Coronary revascularisation for postischaemic heart failure: How myocardial viability affects survival

D. Pagano, M. E. Lewis, J. N. Townend, P. Davies, P. G. Camici, R. S. Bonser

Research output: Contribution to journalArticlepeer-review

Abstract

Objective - To assess the impact of revascularisation of viable myocardium on survival in patients with postischaemic heart failure. Methods - 35 patients (mean (SD) age 58 (7) years) with severe heart failure (New York Heart Association (NYHA) functional class ≥ III), mean left ventricular ejection fraction (LVEF) 24 (7)% (range 10-35%), and limited exercise capacity (peak oxygen consumption (VO2) 15 (4) ml/kg/min) were studied. 21135 patients had no angina. Myocardial viability was assessed with quantitative positron emission tomography and the glucose analogue 13F- fluorodeoxyglucose (FDG) (viable segment = FDG uptake ≥ 0.25 μmol/min/g) in all patients before coronary artery bypass grafting. Patients were divided into two groups: group 1, ≥ 8 viable dysfunctional segments (mean 12 (2), range 8-15); and group 2, <8 viable dysfunctional segments (mean 3.5 (3), range 0-7). The two groups were comparable for age, sex, NYHA class, LVEF, and peak VO2. Results - Two patients died perioperatively and seven patients died during follow up (mean 33 (14) months). All deaths were from cardiac causes. Kaplan-Meyer survival analysis showed 86% survival for group 1 patients versus 57% for group 2 (p = 0.03). Analysis by Cox proportional hazard model revealed three independent factors for cardiac event free survival: presence of ≥ 8 viable segments (p = 0.006); preoperative LVEF (p = 0.002); and patient age (p = 0.01). Conclusion - Revascularisation for postischaemic heart failure can be associated with good survival, which is critically dependent upon the amount of viable myocardium.

Original languageEnglish
Pages (from-to)684-688
Number of pages5
JournalHeart
Volume82
Issue number6
Publication statusPublished - 1999

Keywords

  • Heart failure
  • Hibernating myocardium
  • Myocardial viability
  • Survival

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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