Abstract
Currently, the prediction of improvement of left ventricular (LV) ejection fraction
(EF) after revascularization in patients with ischemic cardiomyopathy relies only
on viable myocardium extent, whereas both the amount of viable and scar tissue may
be important. A model was developed, based on the amount of viable and nonviable myocardium,
to predict functional recovery. Viable and scarred myocardium was defined by dobutamine
stress echocardiography (DSE) in 108 consecutive patients. LVEF before and 9 to 12
months after revascularization was assessed by radionuclide ventriculography; an improvement
of ≥5% was considered significant. In the 1,089 dysfunctional segments (63%), DSE
elicited biphasic response in 216 segments (20%), sustained improvement in 205 (19%),
worsening in 43 (4%), and no change in 625 (57%). LVEF improved in 39 patients (36%).
Only the numbers of biphasic and scar segments were predictors of improvement or no
improvement of LVEF (odds ratio 1.5, 95% confidence interval 1.2 to 1.7, p <0.0001
for biphasic segments; odds ratio 0.8, 95% confidence interval 0.7 to 0.9, p <0.0005
for scarred segments). The sustained improvement and worsening pattern were not predictive
of improvement or no improvement. A regression function, based on the number of scar
and biphasic segments, showed that the likelihood of recovery was 85% in patients
with extensive biphasic tissue and no scars and 11% in patients with extensive scars
and no biphasic myocardium. Patients with a mixture of scar and biphasic tissue had
an intermediate likelihood of improvement (50%). In patients with ischemic cardiomyopathy
and a mixture of viable and nonviable tissue, both numbers of viable and nonviable
segments should be considered to accurately predict functional recovery after revascularization.
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Article Info
Publication History
Accepted:
March 14,
2003
Received in revised form:
March 14,
2003
Received:
December 27,
2002
Identification
Copyright
© 2003 Excerpta Medica Inc. Published by Elsevier Inc. All rights reserved.
