title: Prediction of long-term segmental and global functional recovery of hibernating myocardium after revascularisation based on low dose dobutamine and late gadolinium enhancement cardiovascular magnetic resonance.
abstract: BACKGROUND
  This study sought to evaluate the relation between long-term segmental and global functional outcome after revascularisation in patients with chronic ischaemic left ventricular dysfunction (LVD) and baseline markers of viability: late gadolinium enhancement (LGE) transmurality and contractile reserve (CR).
  
  
  METHODS
  Forty-two patients with chronic ischaemic LVD underwent low-dose dobutamine- (LDD) and late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) before surgical or percutaneous revascularisation. Regional and global left ventricular (LV) functions and LGE were repeatedly assessed 6 ± 1 and 35 ± 6 months after revascularisation. In total, 319 at baseline dysfunctional and successfully revascularised segments were available for statistical analysis.
  
  
  RESULTS
  The likelihood of long-term functional improvement was directly related to the presence of CR and inversely related to both the LGE and the degree of contractile dysfunction at baseline. The time course of functional improvement was protracted, with significantly more delay in segments with more extensive LGE (p = 0.005) and more severe contractile dysfunction at baseline (p = 0.002). The presence of CR was the predictor of earlier functional improvement (p < 0.0001). Using a definition of viable segment as a segment without any LGE or with any LGE and producing CR during LDD stimulation, ≥ 55% of viable segments from all dysfunctional and revascularised segments in a patient was the only independent predictor of significant improvement (≥ 5%) in the left ventricular ejection fraction (LVEF) after revascularisation, with a 72% sensitivity and an 80% specificity (AUC 0.76, p = 0.014). Reverse LV remodelling was observed in patients who had a significant amount of viable myocardium successfully revascularised.
  
  
  CONCLUSIONS
  In patients with chronic ischaemic LVD, improvement of dysfunctional but viable myocardium can be considerably delayed. Both the likelihood and the time course of functional improvement are related to the LGE, CR and the degree of contractile dysfunction at baseline. At 35 ± 6 months after revascularisation, patients with ≥55% of viable segments from all dysfunctional and revascularised segments significantly improve LVEF and experience reverse LV remodelling. A combination of LDD-CMR and LGE-CMR is a simple and powerful tool for identifying which patients with impaired LV function will benefit from revascularisation.
authors.affiliation: Department of Cardiovascular Medicine, Vilnius University; Centre of Cardiology and Angiology, Vilnius University Hospitals Santariskiu Klinikos, Santariskiu str. 2, 08661, Vilnius, Lithuania. sigita.glaveckaite@santa.lt.
authors.forename: Sigita
authors.initials: S
authors.lastname: Glaveckaite
authors.affiliation: Department of Radiology, Nuclear Medicine and Physics of Medicine, Vilnius University; Centre of Radiology and Nuclear Medicine, Vilnius University Hospitals Santariskiu Klinikos, Vilnius, Lithuania. nomeda.valeviciene@santa.lt.
authors.forename: Nomeda
authors.initials: N
authors.lastname: Valeviciene
authors.affiliation: Department of Radiology, Nuclear Medicine and Physics of Medicine, Vilnius University; Centre of Radiology and Nuclear Medicine, Vilnius University Hospitals Santariskiu Klinikos, Vilnius, Lithuania. darius.palionis@santa.lt.
authors.forename: Darius
authors.initials: D
authors.lastname: Palionis
authors.affiliation: Department of Cardiovascular Medicine, Vilnius University; Centre of Cardiology and Angiology, Vilnius University Hospitals Santariskiu Klinikos, Santariskiu str. 2, 08661, Vilnius, Lithuania. roma.puronaite@santa.lt.
authors.forename: Roma
authors.initials: R
authors.lastname: Puronaite
authors.affiliation: Department of Cardiovascular Medicine, Vilnius University; Centre of Cardiology and Angiology, Vilnius University Hospitals Santariskiu Klinikos, Santariskiu str. 2, 08661, Vilnius, Lithuania. pranas.serpytis@santa.lt.
authors.forename: Pranas
authors.initials: P
authors.lastname: Serpytis
authors.affiliation: Department of Cardiovascular Medicine, Vilnius University; Centre of Cardiology and Angiology, Vilnius University Hospitals Santariskiu Klinikos, Santariskiu str. 2, 08661, Vilnius, Lithuania. alius@cardio.lt.
authors.forename: Aleksandras
authors.initials: A
authors.lastname: Laucevicius
mesh_terms: D058665:Adrenergic beta-1 Receptor Agonists; D000368:Aged; D002908:Chronic Disease; D003287:Contrast Media; D004280:Dobutamine; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction; D009204:Myocardial Revascularization; D017682:Myocardial Stunning / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D020127:Recovery of Function; D013318:Stroke Volume; D013997:Time Factors; D014022:Tissue Survival; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy*; D016277:Ventricular Function, Left; D020257:Ventricular Remodeling
chemical_list: D058665:Adrenergic beta-1 Receptor Agonists; D003287:Contrast Media; D004280:Dobutamine; C064925:gadodiamide; D019786:Gadolinium DTPA