Myocardial positive pre-ejection velocity accurately detects presence of viable myocardium, predicts recovery of left ventricular function and bears a prognostic value after surgical revascularization.
OBJECTIVE
To assess the accuracy of tissue Doppler imaging-derived myocardial positive pre-ejection velocity (+Vic) in detecting myocardial viability defined by dobutamine stress echocardiography (DSE), fluorine-18 fluorodeoxyglucose positron emission tomography (PET), and contrast-enhanced magnetic resonance imaging (MRI), and in predicting recovery of left ventricular (LV) function after coronary artery bypass grafting (CABG) in patients with chronic ischaemic LV dysfunction.


RESULTS
+Vic in dysfunctional segments was recorded in 54 patients treated medically and 65 patients undergoing CABG [age 67 +/- 9 year; LV ejection fraction (EF) 30 +/- 6%]. A good agreement was observed between +Vic and detection of viable myocardium at DSE, PET, and MRI (kappa = 0.76). The presence of +Vic in greater than or equal to five dysfunctional segments had the highest sensitivity (93%) and specificity (60%) to identify patients (n = 28) with > or =10% increase in LV EF between baseline and 6-month echocardiogram. During follow-up (median 333 days, interquartile range 209-490 days), 13 cardiac events (6 deaths, 7 hospitalizations) occurred in 24 patients with small extent of viable myocardium (< 5 + Vic), whereas only four hospitalizations in 39 patients with > or =5 + Vic (54% vs. 10%; P < 0.001).


CONCLUSIONS
The extent of +Vic in dysfunctional segments accurately predicts extent of viable myocardium and bears a clinical prognostic value in patients with ischaemic LV dysfunction considered for CABG.
Penicka
Martin
M
Cardiocenter, Department of Cardiology, 3rd Medical School Charles University and University Hospital Kralovske Vinohrady Srobarova 50, 100 34 Prague, Czech Republic.
Tousek
Petr
P
De Bruyne
Bernard
B
Wijns
William
W
Lang
Otto
O
Madaric
Juraj
J
Vanderheyden
Marc
M
Tintera
Jaroslav
J
Malý
Marek
M
Widimsky
Petr
P
Bartunek
Jozef
J
D000368:Aged; D001783:Blood Flow Velocity / Q000502:physiology; D003326:Coronary Circulation / Q000502:physiology; D016757:Death, Sudden, Cardiac / Q000209:etiology; D005260:Female; D006333:Heart Failure / Q000209:etiology; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D009204:Myocardial Revascularization / Q000379:methods* / Q000401:mortality; D049268:Positron-Emission Tomography; D011379:Prognosis; D011446:Prospective Studies; D020127:Recovery of Function; D013318:Stroke Volume / Q000502:physiology; D016019:Survival Analysis; D018487:Ventricular Dysfunction, Left / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D016277:Ventricular Function, Left / Q000502:physiology