title: Extensive left ventricular remodeling does not allow viable myocardium to improve in left ventricular ejection fraction after revascularization and is associated with worse long-term prognosis.
abstract: BACKGROUND
  Extensive left ventricular (LV) remodeling may not allow functional recovery after revascularization, despite the presence of viable myocardium.
  
  
  RESULTS
  Seventy-nine consecutive patients with ischemic cardiomyopathy (left ventricle ejection fraction [LVEF] 29+/-7%) underwent surgical revascularization. Before revascularization, viability was assessed by metabolic imaging with F18-fluorodeoxyglucose and SPECT. LV volumes and LVEF were assessed by resting echocardiography. LVEF was re-assessed by echocardiography 8 to 12 months after revascularization. Three-year clinical follow-up (events: cardiac death, infarction, and hospitalization for heart failure) was also obtained. Forty-nine patients had substantial viability; 5 died before re-assessment of LVEF. Of the remaining 44 patients, 24 improved > or =5% in LVEF after revascularization, whereas 20 did not improve in LVEF. LV end-systolic volume was the only parameter that was significantly different between the groups (109+/-46 mL for the improvers versus 141+/-31 mL for the nonimprovers; P<0.05). The change in LVEF after revascularization was linearly related to the baseline LV end-systolic volume, with a higher LV end-systolic volume associated with a low likelihood of improvement in LVEF after revascularization. During the 3-year follow-up, the highest event-rate (67%) was observed in patients without viable myocardium with a large LV size, whereas the lowest event rate (5%) was observed in patients with viable myocardium and a small LV size. Intermediate event rates were observed in patients with viable myocardium and a large LV size (38%), and in patients without viable myocardium and a small LV size (24%).
  
  
  CONCLUSIONS
  Extensive LV remodeling prohibits improvement in LVEF after revascularization and affects long-term prognosis negatively, despite the presence of viability.
authors.affiliation: Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands. jbax@knoware.nl
authors.forename: Jeroen J
authors.initials: JJ
authors.lastname: Bax
authors.forename: Arend F L
authors.initials: AF
authors.lastname: Schinkel
authors.forename: Eric
authors.initials: E
authors.lastname: Boersma
authors.forename: Abdou
authors.initials: A
authors.lastname: Elhendy
authors.forename: Vittoria
authors.initials: V
authors.lastname: Rizzello
authors.forename: Alexander
authors.initials: A
authors.lastname: Maat
authors.forename: Jos R T C
authors.initials: JR
authors.lastname: Roelandt
authors.forename: Ernst E
authors.initials: EE
authors.lastname: van der Wall
authors.forename: Don
authors.initials: D
authors.lastname: Poldermans
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000401:mortality; D002470:Cell Survival; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D006321:Heart / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000150:complications; D017202:Myocardial Ischemia / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D009204:Myocardial Revascularization / Q000706:statistics & numerical data*; D009206:Myocardium / Q000473:pathology*; D011379:Prognosis; D013318:Stroke Volume; D015899:Tomography, Emission-Computed, Single-Photon; D016896:Treatment Outcome; D014463:Ultrasonography; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000503:physiopathology; D020257:Ventricular Remodeling / Q000502:physiology*