Effect of revascularization on left ventricular remodeling in patients with heart failure from severe chronic ischemic left ventricular dysfunction

Few data exist regarding the effect of revascularization on left ventricula r (Ll geometry in patients with severe IV systolic dysfunction and viable m yocardium. We hypothesized that patients with chronic ischemic IV dysfuncti on but viable myocardium will have improved IV geometry after revasculariza tion, which in turn will improve long-term outcome. Accordingly, 70 patient s with severe ischemic IV dysfunction (IV ejection fraction <0.35) were stu died at rest. They then either underwent revascularization (n = 36) or were treated medically (n = 34). Fifty-four patients had viable myocardium, and 16 did not. They were evaluated for change in IV function and geometry (si ze and shape) a mean of 21 months later. Further follow-up was performed fo r a mean of 3.5 years to determine outcome. Patients with viable myocardium had improvement not only in regional and global function, but also in LV g eometry (shape and size), which was independent of and incremental to the i mprovement in function. On longterm follow-up, change in IN end-systolic vo lume was the only multivariate discriminator between 15 patients who died a nd 55 who did not, irrespective of whether they had undergone revasculariza tion. Thus, measurement of the effect of revascularization of viable myocar dium in chronic ischemic heart disease should not only include improvement in resting regional and global IN function, but also IN geometry. Improveme nt in LV geometry contributes to better LV systolic function, which in turn is the best predictor of survival after revascularization. (C) 2001 by Exc erpta Medica, Inc.