Myocardial viability by echocardiography predicts long-term survival after revascularisation in patients with heart failure due to ischaemic cardiomyopathy

Revascularisation (Rev) improves survival in coronary artery disease (CAD) patients with angina and left ventricular (LV) systolic dysfunction however, there is insufficient long term data regarding survival benefit of Rev in patients with predominant symptoms of heart failure (HF). Follow-up was obtained in 87 consecutive patients with HF due to ischaemic LV systolic dysfunction (NYHA Class II-IV; LVEF: 0.25±0.09) who were investigated with low dose dobutamine echocardiography (DE) Myocardial viability (MV) within each of the 12 myocardial segments representing the LV was defined as having either normal function or mild dysynergy at rest or severe resting dysynergy that improved or worsened on DE. Thirty seven patients underwent revascularisation based on clinical grounds. At a mean follow up of 40±17 months there were 22 (25%) cardiac related deaths. Multivariate analysis using clinical data (age, sex, history of infarction, angina, hypertension, diabetes mellitus and hyperlipedermia), drug therapy, LVEF, number of diseased coronary arteries and number of viable segments, revealed that patients with ≥5 segments with MV who underwent Rev was the only independent predictor of survival; hazard ratio (95% Cl): 0.39 (0.17-0.91), p=0.01. Patients with <5 segment MV who underwent Rev and those on medical therapy with and without ≥5 segment MV had significantly higher mortality compared to patients with ≥5 segment MV and Rev (p<0.001). The latter group also showed significant improvem.ent in NYHA class (p<0.001) and LVEF (p<0.01) compared to the other groups. Rev produced clear survival and functional benefits in patients with HF due to ischaemic cardiomyopathy who have significant MV, and this was also associated with improved symptoms and LV function.