Prognosis of patients with ischaemic cardiomyopathy after coronary revascularisation: relation to viability and improvement in left ventricular ejection fraction.
BACKGROUND
In patients with ischaemic cardiomyopathy and viable myocardium, left ventricular ejection fraction (LVEF) does not always improve after revascularisation. Whether this may affect prognosis is unclear.


OBJECTIVE
To evaluate the prognosis of viable patients with and without improvement of LVEF after coronary revascularisation.


METHODS
Before revascularisation, radionuclide ventriculography (RNV) and dobutamine stress echocardiography were performed to assess LVEF and myocardial viability, respectively. Nine to 12 months after revascularisation, LVEF improvement was assessed by RNV. Patients were divided into three groups: group 1, viable patients with LVEF improvement (n = 27); group 2, viable patients without LVEF improvement (n = 15), group 3, non-viable patients (n = 48). Cardiac events were evaluated during a 4-year follow-up.


RESULTS
After revascularisation, the mean (SD) LVEF improved from 32 (9)% to 42 (10)% in group 1, but did not change significantly in group 2 and in group 3, p<0.001 by analysis of variance (ANOVA). Heart failure symptoms improved in both groups 1 (mean (SD) NYHA class from 3.1 (0.9) to 1.7 (0.7)) and 2 (from 3.2 (0.7) to 1.7 (0.9)), but not in group 3 (from 2.8 (1.0) to 2.7 (0.5)), p<0.001 by ANOVA. During follow-up, the cardiac event rate was low (4%) in group 1, intermediate (21%) in group 2 and high (33%) in group 3 (p = 0.01).


CONCLUSIONS
The best prognosis after revascularisation may be expected in those viable patients whose LVEF improves. Conversely, viable patients without functional improvement have an intermediate prognosis.
Rizzello
V
V
Department of Cardiovascular Disease, San Giovanni-Addolorata Hospital, Via dell' Amba Aradam 8, 00184 Rome, Italy. vittoria.rizzello@gmail.com
Poldermans
D
D
Biagini
E
E
Schinkel
A F L
AF
Boersma
E
E
Boccanelli
A
A
Marwick
T
T
Roelandt
J R T C
JR
Bax
J J
JJ
D000704:Analysis of Variance; D000787:Angina Pectoris / Q000503:physiopathology / Q000601:surgery; D004452:Echocardiography; D005260:Female; D006333:Heart Failure / Q000209:etiology; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000503:physiopathology / Q000601:surgery; D017202:Myocardial Ischemia / Q000503:physiopathology / Q000601:surgery*; D009204:Myocardial Revascularization; D013318:Stroke Volume / Q000502:physiology*; D016896:Treatment Outcome; D016277:Ventricular Function, Left / Q000502:physiology