In patients with ischaemic cardiomyopathy undergoing revascularisation, myocardial viability (contractile reserve in ≥25% of dysfunctional segments) predicted a lower risk of cardiac death (HR 0.34, p=0.02).
Cohort (n=128)
Does myocardial viability and ischaemia assessed by dobutamine stress echocardiography predict cardiac death in patients with ischaemic cardiomyopathy undergoing coronary revascularisation?
In patients with ischemic cardiomyopathy undergoing revascularization, myocardial viability (contractile reserve) assessed by dobutamine stress echocardiography is a strong predictor of long-term prognosis, whereas ischemia does not provide additional predictive value.
Hazard Ratio: 0.34
p-value: p=0.02
OBJECTIVE: To evaluate the relative merits of viability and ischaemia for prognosis after revascularisation. METHODS: Low-high dose dobutamine stress echocardiography (DSE) was performed before revascularisation in 128 consecutive patients with ischaemic cardiomyopathy (mean (SD) left ventricular ejection fraction (LVEF) 31 (8)%). Viability (defined as contractile reserve (CR)) and ischaemia were assessed during low and high dose dobutamine infusion, respectively. Cardiac death was evaluated during a five year follow up. Clinical, angiographic, and echocardiographic data were analysed to identify predictors of events. RESULTS: Univariable predictors of cardiac death were the presence of multivessel disease (hazard ratio (HR) 0.21, p or = 25% of dysfunctional segments (HR 0.34, p = 0.02). The best multivariable model to predict cardiac death included the presence of multivessel disease, WMSI at low dose DSE, and the presence of CR in > or = 25% of the severely dysfunctional segments (HR 9.62, p < 0.0001). Inclusion of ischaemia in the model did not provide additional predictive value. CONCLUSION: The findings of the present study illustrate that in patients with ischaemic cardiomyopathy, the extent of viability (CR) is a strong predictor of long term prognosis after revascularisation. Ischaemia did not add significantly in predicting outcome.
Rizzello et al. (Wed,) conducted a cohort in Ischaemic cardiomyopathy (n=128). Myocardial viability (contractile reserve in ≥25% of dysfunctional segments) vs. Absence of significant myocardial viability was evaluated on Cardiac death (HR 0.34, p=0.02). In patients with ischaemic cardiomyopathy undergoing revascularisation, myocardial viability (contractile reserve in ≥25% of dysfunctional segments) predicted a lower risk of cardiac death (HR 0.34, p=0.02).