OBJECTIVES: To evaluate the impact of viability/ischemia before revascularization on improvement in systolic performance, reverse remodeling, symptoms and long-term prognosis post-revascularization. METHODS: Fifty patients underwent thallium-201 imaging before revascularization to assess stress-induced ischemia and viability ('jeopardized myocardium'). Left ventricular (LV) ejection fraction (EF), LV end-systolic volume index (LVESVI) and LV end-diastolic volume index (LVEDVI) were determined before and 3 months post-revascularization. Graft/vessel patency was controlled by repeat angiography. Long-term follow-up data (New York Heart Association (NYHA) class, hard events) were acquired up to 3 years. RESULTS: Patients with > or = 5 jeopardized segments on thallium-201 imaging demonstrated improvement of LVEF at 3 months (from 35+/-6 to 43+/-6%, P<0.001), with reverse remodeling (LVESVI decreased from 68+/-16 to 52+/-14 ml/m(2), P<0.001; LVEDVI decreased from 103+/-21 to 91+/-18 ml/m(2), P<0.001), and improved in NYHA class with excellent long-term prognosis (0% event rate). Conversely, patients with <5 jeopardized segments failed to improve in LVEF (34+/-4 vs. 33+/-7%, NS), and exhibited ongoing remodeling (LVESVI increased from 70+/-14 to 78+/-23 ml/m(2), P<0.001; LVEDVI increased from 106+/-19 to 116+/-25 ml/m(2), P<0.001), without improvement in NYHA class, and worse long-term prognosis (29% event rate). CONCLUSION: Patients with jeopardized myocardium benefit from revascularization with improvement in LVEF, reverse remodeling, improvement in NYHA class and favorable long-term prognosis.
OBJECTIVES: To evaluate the impact of viability/ischemia before revascularization on improvement in systolic performance, reverse remodeling, symptoms and long-term prognosis post-revascularization. METHODS: Fifty patients underwent thallium-201 imaging before revascularization to assess stress-induced ischemia and viability ('jeopardized myocardium'). Left ventricular (LV) ejection fraction (EF), LV end-systolic volume index (LVESVI) and LV end-diastolic volume index (LVEDVI) were determined before and 3 months post-revascularization. Graft/vessel patency was controlled by repeat angiography. Long-term follow-up data (New York Heart Association (NYHA) class, hard events) were acquired up to 3 years. RESULTS:Patients with > or = 5 jeopardized segments on thallium-201 imaging demonstrated improvement of LVEF at 3 months (from 35+/-6 to 43+/-6%, P<0.001), with reverse remodeling (LVESVI decreased from 68+/-16 to 52+/-14 ml/m(2), P<0.001; LVEDVI decreased from 103+/-21 to 91+/-18 ml/m(2), P<0.001), and improved in NYHA class with excellent long-term prognosis (0% event rate). Conversely, patients with <5 jeopardized segments failed to improve in LVEF (34+/-4 vs. 33+/-7%, NS), and exhibited ongoing remodeling (LVESVI increased from 70+/-14 to 78+/-23 ml/m(2), P<0.001; LVEDVI increased from 106+/-19 to 116+/-25 ml/m(2), P<0.001), without improvement in NYHA class, and worse long-term prognosis (29% event rate). CONCLUSION:Patients with jeopardized myocardium benefit from revascularization with improvement in LVEF, reverse remodeling, improvement in NYHA class and favorable long-term prognosis.
Authors: Mihai Gheorghiade; James D Flaherty; Gregg C Fonarow; Ravi V Desai; Richard Lee; David McGiffin; Thomas E Love; Inmaculada Aban; Eric J Eichhorn; Robert O Bonow; Ali Ahmed Journal: Int J Cardiol Date: 2010-06-16 Impact factor: 4.164
Authors: Riemer H J A Slart; Jeroen J Bax; Dirk J van Veldhuisen; Ernst E van der Wall; Rudi A Dierckx; Jaep de Boer; Pieter L Jager Journal: J Nucl Cardiol Date: 2006 Mar-Apr Impact factor: 5.952
Authors: Riemer H J A Slart; Jeroen J Bax; Dirk J van Veldhuisen; Ernst E van der Wall; Roy Irwan; Wim J Sluiter; Rudi A Dierckx; Jaep de Boer; Pieter L Jager Journal: Eur J Nucl Med Mol Imaging Date: 2006-03-08 Impact factor: 9.236