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J Thorac Cardiovasc Surg 1998;115:791-799
© 1998 Mosby, Inc.
SURGERY FOR ACQUIRED HEART DISEASE |
D. Pagano was supported by a Sheldon Clinical Research Fellowship of the West Midlands Health Authority, UK.
This paper was presented in part at the Sixty-ninth Meeting of the American Heart Association, New Orleans, La., 1996.
Received for publication July 11, 1997. Revisions requested Oct. 13, 1997; revisions received Nov. 3, 1997. Accepted for publication Nov. 6, 1997. Address for reprints: Robert S. Bonser, MRCP, FRCS, Consultant Cardiothoracic Surgeon, Cardiothoracic Surgical Unit, Queen Elizabeth Hospital, Edgbaston, Birmingham B15 2TH, United Kingdom.
Abstract
Objectives: To determine the predictive value of quantitative evaluation of myocardial viability on changes in left ventricular function, exercise capacity, and quality of life after coronary artery bypass grafting in patients with ischemic heart failure (congestive heart failure, New York Heart Association class 
III) with and without angina.
Methods: Thirty-five patients, 14 with congestive heart failure and angina (CHF-angina) and 21 with congestive heart failure without angina (CHF–no angina) were studied at baseline and 6 months after coronary bypass grafting. Left ventricular function was evaluated with transthoracic echocardiography and radionuclide ventriculography. Myocardial viability was assessed with [18F]-2-fluoro-2-deoxy-D-glucose using positron emission tomography. Peak aerobic capacity (peak oxygen consumption) and anaerobic threshold were assessed with treadmill exercise test and quality of life with a questionnaire.
Results: A total of 286 of 336 dysfunctional left ventricular segments were viable. There were two perioperative deaths (5.7%) and three late deaths. Left ventricular ejection fraction increased from 23% ± 7% to 32% ± 9% (p < 0.0001), and a linear correlation was found between the number of viable segments and the changes in ejection fraction (r = 0.65; p = 0.0001). Receiver operating characteristics curve identified eight viable segments as the best predictor for increase of ejection fraction more than 5 percentage points. Peak oxygen consumption increased from 15 ± 4 to 22 ± 5 ml/kg per minute (p < 0.0001). Preoperatively, anaerobic threshold was identified in one patient from the CHF-angina group and in all from the CHF–no angina group and increased from 13 ± 4 to 19 ± 4 ml/kg per minute (p < 0.0001). Quality of life scores improved significantly in both groups. No correlation was found between the amount of viable dysfunctional myocardium and changes in exercise capacity or quality of life.
Conclusions: In patients with postischemic congestive heart failure the amount of viable myocardium dictates the degree of improvement in left ventricular function after revascularization. (J Thorac Cardiovasc Surg 1998;115:791-9
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