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Eur J Cardiothorac Surg 2002;21:417-423
© 2002 Elsevier Science NL

Prolonged ischemic heart disease and coronary artery bypass — relation to contractile reserve

^a Division of Cardiology, Medical Department B, The Heart Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
^b Division of Thoracic Surgery, The Heart Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
^c Department of Clinical Physiology and Nuclear Medicine, The Imaging Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark

Received 30 August 2001; received in revised form 23 November 2001; accepted 3 December 2001.

* Corresponding author. Cardiovascular PET Research Unit, Section 9201, Medical Department B, The Heart Center, Rigshospitalet, University of Copenhagen, Juliane Mariesvej 24 DK-2100 Copenhagen, Denmark. Tel.: +45-35456704; fax: +45-35456713
e-mail: kkofoed{at}pet.rh.dk

Objective: A major effect of coronary artery bypass grafting (CABG) in patients with ischemic heart disease and impaired left ventricular (LV) contractile function is believed to be an improvement in LV function due to recovery of dysfunctional, but viable myocardium. However, recent studies have indicated a time limit for such a recovery. We therefore investigated the extent of viable myocardium in patients with impaired LV function due to ischemic heart disease after a prolonged strategy of medical treatment and its relation to changes in clinical variables after CABG. Methods: Forty-five consecutive patients with a mean duration of ischemic heart symptoms of 9 years and LV ejection fraction (EF) <45% referred for CABG were included and LV extent of viable myocardium was measured preoperatively by glucose metabolism–blood flow positron emission tomography imaging and dobutamine stress echocardiography. Symptoms, exercise-capacity and LV function were evaluated before and 7 months after surgery in event-free survivors. Results: LV extent of myocardial viability was <30% in most patients. In event-free survivors, LVEF decreased from 31±7 to 26±8% 7 months after CABG. The decrease in LVEF was correlated to the LV extent of myocardial metabolism–blood flow reverse mismatch. Most of the patients experienced an improvement in their angina pectoris, heart failure symptoms and exercise capacity after CABG; the overall 3-year survival was 77%. Conclusions: Patients with chronic ischemic heart disease and impairment of LV function, in whom an initial long-standing conservative treatment has been practiced, benefit from CABG, despite a lack of LV functional reserve.

Key Words: Coronary bypass surgery • Left ventricular dysfunction • Myocardial viability

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