August 17, 2026Journal of the American College of Cardiology363 citationsOpen Access
Improvement of left ventricular ejection fraction, heart failure symptoms and prognosis after revascularization in patients with chronic coronary artery disease and viable myocardium detected by dobutamine stress echocardiography
Key Result
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).
Key Points
- To determine whether dobutamine stress echocardiography predicts improvements in left ventricular ejection fraction, functional symptoms, and long-term prognosis after coronary revascularization in patients with severe ischemic left ventricular dysfunction.
- Evaluated 68 patients with severe ischemic left ventricular dysfunction using dobutamine stress echocardiography (DSE) prior to surgical or percutaneous revascularization.
- Assessed left ventricular ejection fraction (LVEF) with resting echocardiography or radionuclide ventriculography before and 3 months after revascularization in 62 patients.
- Tracked New York Heart Association (NYHA) functional class, Canadian Cardiovascular Society (CCS) angina class, and clinical event rates up to 2 years of follow-up.
- Patients with ≥4 viable segments (Group A, n=22) significantly improved LVEF from 27±6% to 33±7% (p<0.01) and NYHA functional class from 3.2±0.7 to 1.6±0.5 (p<0.01) at 3 months, whereas patients with <4 viable segments (Group B, n=40) showed no significant functional or LVEF recovery.
- Angina symptoms improved significantly across both groups, with CCS scores decreasing from 2.9±0.3 to 1.2±0.4 in Group A and from 3.0±0.8 to 1.3±0.5 in Group B (both p<0.01).
- Patients with <4 viable segments experienced a significantly higher adverse event rate over up to 2 years of follow-up compared to those with ≥4 viable segments (47% vs. 17%, p<0.05).
Study Design
Type
Cohort (n=68)
Structured PICO
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?
P
Population
68 patients with severe ischemic left ventricular dysfunction evaluated with dobutamine stress echocardiography before revascularization, followed for up to two years.
E
Exposure
Revascularization in patients with substantial myocardial viability (≥4 viable segments on dobutamine stress echocardiography, n=22).
C
Comparator
Revascularization in patients with limited myocardial viability (<4 viable segments on dobutamine stress echocardiography, n=40).
O
Outcome
Improvement of left ventricular ejection fraction (LVEF), New York Heart Association (NYHA) functional class, and Canadian Cardiovascular Society (CCS) classification at 3 months, and long-term events up to 2 years.
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.
Main Result
Absolute Event Rate: 17% vs 47%
p-value: p=< 0.05
Abstract
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.