HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Bartolo Zingone Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Mule, J. D. Articles by Soravia, G. Search for Related Content PubMed PubMed Citation Articles by Mule, J. D. Articles by Soravia, G. Related Collections Coronary disease Myocardial infarction

Eur J Cardiothorac Surg 2002;22:426-430
© 2002 Elsevier Science NL

The beneficial effect of revascularization on jeopardized myocardium: reverse remodeling and improved long-term prognosis

^a Unità Operativa di Cardiologia, Ospedale di Pieve di Cadore, ASL 1 Belluno, Italy
^b Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
^c Divisione di Cardiochirurgia, Ospedale Maggiore di Trieste, Trieste, Italy
^d Servizio di Medicina Nucleare, Ospedale S. Martino, ASL 1 Belluno, Italy
^e Unità di Emodinamica, Divisione di Cardiologia, Azienda Ospedaliera Pordenonese, Pordenone, Italy
^f Divisione di Cardiologia, Ospedale S. Martino, ASL 1 Belluno, Italy

Received 14 February 2002; received in revised form 20 May 2002; accepted 4 June 2002.

* Corresponding author. Tel.: +31-71-5262020; fax: +31-71-5266809
e-mail: jbax{at}knoware.nl

Objectives: To evaluate the impact of viability/ischemia before revascularization on improvement in systolic performance, reverse remodeling, symptoms and long-term prognosis post-revascularization. Methods: Fifty patients underwent thallium-201 imaging before revascularization to assess stress-induced ischemia and viability (‘jeopardized myocardium’). Left ventricular (LV) ejection fraction (EF), LV end-systolic volume index (LVESVI) and LV end-diastolic volume index (LVEDVI) were determined before and 3 months post-revascularization. Graft/vessel patency was controlled by repeat angiography. Long-term follow-up data (New York Heart Association (NYHA) class, hard events) were acquired up to 3 years. Results: Patients with 5 jeopardized segments on thallium-201 imaging demonstrated improvement of LVEF at 3 months (from 35±6 to 43±6%, P<0.001), with reverse remodeling (LVESVI decreased from 68±16 to 52±14 ml/m², P<0.001; LVEDVI decreased from 103±21 to 91±18 ml/m², P<0.001), and improved in NYHA class with excellent long-term prognosis (0% event rate). Conversely, patients with <5 jeopardized segments failed to improve in LVEF (34±4 vs. 33±7%, NS), and exhibited ongoing remodeling (LVESVI increased from 70±14 to 78±23 ml/m², P<0.001; LVEDVI increased from 106±19 to 116±25 ml/m², P<0.001), without improvement in NYHA class, and worse long-term prognosis (29% event rate). Conclusion: Patients with jeopardized myocardium benefit from revascularization with improvement in LVEF, reverse remodeling, improvement in NYHA class and favorable long-term prognosis.

Key Words: Viable myocardium • Heart failure • Nuclear imaging • Remodeling

This article has been cited by other articles:

				J. S. Rossi, J. D. Flaherty, G. C. Fonarow, E. Nunez, W. Gattis Stough, W. T. Abraham, N. M. Albert, B. H. Greenberg, C. M. O'Connor, C. W. Yancy, et al. Influence of coronary artery disease and coronary revascularization status on outcomes in patients with acute heart failure syndromes: A report from OPTIMIZE-HF (Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure) Eur J Heart Fail, December 1, 2008; 10(12): 1215 - 1223. [Abstract] [Full Text] [PDF]

				A. F.L. Schinkel, D. Poldermans, A. Elhendy, and J. J. Bax Assessment of Myocardial Viability in Patients with Heart Failure J. Nucl. Med., July 1, 2007; 48(7): 1135 - 1146. [Abstract] [Full Text] [PDF]

				E. Biagini, M. Valgimigli, P. C. Smits, D. Poldermans, A. F.L. Schinkel, V. Rizzello, E. E.M. Onderwater-, M. Bountioukos, and P. W. Serruys Stress and tissue Doppler echocardiographic evidence of effectiveness of myoblast transplantation in patients with ischaemic heart failure Eur J Heart Fail, October 1, 2006; 8(6): 641 - 648. [Abstract] [Full Text] [PDF]

				V. Rizzello, D. Poldermans, E. Boersma, E. Biagini, A. F.L. Schinkel, B. Krenning, A. Elhendy, E. C. Vourvouri, F. B. Sozzi, A. Maat, et al. Opposite Patterns of Left Ventricular Remodeling After Coronary Revascularization in Patients With Ischemic Cardiomyopathy: Role of Myocardial Viability Circulation, October 19, 2004; 110(16): 2383 - 2388. [Abstract] [Full Text] [PDF]

				J J Bax, E E van der Wall, and M Harbinson Radionuclide techniques for the assessment of myocardial viability and hibernation Heart, August 1, 2004; 90(suppl_5): v26 - v33. [Full Text] [PDF]