Improved Outcome After Coronary Bypass Surgery in Patients With Ischemic Cardiomyopathy and Residual Myocardial Viability

Abstract

We conclude that resting 201Tl scintigraphy may be useful in preoperative risk stratification for identification of patients more likely to benefit from surgical revascularization.

Prognostic Value of Myocardial Ischemia and Viability in Patients With Chronic Left Ventricular Ischemic Dysfunction

“…Whereas in the studies of Eitzman et al, 18 Di Carli et al, 20 and Lee et al, 21 patients with nonviable myocardium had an excellent prognosis (3-year survival, 82% to 100%), these patients definitely had a poorer outcome in our study. Our results are nonetheless in agreement with those of Yoshida and Gould, 22 who used 82 Rb and PET to identify myocardial viability, and with the more recent reports of Pagley et al 23 and Petretta et al, 24 who used thallium scintigraphy as a means of identifying viable myocardium. They also concur with those of Williams et al, 25 who studied 136 medically treated patients with LV ischemic dysfunction with low-dose dobutamine echocardiography.…”

Can late gadolinium enhancement by cardiovascular magnetic resonance identify coronary artery disease as the etiology of new onset congestive heart failure?

“…Discerning the etiology of LV dysfunction is often the first step in management. Underlying coronary artery disease (CAD) and ischemia are responsible for approximately two-thirds of all systolic dysfunction [1] and delineating it from nonischemic causes has essential therapeutic [2,3,4] and prognostic [5,6,7,8] implications. The electrocardiogram (ECG) [9], presence of anginal chest pain [10], and elevated troponins [11] are unable to accurately differentiate ischemic from nonischemic cardiomyopathy (NICM).…”

Steps Forward in the Assessment of Myocardial Viability in Left Ventricular Dysfunction

“…Lombardo and colleagues 41 recently reported that after revascularization of dyssynergic but viable myocardium, contractile reserve was recovered even in segments in which resting function did not itself improve. Pagley and coworkers 4 observed that among patients with severe CAD and LV dysfunction undergoing revascularization, those patients with more preserved viability by thallium imaging had a significantly more favorable eventfree survival compared with patients with less evidence of preserved viability. Follow-up LV function was not uniformly reported among patients in this study.…”

“…This is perhaps most important and most relevant in patients with a clinical syndrome of heart failure and a significant degree of global LV dysfunction, a subset of whom will derive considerable benefit in terms of outcome and recovery of LV function after revascularization. Several studies have now suggested that revascularization in the setting of LV dysfunction and significantly retained myocardial viability is associated with an improved natural history [1][2][3][4][5] as well as improvement in heart failure symptoms and functional capacity. 6 Besides providing clinically relevant data, noninvasive scintigraphic and echocardiographic techniques have also helped to illuminate the complex perfusion, metabolic, and functional correlates of these states of reversible LV dysfunction, which remain subjects for debate.…”