title: Effect of revascularizing viable myocardium on left ventricular diastolic function in patients with ischaemic cardiomyopathy.
abstract: OBJECTIVE
  In patients with ischaemic left ventricular (LV) dysfunction and viable myocardium, revascularization improves systolic function. Diastolic dysfunction is also present in such patients; however, whether revascularization improves diastolic function also is largely unknown.
  
  
  METHODS
  Twenty-six patients with chronic ischaemic cardiomyopathy [ejection fraction (EF) 32 +/- 6%, wall motion score index (WMSI) 2.45 +/- 0.33] and viable myocardium (low-dose dobutamine echocardiography) were examined at baseline and > or =4 months after revascularization. Diastolic function was assessed by transmitral pulsed-wave Doppler and tissue Doppler imaging (TDI) at the mitral annulus.
  
  
  RESULTS
  At baseline, 62% of patients showed non-restrictive filling (non-RF) pattern, and 38% restrictive filling (RF) pattern. After revascularization, along with improvement in systolic function (EF 43 +/- 10%, WMSI 1.78 +/- 0.47, P = 0.0002 for both), diastolic filling improved in most patients, with only three patients still exhibiting RF pattern (P = 0.016); furthermore, E' velocity increased (32 +/- 42%, P = 0.0028) and E/E' decreased (-19 +/- 31%, P = 0.0378) compared with baseline. Left ventricular filling pressure also decreased, from 17.5 +/- 6.8 to 13.1 +/- 6.5 mmHg (P = 0.005). Improvement of diastolic function by TDI was related to the extent of viability at baseline (P = 0.0098) and to LV reverse remodelling after revascularization (P = 0.0092).
  
  
  CONCLUSIONS
  In patients with ischaemic cardiomyopathy, LV diastolic filling may largely improve after revascularization. Improvement of diastolic dysfunction is related to the amount of viable tissue and it may represent an additional advantage of revascularizing dyssinergic but viable myocardium.
authors.affiliation: Division of Cardiology, University of Perugia, Ospedale Silvestrini, S. Andrea delle Fratte, Perugia, Italy.
authors.forename: Erberto
authors.initials: E
authors.lastname: Carluccio
authors.forename: Paolo
authors.initials: P
authors.lastname: Biagioli
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Alunni
authors.forename: Adriano
authors.initials: A
authors.lastname: Murrone
authors.forename: Valeria
authors.initials: V
authors.lastname: Leonelli
authors.forename: Paola
authors.initials: P
authors.lastname: Pantano
authors.forename: Gabriella
authors.initials: G
authors.lastname: Vincenti
authors.forename: Claudio
authors.initials: C
authors.lastname: Giombolini
authors.forename: Temistocle
authors.initials: T
authors.lastname: Ragni
authors.forename: Gianpaolo
authors.initials: G
authors.lastname: Reboldi
authors.forename: Federico
authors.initials: F
authors.lastname: Gentile
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Ambrosio
mesh_terms: D000368:Aged; D002311:Cardiomyopathy, Dilated / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery; D002316:Cardiotonic Agents / Q000008:administration & dosage; D003971:Diastole / Q000502:physiology; D004280:Dobutamine / Q000008:administration & dosage; D004452:Echocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery*; D009204:Myocardial Revascularization; D011379:Prognosis; D013318:Stroke Volume / Q000502:physiology; D013599:Systole / Q000502:physiology; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery
chemical_list: D002316:Cardiotonic Agents; D004280:Dobutamine