Resting echocardiographic assessment of regional wall motion, thickness and reflectivity in chronic ischemic cardiomyopathy: an alternative to the viability test?
BACKGROUND
A resting echo showing a regional end-diastolic wall thickness < or = 6 mm with a hyperechoic texture is pathognomonic of scar tissue and of non-viable myocardium. The aim of this study was to assess the prognostic value of the resting echo scar texture in patients with chronic ischemic cardiomyopathy evaluated prior to coronary artery bypass surgery.


METHODS
The preoperative clinical and echocardiographic data of 70 patients with a mean ejection fraction of 29.8 +/- 4% scheduled for coronary revascularization were correlated to the cardiac events observed during a mean follow-up of 24 +/- 12 months after surgery. Akinetic segments of the left ventricular wall with a reduced diastolic thickness and increased echoreflectivity were judged scarred.


RESULTS
Sixty-eight patients were discharged alive from hospital. On the basis of ROC analysis, we identified: group A (27 patients) with > 5 and group B (41 patients) with < or = 5 scarred segments. There were 10 events (3 deaths, 4 heart transplants and 3 refractory heart failures), 8 in group A (29%) and 2 in group B (5%). At multivariate analysis the only independent predictor of the clinical outcome after revascularization was whether the patient was included in group A or B (Wald 6.3, p < 0.012). One year after surgery, the ejection fraction improved only in group B patients (p < 0.03).


CONCLUSIONS
The extent of scarred myocardial tissue as assessed at resting echocardiography predicted the benefit of revascularization in patients with chronic ischemic left ventricular dysfunction. This simple and straightforward echo parameter should be taken into consideration when assessing the instrumental value of more technologically demanding and costly viability testing.
Massa
Daria
D
Department of Cardiology and Cardiac Surgery A. De Gasperis, Niguarda Hospital, Milan, Italy.
Cataldo
Gabriella
G
Ciliberto
Guglielma Rita
GR
Colombo
Paola
P
Vitali
Ettore
E
Pirelli
Salvatore
S
D000328:Adult; D000368:Aged; D009202:Cardiomyopathies / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D002921:Cicatrix / Q000150:complications / Q000000981:diagnostic imaging*; D001026:Coronary Artery Bypass; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D009336:Necrosis; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D014463:Ultrasonography