MYOCARDIAL REVASCULARIZATION IN PATIENTS WITH ISCHEMIC CARDIOMYOPATHY- FUNCTIONAL OBSERVATIONS

Objective. A prospective angiographic study was undertaken to investig ate, with an objective analysis, the global and regional wall response to myocardial revascularization. Methods. Thirty-one patients (30 men and 1 woman, mean age, 61 years) with a left ventricular ejection fra ction of less than 0.30 were admitted to our institution between 1992 and 1995 for two-or three-vessel coronary artery disease requiring myo cardial revascularization. All patients underwent isolated coronary ar tery bypass grafting and were studied 3 months later with angiography. Preoperative and postoperative wall motion were analyzed using specia l software that computed a segmental left ventricular ejection fractio n, generating a segmental score. Computerized analysis allowed us to d istinguish patients with diffuse hypokinesis and a symmetric contracti on pattern from patients with akinesis involving at least two segments and an asymmetric contraction pattern. Results. There were no operati ve deaths and no patient required intraaortic balloon counterpulsation . One patient had postoperative enzymatic evidence of myocardial infar ction. Postoperative angiography showed a graft patency rate of 84%. G lobal analysis showed a small but significant rise in the left ventric ular ejection fraction (0.25 +/- 0.51 to 0.31 +/- 0.70, p < 0.001) and a fall in the left ventricular end-diastolic pressure (23.7 +/- 10 to 16.5 +/- 9 mm Hg, p < 0.01). Mean scores always have been lower after the operation than before it, with the best results obtained for the apex and the worst for the anterobasal segment. The group with a symme tric contraction pattern showed a trend toward a better hemodynamic re sponse than the group with an asymmetric contraction pattern. Regressi on analysis revealed two important predictors of segmental functional improvement: (1) the absence of an echocardiographic scar, and (2) the presence of a collateral circulation. Conclusions. Coronary artery by pass grafting produced a small but substantial improvement in patients with ischemic cardiomyopathy. The greater benefit occurred in patient s with a symmetric contraction pattern. The absence of an echocardiogr aphic scar and the presence of a collateral circulation predicted segm ental functional improvement. (C) 1997 by The Society of Thoracic Surg eons.