Having ≥4 viable segments on dobutamine stress echocardiography before revascularization was associated with improved LVEF and a lower long-term event rate compared to <4 segments (17% vs 47%, p<0.05).
Cohort (n=68)
Does the presence of ≥4 viable segments on dobutamine stress echocardiography predict improvement in LVEF, symptoms, and prognosis after revascularization in patients with severe ischemic left ventricular dysfunction?
Substantial myocardial viability (≥4 segments) detected by dobutamine stress echocardiography predicts LVEF improvement, symptom relief, and better long-term prognosis following revascularization in patients with severe ischemic LV dysfunction.
Absolute Event Rate: 17% vs 47%
p-value: p=< 0.05
OBJECTIVES: This study was designed to address, in patients with severe ischemic left ventricular dysfunction, whether dobutamine stress echocardiography (DSE) can predict improvement of left ventricular ejection fraction (LVEF), functional status and long-term prognosis after revascularization. BACKGROUND: Dobutamine stress echocardiography can predict improvement of wall motion after revascularization. The relation between viability, improvement of function, improvement of heart failure symptoms and long-term prognosis has not been studied. METHODS: We studied 68 patients with DSE before revascularization; 62 patients underwent resting echocardiography/radionuclide ventriculography before and three months after revascularization. Long-term follow-up data (New York Heart Association NYHA functional class, Canadian Cardiovascular Society CCS classification and events) were acquired up to two years. RESULTS: Patients with > or =4 viable segments on DSE (group A, n = 22) improved in LVEF at three months (from 27+/-6% to 33+/-7%, p < 0.01), in NYHA functional class (from 3.2+/-0.7 to 1.6+/-0.5, p < 0.01) and in CCS classification (from 2.9+/-0.3 to 1.2+/-0.4, p < 0.01); in patients with <4 viable segments (group B, n = 40) LVEF and NYHA functional class did not improve, whereas CCS classification improved significantly (from 3.0+/-0.8 to 1.3+/-0.5, p < 0.01). A higher event rate was observed at long-term follow-up in group B versus group A (47% vs. 17%, p < 0.05). CONCLUSIONS: Patients with substantial viability on DSE demonstrated improvement in LVEF and NYHA functional class after revascularization; viability was also associated with a favorable prognosis after revascularization.
Bax et al. (1999) conducted a cohort in chronic coronary artery disease and severe ischemic left ventricular dysfunction (n=68). ≥4 viable segments on dobutamine stress echocardiography vs. <4 viable segments was evaluated on Long-term events (p=< 0.05). Having ≥4 viable segments on dobutamine stress echocardiography before revascularization was associated with improved LVEF and a lower long-term event rate compared to <4 segments (17% vs 47%, p<0.05).