Key result
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).
Why the study?
Does myocardial viability and ischaemia assessed by dobutamine stress echocardiography predict cardiac death in patients with ischaemic cardiomyopathy undergoing coronary revascularisation?
Cohort (n=128)
Does myocardial viability and ischaemia assessed by dobutamine stress echocardiography predict cardiac death in patients with ischaemic cardiomyopathy undergoing coronary revascularisation?
Hazard Ratio: 0.34
p-value: p=0.02
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.
Viability assessment may refine post-revascularisation prognosis in ischaemic cardiomyopathy; hypothesis-generating and requires prospective validation before guiding care.
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 < 0.001), baseline LVEF (HR 0.90, p < 0.0001), wall motion score index (WMSI) at rest (HR 4.02, p = 0.0006), low dose DSE (HR 7.01, p < 0.0001), peak dose DSE (HR 4.62, p < 0.0001), the extent of scar (HR 1.39, p < 0.0001), and the presence of CR in > 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.
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Rizzello et al. (2005) 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).
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