The natural history of myocardium awaiting revascularisation in patients with impaired left ventricular function

Michael Pitt, David Dutka, Domenico Pagano, Paolo Camici, Robert Bonser

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Aims: Our aim was to follow changes in myocardial function and physiology in patients awaiting coronary artery bypass surgery (CABG) and relate changes to post-revascularisation functional response. Methods: and results In 21 patients with CAD and LV dysfunction, myocardial glucose utilisation (MGU) and blood flow (MBF) were measured with positron emission tomography using F-18-fluorodeoxyglucose and oxygen-15-labelled water. Left ventricular function, MGU, and MBF were re-assessed after one year, immediately prior to CABG. At baseline, dysfunctional myocardium displayed a reduction in MGU, hyperaemic MBF, and coronary vasodilator reserve (CVR) compared to normally functioning muscle. In the year preceding CABG, the overall wall motion score index increased (2. 09 ± 0.65 vs. 2.3 ± 0.7, p = 0.0001) and the LV ejection fraction decreased (30.6 ± 11.1% vs. 27.3 ± 11.5%, p <0.001). LVEF fell in 14 patients (28.7 ± 9.4 vs. 23.8, p <0.0001). Aggregate regional wall motion worsened in 15 patients. In contrast to myocardium displaying stable function at echocardiography, myocardium with evidence of deterioration showed a parallel decrease in hyperaemic MBF and CVR (1.57 ± 0.67 vs. 1.19 ± 0.7 ml/min/g, [p = 0.004] and 1.9 ± 0.75 vs. 1.33 ± 0.6, [p = 0.005], respectively). Such myocardium displayed attenuated recovery postoperatively (21/68 [31%] LV segments) versus 'waiting-time' stable myocardium (98/169 [58%], p = 0.0002). Conclusion: Delayed revascularisation in ischaemic left ventricutar impairment results in declining function and a reduced likelihood of contractile improvement.

Original languageEnglish
Pages (from-to)500-507
Number of pages8
JournalEuropean Heart Journal
Volume25
Issue number6
DOIs
Publication statusPublished - Mar 2004

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Natural History
Left Ventricular Function
Myocardium
Coronary Artery Bypass
Vasodilator Agents
Glucose
Fluorodeoxyglucose F18
Positron-Emission Tomography
Echocardiography
Blood Glucose
Oxygen
Muscles
Water

Keywords

  • Blood flow
  • Coronary disease
  • Metabolism
  • Revascularisation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

The natural history of myocardium awaiting revascularisation in patients with impaired left ventricular function. / Pitt, Michael; Dutka, David; Pagano, Domenico; Camici, Paolo; Bonser, Robert.

In: European Heart Journal, Vol. 25, No. 6, 03.2004, p. 500-507.

Research output: Contribution to journalArticle

Pitt, Michael ; Dutka, David ; Pagano, Domenico ; Camici, Paolo ; Bonser, Robert. / The natural history of myocardium awaiting revascularisation in patients with impaired left ventricular function. In: European Heart Journal. 2004 ; Vol. 25, No. 6. pp. 500-507.
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abstract = "Aims: Our aim was to follow changes in myocardial function and physiology in patients awaiting coronary artery bypass surgery (CABG) and relate changes to post-revascularisation functional response. Methods: and results In 21 patients with CAD and LV dysfunction, myocardial glucose utilisation (MGU) and blood flow (MBF) were measured with positron emission tomography using F-18-fluorodeoxyglucose and oxygen-15-labelled water. Left ventricular function, MGU, and MBF were re-assessed after one year, immediately prior to CABG. At baseline, dysfunctional myocardium displayed a reduction in MGU, hyperaemic MBF, and coronary vasodilator reserve (CVR) compared to normally functioning muscle. In the year preceding CABG, the overall wall motion score index increased (2. 09 ± 0.65 vs. 2.3 ± 0.7, p = 0.0001) and the LV ejection fraction decreased (30.6 ± 11.1{\%} vs. 27.3 ± 11.5{\%}, p <0.001). LVEF fell in 14 patients (28.7 ± 9.4 vs. 23.8, p <0.0001). Aggregate regional wall motion worsened in 15 patients. In contrast to myocardium displaying stable function at echocardiography, myocardium with evidence of deterioration showed a parallel decrease in hyperaemic MBF and CVR (1.57 ± 0.67 vs. 1.19 ± 0.7 ml/min/g, [p = 0.004] and 1.9 ± 0.75 vs. 1.33 ± 0.6, [p = 0.005], respectively). Such myocardium displayed attenuated recovery postoperatively (21/68 [31{\%}] LV segments) versus 'waiting-time' stable myocardium (98/169 [58{\%}], p = 0.0002). Conclusion: Delayed revascularisation in ischaemic left ventricutar impairment results in declining function and a reduced likelihood of contractile improvement.",
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