January 5, 2007
View Full PaperMyocardial positive pre-ejection velocity accurately detects presence of viable myocardium, predicts recovery of left ventricular function and bears a prognostic value after surgical revascularization
Key Result
Myocardial positive pre-ejection velocity (+Vic) in ≥5 dysfunctional segments was associated with significantly fewer cardiac events compared to <5 segments (10% vs 54%; P<0.001).
Study Design
Type
Observational (n=119)
Structured PICO
Does tissue Doppler imaging-derived myocardial positive pre-ejection velocity (+Vic) accurately detect myocardial viability and predict LV function recovery in patients with chronic ischaemic LV dysfunction?
P
Population
119 patients with chronic ischaemic left ventricular (LV) dysfunction (54 treated medically, 65 undergoing CABG), mean age 67 +/- 9 years, mean LV ejection fraction 30 +/- 6%.
I
Intervention
Tissue Doppler imaging-derived myocardial positive pre-ejection velocity (+Vic) assessment
C
Comparator
Standard viability assessment (dobutamine stress echocardiography, fluorine-18 fluorodeoxyglucose PET, and contrast-enhanced MRI)
O
Outcome
Detection of viable myocardium (agreement with DSE, PET, and MRI) and recovery of left ventricular function (>=10% increase in LV EF between baseline and 6-month echocardiogram)surrogate
Tissue Doppler imaging-derived +Vic is an accurate marker for detecting myocardial viability, predicting LVEF recovery, and assessing prognosis in patients with chronic ischemic LV dysfunction.
Main Result
Absolute Event Rate: 10% vs 54%
p-value: p=<0.001
Abstract
AIMS: To assess the accuracy of tissue Doppler imaging-derived myocardial positive pre-ejection velocity (+Vic) in detecting myocardial viability defined by dobutamine stress echocardiography (DSE), fluorine-18 fluorodeoxyglucose positron emission tomography (PET), and contrast-enhanced magnetic resonance imaging (MRI), and in predicting recovery of left ventricular (LV) function after coronary artery bypass grafting (CABG) in patients with chronic ischaemic LV dysfunction. METHODS AND RESULTS: +Vic in dysfunctional segments was recorded in 54 patients treated medically and 65 patients undergoing CABG age 67 +/- 9 year; LV ejection fraction (EF) 30 +/- 6%. A good agreement was observed between +Vic and detection of viable myocardium at DSE, PET, and MRI (kappa = 0.76). The presence of +Vic in greater than or equal to five dysfunctional segments had the highest sensitivity (93%) and specificity (60%) to identify patients (n = 28) with > or =10% increase in LV EF between baseline and 6-month echocardiogram. During follow-up (median 333 days, interquartile range 209-490 days), 13 cardiac events (6 deaths, 7 hospitalizations) occurred in 24 patients with small extent of viable myocardium ( or =5 + Vic (54% vs. 10%; P < 0.001). CONCLUSION: The extent of +Vic in dysfunctional segments accurately predicts extent of viable myocardium and bears a clinical prognostic value in patients with ischaemic LV dysfunction considered for CABG.