Benefits of coronary revascularisation in diabetic and non-diabetic patients with ischaemic cardiomyopathy: role of myocardial viability.
BACKGROUND
Diabetes mellitus in patients with coronary artery disease is associated with poor outcome. In this study, the relation between myocardial viability, diabetes, coronary revascularisation and outcome was evaluated.


METHODS
129 patients (31 diabetic, 98 non-diabetic) with ischaemic cardiomyopathy underwent dobutamine stress echocardiography to assess myocardial viability. Patients with >or=4 viable segments were defined as viable and patients with <4 viable segments as nonviable. Left ventricular ejection fraction (LVEF) was assessed before and 9-12 months post-revascularisation. At the same time-points, LV volumes were measured to evaluate LV remodelling. Finally, cardiac events were noted during 5-year follow-up.


RESULTS
The extent of viable myocardium was comparable between diabetic and non-diabetic patients. After revascularisation, LVEF increased >or=5% in 44% of diabetic and in 40% of non-diabetic patients. LVEF only improved in patients with viable myocardium. Ongoing LV remodelling occurred in 36% and 35% of diabetic and non-diabetic patients respectively, and was related to non-viability, whereas viability protected against ongoing LV remodelling, both in diabetic and non-diabetic patients. Viability was the only predictor of survival after revascularisation.


CONCLUSIONS
Diabetic, viable patients with ischaemic LV dysfunction exhibit improvement in LVEF post-revascularisation with prevention of ongoing LV remodelling, similar to non-diabetic patients. Myocardial viability was also the only predictor of long-term outcome.
Rizzello
Vittoria
V
Department of Cardiology, The Catholic University, Rome, Italy.
Poldermans
Don
D
Biagini
Elena
E
Schinkel
Arend F L
AF
Boersma
Eric
E
Elhendy
Abdou
A
Sozzi
Fabiola B
FB
Maat
Alexander
A
Roelandt
Jos R T C
JR
Bax
Jeroen J
JJ
D000368:Aged; D048909:Diabetes Complications / Q000503:physiopathology / Q000601:surgery*; D004280:Dobutamine; D025401:Echocardiography, Stress; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000503:physiopathology / Q000601:surgery*; D009204:Myocardial Revascularization; D013318:Stroke Volume; D016277:Ventricular Function, Left; D020257:Ventricular Remodeling
D004280:Dobutamine