title: Effect of improvement in left ventricular ejection fraction on long-term survival in revascularized patients with ischaemic left ventricular systolic dysfunction.
abstract: OBJECTIVE
  The importance of improvement in the ejection fraction to the prognosis of revascularized patients with ischaemic left ventricular (LV) dysfunction is uncertain.
  
  
  RESULTS
  Eighty-seven patients with ischaemic LV dysfunction (mean ejection fraction 29 ± 8% by biplane Simpson's) had dobutamine echocardiography before revascularization (coronary bypass graft surgery-81, percutaneous intervention-6). Follow-up echocardiograms were performed a mean of 4.8 ± 6.2 months after revascularization. An 8% increase in the ejection fraction was considered significant (two times the inter-observer difference of 3.7%). Patients were followed for cardiac death. During a mean follow-up of 5.2 ± 3.9 years, there were 20 (23%) cardiac deaths. Class 3/4 heart failure, increasing low-dose wall motion score, increasing % non-viable myocardium, and digoxin use in follow-up were univariate predictors of death. Beta-blocker use, ejection fraction improvement, angina, aspirin use, and increasing fractional shortening were univariate predictors of survival. Ejection fraction improvement [P= 0.02, hazard ratio (HR) = 0.26], digoxin use in follow-up (P= 0.006, HR = 5.85), and low-dose wall motion score (P= 0.017, HR = 4.78) were independent predictors of outcome. In step-wise analysis, low-dose wall motion score added incremental prognostic value to ejection fraction improvement (P= 0.003), and digoxin use in follow-up (P= 0.003) added incremental value to a low-dose score and ejection fraction improvement.
  
  
  CONCLUSIONS
  Ejection fraction improvement is an independent predictor of long-term outcome in revascularized patients but viability (low-dose wall motion score) and digoxin use in follow-up are also independent predictors and add incremental prognostic value to ejection fraction improvement.
authors.affiliation: Krannert Institute of Cardiology, Indiana University School of Medicine, 1801 North Senate Blvd., M.P.C. II, Suite D4082, Indianapolis, IN 46202, USA.
authors.forename: Kruti
authors.initials: K
authors.lastname: Joshi
authors.forename: Irshad
authors.initials: I
authors.lastname: Alam
authors.forename: Emily
authors.initials: E
authors.lastname: Ruden
authors.forename: Irmina
authors.initials: I
authors.lastname: Gradus-Pizlo
authors.forename: Jothiharan
authors.initials: J
authors.lastname: Mahenthiran
authors.forename: Masoor
authors.initials: M
authors.lastname: Kamalesh
authors.forename: Harvey
authors.initials: H
authors.lastname: Feigenbaum
authors.forename: Stephen
authors.initials: S
authors.lastname: Sawada
mesh_terms: D025401:Echocardiography, Stress; D006305:Health Status Indicators; D006801:Humans; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology*; D009204:Myocardial Revascularization / Q000295:instrumentation / Q000379:methods; D011237:Predictive Value of Tests; D011379:Prognosis; D013223:Statistics as Topic; D013318:Stroke Volume; D013599:Systole; D013997:Time Factors; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology*; D016277:Ventricular Function, Left