname: Heyman
authors.forename: S
authors.initials: S
authors.lastname: Polimeno
authors.forename: O
authors.initials: O
authors.lastname: Silvestri
authors.forename: V
authors.initials: V
authors.lastname: Gimenez
authors.forename: P
authors.initials: P
authors.lastname: Caso
authors.forename: S
authors.initials: S
authors.lastname: Severino
authors.forename: A
authors.initials: A
authors.lastname: Djordjevic-Dikic
authors.forename: M
authors.initials: M
authors.lastname: Ostojic
authors.forename: C
authors.initials: C
authors.lastname: Baldi
authors.forename: G
authors.initials: G
authors.lastname: Seveso
authors.forename: N
authors.initials: N
authors.lastname: Petix
mesh_terms: D000368:Aged; D002908:Chronic Disease; D004176:Dipyridamole / Q000008:administration & dosage*; D004452:Echocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D009204:Myocardial Revascularization / Q000401:mortality; D009206:Myocardium / Q000473:pathology*; D011379:Prognosis; D011446:Prospective Studies; D015996:Survival Rate; D014665:Vasodilator Agents / Q000008:administration & dosage*; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000401:mortality / Q000503:physiopathology*
chemical_list: D014665:Vasodilator Agents; D004176:Dipyridamole