Myocardial viability on echocardiography predicts long-term survival afterrevascularization in patients with ischemic congestive heart failure

OBJECTIVES This study was conducted to evaluate the effect of revasculariza tion on survival in patients with congestive heart failure (CHF) due to isc hemic left ventricular (LV) systolic dysfunction based on the presence of m yocardial viability (MV). BACKGROUND There are insufficient data regarding the survival benefit of re vascularization in patients with CHF due to ischemic LV systolic dysfunctio n. METHODS Follow-up was obtained in 87 consecutive patients with CHF due to i schemic LV systolic dysfunction (New York Heart Association [NYHA] class II -IV; LV ejection fraction <0.35) who underwent low-dose dobutamine echocard iography (DE). MV within each of 12 myocardial segments representing the LV was defined as having either: 1) normal function or mild dyssynergy at res t; 2) severe resting dyssynergy that improved on DE, or 3) worsening of fun ction on DE except in the case of akinesia. RESULTS At a mean follow-up of 40 +/- 17 months, 37 patients had received r evascularization on the basis of clinical grounds, and there were 22 (25%) cardiac-related deaths. Multivariate Cox regression analysis revealed that when patients with at least five segments showing MV underwent revasculariz ation, mortality was reduced by an average of 93% (confidence interval of 2 2% to 99%), which was associated with improvement in NYHA class as well as LV ejection fraction. Patients with less than five segments showing MV who underwent revascularization land thus, showing mostly scar), and those with at least 5 segments demonstrating MV who were treated medically, had a muc h higher mortality. CONCLUSIONS Revascularization produces a clear survival benefit in patients with CHF due to ischemic LV systolic dysfunction who have a significant re gion of the LV demonstrating MV. These data may have wide-ranging implicati ons in the management of patients with coronary artery disease whose main c linical presentation is CHF. (C) 1999 by the American College of Cardiology .