title: Improvement of stress LVEF rather than rest LVEF after coronary revascularisation in patients with ischaemic cardiomyopathy and viable myocardium.
abstract: OBJECTIVE
  To evaluate prospectively the response of left ventricular ejection fraction (LVEF) to high dose dobutamine infusion in patients showing substantial viability, with and without improved resting LVEF after revascularisation.
  
  
  METHODS
  Before and 9-12 months after revascularisation, 50 patients with ischaemic cardiomyopathy (LVEF 32 (8)%) and substantial myocardial viability (> or = 4 viable segments) underwent radionuclide ventriculography and dobutamine stress echocardiography. Patients were divided into group 1, patients with, and group 2, patients without significant improvement in resting LVEF (> or = 5% by radionuclide ventriculography) after revascularisation. The response of LVEF during dobutamine stress echocardiography was compared in these two groups.
  
  
  RESULTS
  Groups 1 and 2 were comparable in baseline characteristics, resting LVEF, and number of viable segments (mean (SD) 7 (4) v 6 (2), not significant). After revascularisation, the LVEF response during dobutamine stress echocardiography improved significantly in both groups (group 1, 34 (10)% to 56 (8)%; group 2, 32 (10)% to 46 (11)%; both p < 0.001). Interestingly, although resting LVEF did not improve in group 2, peak stress LVEF after revascularisation did (p < 0.001). Group 1 patients had, however, a greater increase in peak stress LVEF (group 1, 22 (10)%; group 2, 13 (9)%; p < 0.01). New York Heart Association and Canadian Cardiovascular Society classes decreased in both groups.
  
  
  CONCLUSIONS
  Although patients with viable myocardium did not always have improved rest LVEF after revascularisation, peak stress LVEF improved. Assessment of improvement of resting function may not be the ideal end point to evaluate successful revascularisation.
authors.affiliation: Department of Cardiology, Thoraxcentre, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: V
authors.initials: V
authors.lastname: Rizzello
authors.forename: D
authors.initials: D
authors.lastname: Poldermans
authors.forename: E
authors.initials: E
authors.lastname: Biagini
authors.forename: A F L
authors.initials: AF
authors.lastname: Schinkel
authors.forename: R
authors.initials: R
authors.lastname: van Domburg
authors.forename: A
authors.initials: A
authors.lastname: Elhendy
authors.forename: E C
authors.initials: EC
authors.lastname: Vourvouri
authors.forename: M
authors.initials: M
authors.lastname: Bountioukos
authors.forename: A
authors.initials: A
authors.lastname: Lombardo
authors.forename: B
authors.initials: B
authors.lastname: Krenning
authors.forename: J R T C
authors.initials: JR
authors.lastname: Roelandt
authors.forename: J J
authors.initials: JJ
authors.lastname: Bax
mesh_terms: D001794:Blood Pressure / Q000187:drug effects; D002316:Cardiotonic Agents; D004280:Dobutamine; D025401:Echocardiography, Stress / Q000379:methods; D005260:Female; D006321:Heart / Q000503:physiopathology; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000188:drug therapy / Q000503:physiopathology*; D009204:Myocardial Revascularization / Q000379:methods*; D011446:Prospective Studies; D013318:Stroke Volume / Q000187:drug effects / Q000502:physiology; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology*
chemical_list: D002316:Cardiotonic Agents; D004280:Dobutamine