title: Incremental value of myocardial viability for prediction of long-term prognosis in surgically revascularized patients with left ventricular dysfunction.
abstract: OBJECTIVE
  We assessed the incremental long-term prognostic value of myocardial viability in surgically revascularized (CABG) patients with left ventricular (LV) dysfunction.
  
  
  BACKGROUND
  Clinical factors, medical therapy, the degree of LV dysfunction, and stress-induced ischemia may affect the relative prognostic value of myocardial viability.
  
  
  METHODS
  Patients with coronary disease and ventricular dysfunction (mean ejection fraction 33% by echocardiography, 25% by angiography) were studied with dobutamine echocardiography. Follow-up (mean -4.9 years) was obtained in 95 patients (85% triple-vessel disease) who underwent CABG.
  
  
  RESULTS
  The use of angiotensin-converting enzyme inhibitors, advanced heart failure, rest, low- and peak-dose wall motion scores were univariate predictors of cardiac death. The extent of contractile reserve and ischemia were not predictive. Low-dose score was the strongest multivariate predictor of death (p < 0.001, hazard ratio 6.7). A biphasic response predicted better survival (p = 0.045, hazard ratio 0.5). Five-year survival was better in those with extensive (low-dose score <2.00) versus intermediate (score 2.00 to 2.49) amounts of viable myocardium (p = 0.019). Patients with the least viability (score > or =2.5) had the worst outcome (p = 0.0001 vs. those with low-dose score <2.00; p = 0.05 vs. those with score 2.00 to 2.49). In stepwise multivariate analysis, low-dose score added incremental prognostic value (p = 0.024) to clinical information and rest score.
  
  
  CONCLUSIONS
  Low-dose score, representing the extent of viable myocardium, has incremental prognostic value as a predictor of long-term outcome in CABG patients with LV dysfunction.
authors.affiliation: Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana 46202, USA. ssawada@iupui.edu
authors.forename: Stephen
authors.initials: S
authors.lastname: Sawada
authors.forename: Ashutosh
authors.initials: A
authors.lastname: Bapat
authors.forename: Dev
authors.initials: D
authors.lastname: Vaz
authors.forename: Juan
authors.initials: J
authors.lastname: Weksler
authors.forename: Naomi
authors.initials: N
authors.lastname: Fineberg
authors.forename: Adam
authors.initials: A
authors.lastname: Greene
authors.forename: Irmina
authors.initials: I
authors.lastname: Gradus-Pizlo
authors.forename: Harvey
authors.initials: H
authors.lastname: Feigenbaum
mesh_terms: D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000401:mortality; D004280:Dobutamine; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006321:Heart / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D015588:Observer Variation; D011379:Prognosis; D015996:Survival Rate; D018487:Ventricular Dysfunction, Left / Q000150:complications*
chemical_list: D004280:Dobutamine