Key result
Coronary revascularization improves LVEF in ~44% of diabetics, but only myocardial viability predicts long-term survival.
Why the study?
The relation between myocardial viability, diabetes, coronary revascularisation, and outcome in patients with ischaemic cardiomyopathy was evaluated due to the association of diabetes with poor outcomes in coronary artery disease.
Does myocardial viability predict improvement in LVEF, prevention of LV remodelling, and survival after coronary revascularisation in both diabetic and non-diabetic patients with ischaemic cardiomyopathy?
Cohort (n=129)
Does myocardial viability predict improvement in LVEF, prevention of LV remodelling, and survival after coronary revascularisation in both diabetic and non-diabetic patients with ischaemic cardiomyopathy?
Myocardial viability, rather than diabetes status, predicts LVEF improvement, prevention of LV remodelling, and long-term survival after coronary revascularisation in patients with ischaemic cardiomyopathy.
Viability may inform post-revascularisation prognosis in ischaemic cardiomyopathy independent of diabetes; leaves open need for randomized confirmation.
BACKGROUND: Diabetes mellitus in patients with coronary artery disease is associated with poor outcome. In this study, the relation between myocardial viability, diabetes, coronary revascularisation and outcome was evaluated. METHODS: 129 patients (31 diabetic, 98 non-diabetic) with ischaemic cardiomyopathy underwent dobutamine stress echocardiography to assess myocardial viability. Patients with >or=4 viable segments were defined as viable and patients with <4 viable segments as nonviable. Left ventricular ejection fraction (LVEF) was assessed before and 9-12 months post-revascularisation. At the same time-points, LV volumes were measured to evaluate LV remodelling. Finally, cardiac events were noted during 5-year follow-up. RESULTS: The extent of viable myocardium was comparable between diabetic and non-diabetic patients. After revascularisation, LVEF increased >or=5% in 44% of diabetic and in 40% of non-diabetic patients. LVEF only improved in patients with viable myocardium. Ongoing LV remodelling occurred in 36% and 35% of diabetic and non-diabetic patients respectively, and was related to non-viability, whereas viability protected against ongoing LV remodelling, both in diabetic and non-diabetic patients. Viability was the only predictor of survival after revascularisation. CONCLUSIONS: Diabetic, viable patients with ischaemic LV dysfunction exhibit improvement in LVEF post-revascularisation with prevention of ongoing LV remodelling, similar to non-diabetic patients. Myocardial viability was also the only predictor of long-term outcome.
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Rizzello et al. (2005) conducted a cohort in Ischaemic cardiomyopathy (n=129). Diabetes vs. Non-diabetic was evaluated on LVEF improvement ≥5% post-revascularisation. Following coronary revascularisation, LVEF improved by ≥5% in 44% of diabetic and 40% of non-diabetic patients, with myocardial viability being the only predictor of long-term survival.
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