[Assessment of tissue viability for improvement of the left ventricular function after revascularization].
BACKGROUND
Treatment of patients with heart failure following myocardial infarction is still a clinical challenge. Drug therapy in these patients is limited, and invasive revascularization is not always successful and does not guarantee desired results. The aim of this study was to compare the effectiveness of invasive revascularization procedures (coronary artery bypass grafting - CABG or percutaneous transluminal coronary angioplasty - PTCA) with conventional drug therapy in patients with heart failure after acute myocardial infarction in whom significant portion of viable myocardial tissue was detected during low dose dobutamine stress echocardiography.


METHODS
Using a prospective analysis, we investigated 66 patients with heart failure following myocardial infarction and reduced left ventricular ejection fraction (LVEF <35%). 34 patients underwent revascularization procedures including CABG or PTCA. The other 32 patients received only conventional drug therapy. The patients were followed during 12 months examing LVEF, left ventricular wall motion score index (WMSI), NYHA functional class, and cardiac death.


RESULTS
After 12 months, patients undergoing revascularization procedures presented with significantly better functional improvement of LVEF (37.84% vs. 33.14%, p<0.05), better clinical status and significantly less cardiac deaths (8.82% vs. 21.87%, p<0.01) in comparison to patients who stayed on drug therapy. After 12 months WMSI was significantly better in patients who underwent interventional therapy (1.69 +/- 07 vs. 1.82 +/- 04, p<0.01).


CONCLUSIONS
After a 12-month follow up period, patients with presence of viable myocardial tissue after myocardial infarction and undergoing revasculkatization procedures presented with better functional recovery and less cardiac events, including cardiac death, in comparison with patients who received only drug therapy.
Matunović
Radomir
R
Vojnomedicinska akademija, Beograd Klinika za kardiologiju. milaca@verat.net
Stojanović
Aleksandar
A
Mijailović
Zdravko
Z
Gligić
Branko
B
Ristić-Angelokov
Andelka
A
D005260:Female; D006333:Heart Failure / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000473:pathology / Q000628:therapy*; D009204:Myocardial Revascularization; D009206:Myocardium / Q000473:pathology*; D013318:Stroke Volume; D014022:Tissue Survival; D016277:Ventricular Function, Left