Prognosis of patients with left ventricular dysfunction, with and without viable myocardium after myocardial infarction. Relative efficacy of medical therapy and revascularization.

Lee, K S; Marwick, Thomas H.; Cook, Sebastian A.; Go, Raymundo T.; Fix, James; James, Karen B.; Sapp, Shelly; MacIntyre, William J.; Thomas, James D.

doi:10.1161/01.cir.90.6.2687

Cited by 346 publications

(109 citation statements)

References 39 publications

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“…Similarly, in 79 patients with severe LV dysfunction undergoing metabolic imaging with PET, Di Carli et al 20 showed that unrevascularized patients with viable myocardium had a greater likelihood of sudden cardiac death than patients undergoing revascularization. Similar findings were recently reported by Lee et al 21 Thus, with respect to the outcome of patients with viable myocardium, our results agree with those from these earlier reports. They differ, however, with respect to the outcome of patients with nonviable myocardium.…”

Section: Prognostic Implications Of Myocardial Ischemia and Viabilitysupporting

confidence: 94%

“…They differ, however, with respect to the outcome of patients with nonviable myocardium. Whereas in the studies of Eitzman et al, 18 Di Carli et al, 20 and Lee et al, 21 patients with nonviable myocardium had an excellent prognosis (3-year survival, 82% to 100%), these patients definitely had a poorer outcome in our study. Our results are nonetheless in agreement with those of Yoshida and Gould, 22 who used 82 Rb and PET to identify myocardial viability, and with the more recent reports of Pagley et al 23 and Petretta et al, 24 who used thallium scintigraphy as a means of identifying viable myocardium.…”

Section: Prognostic Implications Of Myocardial Ischemia and Viabilitycontrasting

confidence: 72%

“…17 Recent studies using myocardial metabolic imaging with positron emission tomography (PET) have indicated that assessing myocardial viability also provides useful prognostic information in these patients, [17][18][19][20][21] with an effect additive to that of the usual clinical assessment. 21 Whereas PET is expensive and not widely available, exercise-redistribution-reinjection thallium scintigraphy and dobutamine echocardiography are less expensive and potentially more widely available methods that can also distinguish viable from nonviable myocardium. Until now, studies addressing the contribution of these techniques to the detection and treatment of viable myocardium have mainly concentrated on their ability to predict the return of contractile function after revascularization.…”

Section: Discussionmentioning

confidence: 99%

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Prognostic Value of Myocardial Ischemia and Viability in Patients With Chronic Left Ventricular Ischemic Dysfunction

Pasquet¹,

Robert²,

D'hondt³

et al. 1999

Circulation

155

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Background-Previous studies showed that thallium scintigraphy and dobutamine echocardiography were accurate, noninvasive ways of predicting contractile recovery after revascularization in patients with left ventricular (LV) dysfunction. However, the prognostic impact of such methods remains uncertain. Methods and Results-We prospectively studied 137 consecutive patients with coronary disease and LV dysfunction who underwent exercise-redistribution-reinjection thallium scintigraphy and dobutamine echocardiography to identify myocardial ischemia and viability. A total of 94 patients subsequently underwent revascularization, and 43 underwent medical treatment. The primary endpoint was cardiac mortality, and mean follow-up was 33Ϯ10 months. Twenty-four patients died of cardiac causes. By Cox's regression analysis, long-term survival was related to the extent of coronary disease, the presence of diabetes, type of treatment, the presence of ischemic myocardium as determined by thallium scintigraphy, and the presence of viable myocardium as determined by both tests. Three-year survival was greater in patients with ischemic myocardium (as determined by thallium scintigraphy) or viable myocardium (as determined by both tests) who underwent revascularization than in the other groups (Pϭ0.018 with thallium; PϽ0.001 with dobutamine). Subgroup analyses indicated that among patients with 1-or 2-vessel disease, only those with ischemic or viable myocardium improved survival after revascularization, whereas in patients with 3-vessel or left main diseases, revascularization always improved survival, albeit more in the presence of ischemic or viable myocardium. Conclusions-Among the parameters commonly available in patients with LV ischemic dysfunction, the presence of ischemic myocardium (as determined by thallium scintigraphy) and that of viable myocardium (as determined by dobutamine echocardiography) are independent predictors of subsequent mortality. These observations may be useful in the preoperative selection of patients for revascularization. (Circulation. 1999;100:141-148.)

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Section: Prognostic Implications Of Myocardial Ischemia and Viabilitysupporting

confidence: 94%

Section: Prognostic Implications Of Myocardial Ischemia and Viabilitycontrasting

confidence: 72%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Prognostic Value of Myocardial Ischemia and Viability in Patients With Chronic Left Ventricular Ischemic Dysfunction

Pasquet¹,

Robert²,

D'hondt³

et al. 1999

Circulation

155

View full text Add to dashboard Cite

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“…However, because 86% of the recurrences occurred in patients who underwent ICD implantation, the likelihood of sudden cardiac death would have been high when patients would not have received an ICD. Previous studies 19,20 focusing on ischemia, viability, scar tissue, and long-term survival were not capable of distinguishing between these modes of deaths, but because of the presence of the ICD, the present study is the first to provide information on mode of death in these patients. This is probably also the explanation for the relatively low death rate in the present study compared with earlier studies.…”

Section: Eventsmentioning

confidence: 75%

“…This is probably also the explanation for the relatively low death rate in the present study compared with earlier studies. 19,20 The main question is whether these recurrences were caused by jeopardized myocardium or scar tissue.…”

Section: Eventsmentioning

confidence: 99%

Impact of Viability, Ischemia, Scar Tissue, and Revascularization on Outcome After Aborted Sudden Death

et al. 2003

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Background-Survivors of aborted sudden death attributable to ventricular arrhythmias in the presence of coronary artery disease are at risk for recurrences. The substrate underlying these arrhythmias is not clear, and therefore the relation between ischemia, viability, scar tissue (and revascularization), and the incidence of ventricular arrhythmias (and survival) was studied over up to 3 years. Methods and Results-One hundred fifty-three survivors of sudden death underwent stress-rest perfusion imaging.Patients with ischemic/viable myocardium (nϭ73) were revascularized if possible. Final antiarrhythmic therapy was based on the outcome of electrophysiological testing or left ventricular ejection fraction (LVEF). Implantation of a defibrillator was performed in 112 (72%) patients. During 3-year follow-up, 15 cardiac deaths occurred and 42 (29%) patients had recurrent ventricular arrhythmias. Patients with events (death or recurrence) exhibited more often a severely depressed LVEF (Յ30%), more extensive scar tissue, and less ischemic/viable myocardium on perfusion imaging and less frequently underwent revascularization. Multivariate analysis identified extensive scar tissue and LVEF Յ30% as the only predictors of death/recurrent ventricular arrhythmias. Conclusions-In patients with aborted sudden death, extensive scar tissue and severely depressed LVEF are the only predictors of death or recurrent ventricular arrhythmias. These patients should be considered for implantation of a defibrillator.

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Gated Positron Emission Tomography for the Assessment of Myocardial Perfusion and Function

Macháč¹

2006

Clinical Gated Cardiac SPECT

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Prognosis of patients with left ventricular dysfunction, with and without viable myocardium after myocardial infarction. Relative efficacy of medical therapy and revascularization.

Cited by 346 publications

References 39 publications

Prognostic Value of Myocardial Ischemia and Viability in Patients With Chronic Left Ventricular Ischemic Dysfunction

Prognostic Value of Myocardial Ischemia and Viability in Patients With Chronic Left Ventricular Ischemic Dysfunction

Impact of Viability, Ischemia, Scar Tissue, and Revascularization on Outcome After Aborted Sudden Death

Gated Positron Emission Tomography for the Assessment of Myocardial Perfusion and Function

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