Myocardial viability assessment in ischemic cardiomyopathy: Benefits of coronary revascularization

Dreyfus, Gilles; Duboc, Denis; Blasco, Antoine; Vigoni, F.; Dubois, Claude; Brodaty, D; Lentdecker, P. De; Bachet, Jean; Goudot, B; Guilmet, D

doi:10.1016/0003-4975(94)90091-4

Cited by 170 publications

(68 citation statements)

References 14 publications

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“…However, other investigators [13] have shown that the presence of angina had no statistically significant predictive value with regard to long-term mortality and the recurrence of heart failure. Dreyfus and colleagues [22] emphasized the importance of using viability tests instead of clinical evaluation as a crucial determinant of patient selection and subsequent postoperative outcome. In our series, hibernating myocardium was a statistically significant predictor of immediate postoperative recovery, but the preoperative ischemia class and NYHA functional class were statistically significant predictors of long-term outcome.…”

Section: Predictors Of Late Outcomementioning

confidence: 99%

Long-Term Results of Coronary Artery Bypass Grafting in Patients With Left Ventricular Dysfunction

Hamad

Tan

Straten

et al. 2008

The Annals of Thoracic Surgery

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Background. In this prospective study, we investigated the determinants of long-term outcome, symptoms, and left ventricular function after coronary artery bypass grafting in patients with a moderate to severely decreased left ventricular ejection fraction.Methods. Between 1997 and 1998, 75 consecutive patients with moderate to severe left ventricular dysfunction underwent coronary artery bypass grafting procedures. The operative mortality rate was 4.0%, and the 72 survivors were monitored for 8 years. The end points were mortality, symptomatic status (New York Heart Association [NYHA] functional class), and left ventricular function.Results. The total survival rate after 8 years was 89.3%. During follow-up, 8 patients died. Death was attributed to a cardiac cause in 5 patients and to a noncardiac cause in 3. There was no statistically significant difference between preoperative and late postoperative NYHA functional class, despite a statistically significant im-

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Section: Predictors Of Late Outcomementioning

confidence: 99%

Long-Term Results of Coronary Artery Bypass Grafting in Patients With Left Ventricular Dysfunction

Hamad

Tan

Straten

et al. 2008

The Annals of Thoracic Surgery

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“…Multiple studies involving small numbers of patients and considering different end points have reported the prognostic value of estimating viability in patients with heart failure and the impact of revascularization among these patients with varying results. [7][8][9][10][11][12][13][14][15][16][17] Because of this uncertainty of the therapeutic value of aggressive interventions in this setting, we performed a propensity analysis on a large cohort to determine…”

mentioning

confidence: 99%

Myocardial Viability Testing and the Effect of Early Intervention in Patients With Advanced Left Ventricular Systolic Dysfunction

et al. 2006

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Background-The clinical value of revascularization and other procedures in patients with severe systolic heart failure is unclear. It has been suggested that assessing ischemia and viability by positron emission tomography (PET) with fluorodeoxyglucose (FDG) imaging may identify patients for whom revascularization may lead to improved survival. We performed a propensity analysis to determine whether there might be a survival advantage from revascularization. Methods and Results-We analyzed the survival of 765 consecutive patients (age 64Ϯ11 years, 80% men) with advanced left ventricular systolic dysfunction (ejection fraction Յ35%) and without significant valvular heart disease who underwent PET/FDG study at the Cleveland Clinic between 1997 and 2002. Early intervention was defined as any cardiac intervention (surgical or percutaneous) within the first 6 months of the PET/FDG study.

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“…Alternatives to transplantation have been used to improve survival and optimize clinical outcomes. These techniques include dynamic cardiomyoplasty 11 , myocardial revascularization in ischemic DCM 12 , partial left ventriculectomy 13 , biventricular pacemaker insertion 14 and valve reconstruction 3,15 or replacement 4 . FMI is a negative development in the clinical evolution of DCM that increases patient mortality 1 .…”

Section: Discussionmentioning

confidence: 99%

Mitral Valve Replacement and Remodeling of the Left Ventricle in Dilated Cardiomyopathy with Mitral Regurgitation: Initial Results

Lb¹,

Gaiotto

et al. 2002

Arq. Bras. Cardiol.

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Objective -This study evaluated the effects of a new method of mitral valve replacement on left ventricular (LV) remodeling and heart failure functional class. Methods -Eight patients (6 men) Original ArticleFunctional mitral insufficiency (FMI) is not a rare complication of advanced dilated cardiomyopathy (DCM). It reflects changes in left ventricular (LV) geometry, the subvalvular apparatus, the mitral valve area and transvalvular pressures. Patients with DCM and FMI have refractory congestive heart failure and high mortality when in functional class (FC) III or IV. Blondhein et al 1 reported survival rates over 32 months of 59% in patients with DCM without FMI, 26% in those with DCM and discrete FMI, and 17% in patients with DCM and moderate-to-severe FMI.Although heart transplantation is the standard treatment for advanced DCM, the few available donor hearts are insufficient to supply all patients awaiting the organ. Stevenson et al 2 reported a mortality rate of 46% per year in patients with an indication for cardiac transplantation who were waiting for a donor. Others are excluded from the organ waiting list because of advanced age or clinical contraindications.Alternatives to heart transplantation have been proposed to improve quality of life and decrease mortality in these patients. FMI reflects the worst clinical evolution of DCM, and 2 techniques have been used to correct it. The first technique, mitral valve reconstruction, was proposed by Bolling et al 3 . This technique involves reduction of the dilated mitral annulus, thus, LV remodeling because of a decrease in the base diameter. The second technique, mitral valve replacement, was proposed by Buffolo et al 4 . This technique corrects valvular insufficiency and decreases LV base diameter. It involves implanting a small-diameter prosthesis and anchoring the 2 anterior valve hemileaflets, with their respective chordae tendineae, to the mitral annulus to assist the remodeling process.We used mitral valve replacement to treat patients with DCM and FMI in this study. Our primary objective was to evaluate the short-term effects of valve replacement with new positioning of the chordae tendineae on LV remodeling and FC. First, we altered the subvalvular apparatus to isolate 4 pillars with chordae tendineae, 2 from the anterior leaflet

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Myocardial viability assessment in ischemic cardiomyopathy: Benefits of coronary revascularization

Cited by 170 publications

References 14 publications

Long-Term Results of Coronary Artery Bypass Grafting in Patients With Left Ventricular Dysfunction

Long-Term Results of Coronary Artery Bypass Grafting in Patients With Left Ventricular Dysfunction

Myocardial Viability Testing and the Effect of Early Intervention in Patients With Advanced Left Ventricular Systolic Dysfunction

Mitral Valve Replacement and Remodeling of the Left Ventricle in Dilated Cardiomyopathy with Mitral Regurgitation: Initial Results

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