PMID- 10362184
OWN - NLM
STAT- MEDLINE
DCOM- 19990622
LR  - 20190708
IS  - 0735-1097 (Print)
IS  - 0735-1097 (Linking)
VI  - 33
IP  - 7
DP  - 1999 Jun
TI  - Myocardial viability on echocardiography predicts long-term survival after 
      revascularization in patients with ischemic congestive heart failure.
PG  - 1848-54
AB  - OBJECTIVES: This study was conducted to evaluate the effect of revascularization 
      on survival in patients with congestive heart failure (CHF) due to ischemic left 
      ventricular (LV) systolic dysfunction based on the presence of myocardial 
      viability (MV). BACKGROUND: There are insufficient data regarding the survival 
      benefit of revascularization in patients with CHF due to ischemic LV systolic 
      dysfunction. METHODS: Follow-up was obtained in 87 consecutive patients with CHF 
      due to ischemic LV systolic dysfunction (New York Heart Association [NYHA] class 
      II-IV; LV ejection fraction <0.35) who underwent low-dose dobutamine 
      echocardiography (DE). MV within each of 12 myocardial segments representing the 
      LV was defined as having either: 1) normal function or mild dyssynergy at rest; 
      2) severe resting dyssynergy that improved on DE, or 3) worsening of function on 
      DE except in the case of akinesia. RESULTS: At a mean follow-up of 40+/-17 
      months, 37 patients had received revascularization on the basis of clinical 
      grounds, and there were 22 (25%) cardiac-related deaths. Multivariate Cox 
      regression analysis revealed that when patients with at least five segments 
      showing MV underwent revascularization, mortality was reduced by an average of 
      93% (confidence interval of 22% to 99%), which was associated with improvement in 
      NYHA class as well as LV ejection fraction. Patients with less than five segments 
      showing MV who underwent revascularization (and thus, showing mostly scar), and 
      those with at least 5 segments demonstrating MV who were treated medically, had a 
      much higher mortality. CONCLUSIONS: Revascularization produces a clear survival 
      benefit in patients with CHF due to ischemic LV systolic dysfunction who have a 
      significant region of the LV demonstrating MV. These data may have wide-ranging 
      implications in the management of patients with coronary artery disease whose 
      main clinical presentation is CHF.
FAU - Senior, R
AU  - Senior R
AD  - Department of Cardiovascular Medicine, Northwick Park Hospital and Institute of 
      Medical Research, Harrow, United Kingdom.
FAU - Kaul, S
AU  - Kaul S
FAU - Lahiri, A
AU  - Lahiri A
LA  - eng
GR  - HL-48890/HL/NHLBI NIH HHS/United States
PT  - Comparative Study
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PT  - Research Support, U.S. Gov't, P.H.S.
PL  - United States
TA  - J Am Coll Cardiol
JT  - Journal of the American College of Cardiology
JID - 8301365
RN  - 0 (Cardiotonic Agents)
RN  - 3S12J47372 (Dobutamine)
SB  - IM
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Cardiotonic Agents/administration & dosage
MH  - Circadian Rhythm/*physiology
MH  - Coronary Angiography
MH  - Dobutamine/administration & dosage
MH  - *Echocardiography
MH  - Exercise Test
MH  - Female
MH  - Follow-Up Studies
MH  - Heart Failure/diagnostic imaging/*mortality/therapy
MH  - Humans
MH  - Injections, Intravenous
MH  - Male
MH  - Middle Aged
MH  - Myocardial Contraction
MH  - Myocardial Ischemia/diagnostic imaging/*mortality/therapy
MH  - *Myocardial Revascularization
MH  - Predictive Value of Tests
MH  - Prospective Studies
MH  - ROC Curve
MH  - Survival Rate
MH  - Ventricular Dysfunction, Left/diagnostic imaging/mortality/therapy
EDAT- 1999/06/11 00:00
MHDA- 1999/06/11 00:01
CRDT- 1999/06/11 00:00
PHST- 1999/06/11 00:00 [pubmed]
PHST- 1999/06/11 00:01 [medline]
PHST- 1999/06/11 00:00 [entrez]
AID - S0735-1097(99)00102-3 [pii]
AID - 10.1016/s0735-1097(99)00102-3 [doi]
PST - ppublish
SO  - J Am Coll Cardiol. 1999 Jun;33(7):1848-54. doi: 10.1016/s0735-1097(99)00102-3.