Prediction of long-term reverse left ventricular remodeling after revascularization or medical treatment in patients with ischemic cardiomyopathy: a comparative study between SPECT and MRI.
Patients with ischemic heart disease and depressed left ventricular (LV) ejection fraction (LVEF) develop varying degrees of LV remodeling after cardiac surgical revascularization. Fifty-three patients with stable ischemic heart disease and impaired LV function (LVEF 34.9 ± 4%) were prospectively followed up for 24 months. Thirty-seven patients underwent coronary artery bypass grafting (CABG), 16 patients were treated conservatively. Cardiac magnetic resonance imaging (MRI) and SPECT were performed at baseline and after 12 and 24 months of follow-up. The patients were divided into responders and non-responders depending on the degree of LVEF improvement at 24 months follow-up (>5%-responders). MRI with ≤5 segments with DE/wall thickness ratio (DEWTR) ≥50% predicted LV reverse remodeling with a sensitivity of 86% and a specificity of 75% (AUC 0.81). An MRI finding of ≤2 segments with the DEWTR ≥75% had a corresponding sensitivity of 71% and specificity of 67% (AUC 0.75) while fixed perfusion defect on SPECT <16.5% of LV predicted reverse remodeling with a sensitivity of 64% and a specificity of 69% (AUC 0.64). A preoperative number of segments with the DE/wall thickness ratio of ≥50 and ≥75% obtained by MRI, was found to be a better predictor of left ventricular reverse remodeling than fixed perfusion defect by SPECT. No other MRI or SPECT parameter predicted LVEF improvement at 24 months after CABG.
Skala
Tomas
T
1st Department of Internal Medicine (Cardiology), University Hospital Olomouc, I. P. Pavlova 6, 775 20 Olomouc, Czech Republic. tomasskala@gmail.com
Hutyra
Martin
M
Vaclavik
Jan
J
Kaminek
Milan
M
Horak
David
D
Novotny
Josef
J
Zapletalova
Jana
J
Lukl
Jan
J
Marek
Dan
D
Taborsky
Milos
M
D000368:Aged; D000369:Aged, 80 and over; D009202:Cardiomyopathies / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D017023:Coronary Angiography; D001026:Coronary Artery Bypass; D018153:Czech Republic; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D020127:Recovery of Function; D013318:Stroke Volume; D013997:Time Factors; D015899:Tomography, Emission-Computed, Single-Photon; D016896:Treatment Outcome; D016277:Ventricular Function, Left; D020257:Ventricular Remodeling
D002317:Cardiovascular Agents