Prolonged ischemic heart disease and coronary artery bypass - relation to contractile reserve.
OBJECTIVE
A major effect of coronary artery bypass grafting (CABG) in patients with ischemic heart disease and impaired left ventricular (LV) contractile function is believed to be an improvement in LV function due to recovery of dysfunctional, but viable myocardium. However, recent studies have indicated a time limit for such a recovery. We therefore investigated the extent of viable myocardium in patients with impaired LV function due to ischemic heart disease after a prolonged strategy of medical treatment and its relation to changes in clinical variables after CABG.


METHODS
Forty-five consecutive patients with a mean duration of ischemic heart symptoms of 9 years and LV ejection fraction (EF) <45% referred for CABG were included and LV extent of viable myocardium was measured preoperatively by glucose metabolism--blood flow positron emission tomography imaging and dobutamine stress echocardiography. Symptoms, exercise-capacity and LV function were evaluated before and 7 months after surgery in event-free survivors.


RESULTS
LV extent of myocardial viability was <30% in most patients. In event-free survivors, LVEF decreased from 31+/-7 to 26+/-8% 7 months after CABG. The decrease in LVEF was correlated to the LV extent of myocardial metabolism--blood flow reverse mismatch. Most of the patients experienced an improvement in their angina pectoris, heart failure symptoms and exercise capacity after CABG; the overall 3-year survival was 77%.


CONCLUSIONS
Patients with chronic ischemic heart disease and impairment of LV function, in whom an initial long-standing conservative treatment has been practiced, benefit from CABG, despite a lack of LV functional reserve.
Kofoed
Klaus F
KF
Division of Cardiology, Medical Department B, The Heart Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark. kkofoed@pet.rh.dk
Bangsgaard
Regitze
R
Carstensen
Steen
S
Svendsen
Jesper H
JH
Hansen
Peter R
PR
Arendrup
Henrik
H
Hesse
Birger
B
Kelbaek
Henning
H
D001026:Coronary Artery Bypass; D004280:Dobutamine; D004452:Echocardiography; D005260:Female; D006321:Heart / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction / Q000502:physiology; D017202:Myocardial Ischemia / Q000401:mortality / Q000503:physiopathology* / Q000601:surgery*; D014055:Tomography, Emission-Computed; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology*
D004280:Dobutamine