Revascularisation for post-ischaemic heart failure

Myocardial viability affects survival

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

Research output: Contribution to journalArticle

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Abstract

Background- Revascularisation for post-ischaemic heart failure (IHF) is a potential alternative to transplantation. We have previously demonstrated that the presence of a significant amount of viable dysfunctional myocardium (at least 8/16 left ventricular segments) is associated with significant improvements in left ventricular (LV) ejection fraction (EF) in patients (pts) with IHF 6 months following coronary artery bypass (CABG). The aim of this study was to assess the impact of revascularisation of viable myocardium on long-term survival. Methods-We studied 35 patients (31 male; mean age 58±7 years) with severe IHF (NYHA ≥ III), LVEF of 24±7% (range 10-35%; MUGA) and limited exercise capacity (Peak-VO 2=15±4ml/kg/ min). 21/35 pts had no angina. Myocardial viability was assessed with quantitative positron emission tomography and the glucose analogue [ 18F]-2-fluoro-2-deoxy-D-glucose (FDG) (viable segment=FDG uptake ≥0.25 μmol/min gram) in all pts before CABG. Patients were divided into two groups: 1- with ≥ 8 viable dysfunctional segments (mean 12±2; range 8-15) and 2- with 2. Results-Two pts died peri-operatively (mortality 5.7%) and 7 pts during follow-up (mean 33±14 months). All deaths were due to cardiac causes. Kaplan-Meyer survival analysis showed 86% survival for group 1 vs 57% for group 2 (P=0.02). Cox proportional hazard analysis identified ≥8 viable segments (P=0.006), LVEF (P=0.002) and age (P=0.01) as independent predictors of survival. (Graph Presented) Conclusion- Revascularisation for IHF can be associated with good long-term survival, which is critically dependent upon the amount of viable myocardium.

Original languageEnglish
JournalHeart
Volume81
Issue numberSUPPL. 1
Publication statusPublished - May 1999

Fingerprint

Heart Failure
Survival
Myocardium
Fluorodeoxyglucose F18
Deoxyglucose
Survival Analysis
Coronary Artery Bypass
Positron-Emission Tomography
Stroke Volume
Transplantation
Exercise
Glucose
Mortality

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Pagano, D., Lewis, M. E., Townend, J. N., Camici, P. G., & Bonser, R. S. (1999). Revascularisation for post-ischaemic heart failure: Myocardial viability affects survival. Heart, 81(SUPPL. 1).

Revascularisation for post-ischaemic heart failure : Myocardial viability affects survival. / Pagano, D.; Lewis, M. E.; Townend, J. N.; Camici, P. G.; Bonser, R. S.

In: Heart, Vol. 81, No. SUPPL. 1, 05.1999.

Research output: Contribution to journalArticle

Pagano, D, Lewis, ME, Townend, JN, Camici, PG & Bonser, RS 1999, 'Revascularisation for post-ischaemic heart failure: Myocardial viability affects survival', Heart, vol. 81, no. SUPPL. 1.
Pagano, D. ; Lewis, M. E. ; Townend, J. N. ; Camici, P. G. ; Bonser, R. S. / Revascularisation for post-ischaemic heart failure : Myocardial viability affects survival. In: Heart. 1999 ; Vol. 81, No. SUPPL. 1.
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abstract = "Background- Revascularisation for post-ischaemic heart failure (IHF) is a potential alternative to transplantation. We have previously demonstrated that the presence of a significant amount of viable dysfunctional myocardium (at least 8/16 left ventricular segments) is associated with significant improvements in left ventricular (LV) ejection fraction (EF) in patients (pts) with IHF 6 months following coronary artery bypass (CABG). The aim of this study was to assess the impact of revascularisation of viable myocardium on long-term survival. Methods-We studied 35 patients (31 male; mean age 58±7 years) with severe IHF (NYHA ≥ III), LVEF of 24±7{\%} (range 10-35{\%}; MUGA) and limited exercise capacity (Peak-VO 2=15±4ml/kg/ min). 21/35 pts had no angina. Myocardial viability was assessed with quantitative positron emission tomography and the glucose analogue [ 18F]-2-fluoro-2-deoxy-D-glucose (FDG) (viable segment=FDG uptake ≥0.25 μmol/min gram) in all pts before CABG. Patients were divided into two groups: 1- with ≥ 8 viable dysfunctional segments (mean 12±2; range 8-15) and 2- with 2. Results-Two pts died peri-operatively (mortality 5.7{\%}) and 7 pts during follow-up (mean 33±14 months). All deaths were due to cardiac causes. Kaplan-Meyer survival analysis showed 86{\%} survival for group 1 vs 57{\%} for group 2 (P=0.02). Cox proportional hazard analysis identified ≥8 viable segments (P=0.006), LVEF (P=0.002) and age (P=0.01) as independent predictors of survival. (Graph Presented) Conclusion- Revascularisation for IHF can be associated with good long-term survival, which is critically dependent upon the amount of viable myocardium.",
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