Coronary artery bypass surgery as treatment for ischemic heart failure

The predictive value of viability assessment with quantitative positron emission tomography for symptomatic and functional outcome

D. Pagano, J. N. Townend, W. A. Littler, R. Horton, P. G. Camici, R. S. Bonser

Research output: Contribution to journalArticle

82 Citations (Scopus)

Abstract

Objectives: To determine the predictive value of quantitative evaluation of myocardial viability on changes in left ventricular function, exercise capacity, and quality of life after coronary artery bypass grafting in patients with ischemic heart failure (congestive heart failure, New York Heart Association class ≤ III) with and without angina. Methods: Thirty- five patients, 14 with congestive heart failure and angina (CHF-angina) and 21 with congestive heart failure without angina (CHF-no angina) were studied at baseline and 6 months after coronary bypass grafting. Left ventricular function was evaluated with transthoracic echocardiography and radionuclide ventriculography. Myocardial viability was assessed with [18F]-2-fluoro-2- deoxy-D-glucose using positron emission tomography. Peak aerobic capacity (peak oxygen consumption) and anaerobic threshold were assessed with treadmill exercise test and quality of life with a questionnaire. Results: A total of 286 of 336 dysfunctional left ventricular segments were viable. There were two perioperative deaths (5.7%) and three late deaths. Left ventricular ejection fraction increased from 23% ± 7% to 32% ± 9% (p <0.0001), and a linear correlation was found between the number of viable segments and the changes in ejection fraction (r = 0.65;p = 0.0001). Receiver operating characteristics curve identified eight viable segments as the best predictor for increase of ejection fraction more than 5 percentage points. Peak oxygen consumption increased from 15 ± 4 to 22 ± 5 ml/kg per minute (p <0.0001). Preoperatively, anaerobic threshold was identified in one patient from the CHF-angina group and in all from the CHF-no angina group and increased from 13 ± 4 to 19 ± 4 ml/kg per minute (p <0.0001). Quality of life scores improved significantly in both groups. No correlation was found between the amount of viable dysfunctional myocardium and changes in exercise capacity or quality of life. Conclusions: In patients with postischemic congestive heart failure the amount of viable myocardium dictates the degree of improvement in left ventricular function after revascularization.

Original languageEnglish
Pages (from-to)791-799
Number of pages9
JournalJournal of Thoracic and Cardiovascular Surgery
Volume115
Issue number4
DOIs
Publication statusPublished - 1998

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Coronary Artery Bypass
Positron-Emission Tomography
Heart Failure
Left Ventricular Function
Quality of Life
Anaerobic Threshold
Exercise Test
Oxygen Consumption
Myocardium
Therapeutics
Exercise
Radionuclide Ventriculography
Fluorodeoxyglucose F18
ROC Curve
Stroke Volume
Echocardiography

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

@article{9b724d395ecc41c18e362ec93e0fea5a,
title = "Coronary artery bypass surgery as treatment for ischemic heart failure: The predictive value of viability assessment with quantitative positron emission tomography for symptomatic and functional outcome",
abstract = "Objectives: To determine the predictive value of quantitative evaluation of myocardial viability on changes in left ventricular function, exercise capacity, and quality of life after coronary artery bypass grafting in patients with ischemic heart failure (congestive heart failure, New York Heart Association class ≤ III) with and without angina. Methods: Thirty- five patients, 14 with congestive heart failure and angina (CHF-angina) and 21 with congestive heart failure without angina (CHF-no angina) were studied at baseline and 6 months after coronary bypass grafting. Left ventricular function was evaluated with transthoracic echocardiography and radionuclide ventriculography. Myocardial viability was assessed with [18F]-2-fluoro-2- deoxy-D-glucose using positron emission tomography. Peak aerobic capacity (peak oxygen consumption) and anaerobic threshold were assessed with treadmill exercise test and quality of life with a questionnaire. Results: A total of 286 of 336 dysfunctional left ventricular segments were viable. There were two perioperative deaths (5.7{\%}) and three late deaths. Left ventricular ejection fraction increased from 23{\%} ± 7{\%} to 32{\%} ± 9{\%} (p <0.0001), and a linear correlation was found between the number of viable segments and the changes in ejection fraction (r = 0.65;p = 0.0001). Receiver operating characteristics curve identified eight viable segments as the best predictor for increase of ejection fraction more than 5 percentage points. Peak oxygen consumption increased from 15 ± 4 to 22 ± 5 ml/kg per minute (p <0.0001). Preoperatively, anaerobic threshold was identified in one patient from the CHF-angina group and in all from the CHF-no angina group and increased from 13 ± 4 to 19 ± 4 ml/kg per minute (p <0.0001). Quality of life scores improved significantly in both groups. No correlation was found between the amount of viable dysfunctional myocardium and changes in exercise capacity or quality of life. Conclusions: In patients with postischemic congestive heart failure the amount of viable myocardium dictates the degree of improvement in left ventricular function after revascularization.",
author = "D. Pagano and Townend, {J. N.} and Littler, {W. A.} and R. Horton and Camici, {P. G.} and Bonser, {R. S.}",
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T1 - Coronary artery bypass surgery as treatment for ischemic heart failure

T2 - The predictive value of viability assessment with quantitative positron emission tomography for symptomatic and functional outcome

AU - Pagano, D.

AU - Townend, J. N.

AU - Littler, W. A.

AU - Horton, R.

AU - Camici, P. G.

AU - Bonser, R. S.

PY - 1998

Y1 - 1998

N2 - Objectives: To determine the predictive value of quantitative evaluation of myocardial viability on changes in left ventricular function, exercise capacity, and quality of life after coronary artery bypass grafting in patients with ischemic heart failure (congestive heart failure, New York Heart Association class ≤ III) with and without angina. Methods: Thirty- five patients, 14 with congestive heart failure and angina (CHF-angina) and 21 with congestive heart failure without angina (CHF-no angina) were studied at baseline and 6 months after coronary bypass grafting. Left ventricular function was evaluated with transthoracic echocardiography and radionuclide ventriculography. Myocardial viability was assessed with [18F]-2-fluoro-2- deoxy-D-glucose using positron emission tomography. Peak aerobic capacity (peak oxygen consumption) and anaerobic threshold were assessed with treadmill exercise test and quality of life with a questionnaire. Results: A total of 286 of 336 dysfunctional left ventricular segments were viable. There were two perioperative deaths (5.7%) and three late deaths. Left ventricular ejection fraction increased from 23% ± 7% to 32% ± 9% (p <0.0001), and a linear correlation was found between the number of viable segments and the changes in ejection fraction (r = 0.65;p = 0.0001). Receiver operating characteristics curve identified eight viable segments as the best predictor for increase of ejection fraction more than 5 percentage points. Peak oxygen consumption increased from 15 ± 4 to 22 ± 5 ml/kg per minute (p <0.0001). Preoperatively, anaerobic threshold was identified in one patient from the CHF-angina group and in all from the CHF-no angina group and increased from 13 ± 4 to 19 ± 4 ml/kg per minute (p <0.0001). Quality of life scores improved significantly in both groups. No correlation was found between the amount of viable dysfunctional myocardium and changes in exercise capacity or quality of life. Conclusions: In patients with postischemic congestive heart failure the amount of viable myocardium dictates the degree of improvement in left ventricular function after revascularization.

AB - Objectives: To determine the predictive value of quantitative evaluation of myocardial viability on changes in left ventricular function, exercise capacity, and quality of life after coronary artery bypass grafting in patients with ischemic heart failure (congestive heart failure, New York Heart Association class ≤ III) with and without angina. Methods: Thirty- five patients, 14 with congestive heart failure and angina (CHF-angina) and 21 with congestive heart failure without angina (CHF-no angina) were studied at baseline and 6 months after coronary bypass grafting. Left ventricular function was evaluated with transthoracic echocardiography and radionuclide ventriculography. Myocardial viability was assessed with [18F]-2-fluoro-2- deoxy-D-glucose using positron emission tomography. Peak aerobic capacity (peak oxygen consumption) and anaerobic threshold were assessed with treadmill exercise test and quality of life with a questionnaire. Results: A total of 286 of 336 dysfunctional left ventricular segments were viable. There were two perioperative deaths (5.7%) and three late deaths. Left ventricular ejection fraction increased from 23% ± 7% to 32% ± 9% (p <0.0001), and a linear correlation was found between the number of viable segments and the changes in ejection fraction (r = 0.65;p = 0.0001). Receiver operating characteristics curve identified eight viable segments as the best predictor for increase of ejection fraction more than 5 percentage points. Peak oxygen consumption increased from 15 ± 4 to 22 ± 5 ml/kg per minute (p <0.0001). Preoperatively, anaerobic threshold was identified in one patient from the CHF-angina group and in all from the CHF-no angina group and increased from 13 ± 4 to 19 ± 4 ml/kg per minute (p <0.0001). Quality of life scores improved significantly in both groups. No correlation was found between the amount of viable dysfunctional myocardium and changes in exercise capacity or quality of life. Conclusions: In patients with postischemic congestive heart failure the amount of viable myocardium dictates the degree of improvement in left ventricular function after revascularization.

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