Predicting revascularization outcome in patients with coronary artery disease and left ventricular dysfunction (data from the SEMINATOR study).
A main goal of revascularization in patients with chronic ischemic cardiomyopathy is to improve global left ventricular (LV) function. This study aimed to verify whether it is possible to predict an increase in LV ejection fraction (EF) after revascularization on the basis of the extent of LV asynergy, myocardial viability, and revascularization completeness. We studied 77 patients with chronic LV ischemic dysfunction using baseline resting and nitrate-enhanced technetium-99m sestamibi single-photon emission computed tomography. Regional wall motion and global LVEF were assessed with echocardiography before and after revascularization, which was complete in 51 patients and incomplete in 26. The number of viable asynergic segments included in revascularized coronary artery territories was the strongest predictor of significant (> or = 5 EF U) functional improvement in univariate discriminant analysis. According to multivariate stepwise discriminant analysis, this parameter, together with the number of baseline asynergic segments, allowed the detection of patients with significant LVEF improvement with 75% accuracy. With use of a multivariate regression model, including the 2 mentioned variables, the measure of postrevascularization LVEF increase could be accurately quantified (R(2) 0.43, p <0.000001). In conclusion, this study suggests that the severity of baseline asynergy, the extent of myocardial viability, and the completeness of revascularization are the main determinants of postrevascularization functional recovery in patients with LV ischemic dysfunction, and that on the basis of these variables it is possible to predict the measure of LVEF increase.
Sciagrà
Roberto
R
Nuclear Medicine Unit, Department of Clinical Physiopathology, University of Florence, Florence, Italy. rsciagra@dfc.unifi.it
Leoncini
Mario
M
Cannizzaro
Giorgio
G
Marcucci
Gabriella
G
Pupi
Alberto
A
Bisi
Gianni
G
D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D016002:Discriminant Analysis; D004452:Echocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000379:methods*; D009566:Nitrates; D011237:Predictive Value of Tests; D012372:ROC Curve; D019275:Radiopharmaceuticals; D012044:Regression Analysis; D018709:Statistics, Nonparametric; D017256:Technetium Tc 99m Sestamibi; D015899:Tomography, Emission-Computed, Single-Photon; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000503:physiopathology*; D016277:Ventricular Function, Left
D009566:Nitrates; D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi