The beneficial effect of revascularization on jeopardized myocardium: reverse remodeling and improved long-term prognosis.
OBJECTIVE
To evaluate the impact of viability/ischemia before revascularization on improvement in systolic performance, reverse remodeling, symptoms and long-term prognosis post-revascularization.


METHODS
Fifty patients underwent thallium-201 imaging before revascularization to assess stress-induced ischemia and viability ('jeopardized myocardium'). Left ventricular (LV) ejection fraction (EF), LV end-systolic volume index (LVESVI) and LV end-diastolic volume index (LVEDVI) were determined before and 3 months post-revascularization. Graft/vessel patency was controlled by repeat angiography. Long-term follow-up data (New York Heart Association (NYHA) class, hard events) were acquired up to 3 years.


RESULTS
Patients with > or = 5 jeopardized segments on thallium-201 imaging demonstrated improvement of LVEF at 3 months (from 35+/-6 to 43+/-6%, P<0.001), with reverse remodeling (LVESVI decreased from 68+/-16 to 52+/-14 ml/m(2), P<0.001; LVEDVI decreased from 103+/-21 to 91+/-18 ml/m(2), P<0.001), and improved in NYHA class with excellent long-term prognosis (0% event rate). Conversely, patients with <5 jeopardized segments failed to improve in LVEF (34+/-4 vs. 33+/-7%, NS), and exhibited ongoing remodeling (LVESVI increased from 70+/-14 to 78+/-23 ml/m(2), P<0.001; LVEDVI increased from 106+/-19 to 116+/-25 ml/m(2), P<0.001), without improvement in NYHA class, and worse long-term prognosis (29% event rate).


CONCLUSIONS
Patients with jeopardized myocardium benefit from revascularization with improvement in LVEF, reverse remodeling, improvement in NYHA class and favorable long-term prognosis.
Unità Operativa di Cardiologia, Ospedale di Pieve di Cadore, ASL 1 Belluno, Italy.
Jacopo Dalle
JD
Mule
Jeroen J
JJ
Bax
Bartolo
B
Zingone
Felice
F
Martinelli
Claudio
C
Burelli
Anna
A
Stefania
Liberata
L
DiSipio
Giorgio
G
Soravia
D000368:Aged; D017023:Coronary Angiography; D003327:Coronary Disease / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D004452:Echocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction; D009204:Myocardial Revascularization; D011379:Prognosis; D013318:Stroke Volume; D013794:Thallium Radioisotopes; D015899:Tomography, Emission-Computed, Single-Photon; D014654:Vascular Patency
D013794:Thallium Radioisotopes