Abbreviations as in Figure 1. In each panel, study patients are divided according to the presence of 0 to 1 or 2 to 3 prognostic factors. This algorithm should only be applied conceptually to support the notion that among patients with ischemic LV systolic dysfunction, the benefit of surgical revascularization is greater when the disease process is more advanced see text for more detail. However, the efficacy of this approach is uncertain.
Viable myocardium must have the following characteristics 1. Have sufficient perfusion, both for the delivery of substrates and O2 and for the adequate washout of potentially noxious metabolites? Echocardiography 2. Single Photon Emission Computed Tomography 3. Positron Emission Tomography 4. Magnetic Resonance Bonow RO et al. N Engl J Med ; Conclusions 1. The presence of viable myocardium was associated with a greater likelihood of survival in patients with coronary artery disease and left ventricular dysfunction, but this relationship was not significant after adjustment for other baseline variables.
Instead, it is likely that some of the other variables in the analysis e. An analysis of outcomes on the basis of a combination of these two tests poses important limitations, given the fundamental differences in the viability information provided by SPECT and dobutamine echocardiography one related to membrane integrity and the other to contractile reserve and the differences in analytic approaches between the two methods. There are a number of possible explanations for these discrepancies..
Limitations in study design and completion may have prevented the detection of a true interaction between viability status and the benefit of revascularization. It is possible that the advances in medical and device therapy have markedly reduced the added benefit of revascularization, such that it is difficult to demonstrate further improvement in clinical outcomes.
Furthermore patients with ischemic cardiomyopathy constitute a heterogeneous population with an extremely complex condition in which multiple factors play an important prognostic role. So, it would be too simplistic to expect that a single feature like the presence of viable myocardium would provide the answer to such a critical question for all patients. Late percutaneous coronary intervention for an occluded infarct-related artery in patients with preserved infarct zone viability: a pooled analysis of cardiovascular magnetic resonance studies.
OMT alone on cardiac function and remodeling in patients presenting infarct zone with preserved viability on cardiovascular magnetic resonance CMR.
The comparison that is shown has not been adjusted for other prognostic baseline variables. At 5 years in the intention-to-treat analysis, the rates of death for patients without myocardial viability were Among patients with myocardial viability, the respective rates were Maria Foster Dec.
Dr venkata chenchaiah perla Mar. J Am Coll Cardiol ; Coronary-artery bypass surgery in patients with left ventricular dysfunction. Myocardial viability and survival in ischemic left ventricular dysfunction. Eric Velazquez at the ACC. Robert Bonow at the ACC. Presented by Drs. Robert H.
Coronary bypass surgery with or without surgical ventricular reconstruction. N Engl J Med ; Description: The goal of the trial was to evaluate medical therapy versus surgical therapy for patients with obstructive coronary artery disease CAD and congestive heart failure CHF. Share via:. Media Center ACC. All rights reserved. If you continue browsing the site, you agree to the use of cookies on this website.
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