title: Prognostic value of myocardial viability by delayed-enhanced magnetic resonance in patients with coronary artery disease and low ejection fraction: impact of revascularization therapy.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the impact of myocardial viability assessment by delayed-enhanced cardiac magnetic resonance (DE-CMR) and of revascularization therapy on survival in patients with coronary artery disease (CAD) and low ejection fraction (EF).
  
  
  BACKGROUND
  Prior studies have shown that DE-CMR predicts recovery of left ventricular (LV) dysfunction after revascularization.
  
  
  METHODS
  The authors prospectively evaluated survival of 144 consecutive patients (130 males, age 65 ± 11 years) with CAD and LV dysfunction (EF: 24 ± 7%) undergoing DE-CMR. Eighty-six patients underwent complete revascularization of dysfunctional myocardium (79 coronary artery bypass grafting, 7 percutaneous coronary intervention), whereas 58 patients remained under medical treatment.
  
  
  RESULTS
  Over the 3-year median follow-up, 49 patients died. Three-year survival was significantly worse in medically treated patients with dysfunctional viable than with nonviable myocardium (48% vs. 77% survival, p = 0.02). By contrast, in revascularized patients, survival was similar whether myocardium was viable or not (88% and 71% survival, respectively, p = NS). Hazard of death of viable myocardium remaining under medical treatment versus complete revascularization was 4.56 (95% confidence interval [CI]: 1.93 to 10.8). Cox multivariate analysis indicated that interaction of revascularization and viability provided significant additional value (chi-square test = 13.1, p = 0.004) to baseline predictors of survival (New York Heart Association functional class, wall motion score, and peripheral artery disease). More importantly, in 43 pairs of propensity score-matched patients, hazard of death (hazard ratio: 2.5 [95% CI: 1.1 to 6.1], p = 0.02) remained significantly higher for medically treated patients rather than for those with fully revascularized viable myocardium.
  
  
  CONCLUSIONS
  Without revascularization, presence of dysfunctional viable myocardium by DE-CMR is an independent predictor of mortality in patients with ischemic LV dysfunction. This observation may be useful for pre-operative selection of patients for revascularization.
authors.affiliation: Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc, Université Catholique de Louvain, Av. Hippocrate 10/2806, Woluwe St. Lamber, Belgium. bernhard.gerber@uclouvain.be
authors.forename: Bernhard L
authors.initials: BL
authors.lastname: Gerber
authors.forename: Michel F
authors.initials: MF
authors.lastname: Rousseau
authors.forename: Sylvie A
authors.initials: SA
authors.lastname: Ahn
authors.forename: Jean-Benoît
authors.initials: JB
authors.lastname: le Polain de Waroux
authors.forename: Anne-Catherine
authors.initials: AC
authors.lastname: Pouleur
authors.forename: Thomas
authors.initials: T
authors.lastname: Phlips
authors.forename: David
authors.initials: D
authors.lastname: Vancraeynest
authors.forename: Agnès
authors.initials: A
authors.lastname: Pasquet
authors.forename: Jean-Louis J
authors.initials: JL
authors.lastname: Vanoverschelde
mesh_terms: D000368:Aged; D003324:Coronary Artery Disease / Q000150:complications / Q000503:physiopathology* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization; D018579:Patient Selection; D011379:Prognosis; D011446:Prospective Studies; D015203:Reproducibility of Results; D013318:Stroke Volume / Q000502:physiology*; D013997:Time Factors; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology*