Complete percutaneous revascularization for multivessel disease in patients with impaired left ventricular function: pre- and post-procedural evaluation by cardiac magnetic resonance imaging.
OBJECTIVE
The aim of this study was to investigate the effect of complete, incomplete, and unsuccessful revascularization by percutaneous coronary intervention (PCI) on left ventricular ejection fraction (EF) in patients with multivessel disease and impaired left ventricular function and assess the diagnostic accuracy of cardiac magnetic resonance imaging (MRI) for improvement in EF.


BACKGROUND
The effect of PCI for multivessel coronary artery disease on long-term myocardial function and the predictive value of cardiac MRI on global function are incompletely investigated.


METHODS
Cardiac MRI was performed in patients with multivessel disease before and 6 months after complete revascularization (n = 34) or incomplete revascularization (n = 22) or in patients without successful revascularization (n = 15). For the prediction of recovery of EF, wall thickening was quantified on cine images at rest and during 5- and 10-microg/kg/min dobutamine. The transmural extent of infarction was quantified on delayed enhancement cardiac MRI.


RESULTS
The EF improved significantly after complete revascularization (46 +/- 12% to 51 +/- 13%; p < 0.0001) but did not change after incomplete (49 +/- 11% to 49 +/- 10%; p = 0.88) or unsuccessful revascularization (49 +/- 13% to 47 +/- 13%; p = 0.11). Sensitivity, specificity, positive and negative predictive value for the prediction of improvement in EF of >4% after PCI were 100%, 75%, 74%, and 100%, respectively, for dobutamine-cardiac MRI and 70%, 77%, 70%, and 77%, respectively, for delayed enhancement-cardiac MRI.


CONCLUSIONS
Complete revascularization for multivessel coronary artery disease improves EF, whereas EF did not change in patients after incomplete or unsuccessful revascularization. Improvement in EF can be predicted by performing cardiac MRI before PCI.
Kirschbaum
Sharon W
SW
Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands.
Springeling
Tirza
T
Boersma
Eric
E
Moelker
Adriaan
A
van der Giessen
Wim J
WJ
Serruys
Patrick W
PW
de Feyter
Pim J
PJ
van Geuns
Robert-Jan M
RJ
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects; D015415:Biomarkers / Q000097:blood; D016009:Chi-Square Distribution; D003324:Coronary Artery Disease / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D004280:Dobutamine; D005260:Female; D006801:Humans; D016014:Linear Models; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction; D009203:Myocardial Infarction / Q000175:diagnosis / Q000209:etiology; D009206:Myocardium / Q000473:pathology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D020127:Recovery of Function; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome; D014336:Troponin / Q000097:blood; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D016277:Ventricular Function, Left
D015415:Biomarkers; D014336:Troponin; D004280:Dobutamine