Document Detail


Effect of revascularizing viable myocardium on left ventricular diastolic function in patients with ischaemic cardiomyopathy.
MedLine Citation:
PMID:  19389790     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
AIMS: In patients with ischaemic left ventricular (LV) dysfunction and viable myocardium, revascularization improves systolic function. Diastolic dysfunction is also present in such patients; however, whether revascularization improves diastolic function also is largely unknown. METHODS: Twenty-six patients with chronic ischaemic cardiomyopathy [ejection fraction (EF) 32 +/- 6%, wall motion score index (WMSI) 2.45 +/- 0.33] and viable myocardium (low-dose dobutamine echocardiography) were examined at baseline and > or =4 months after revascularization. Diastolic function was assessed by transmitral pulsed-wave Doppler and tissue Doppler imaging (TDI) at the mitral annulus. RESULTS: At baseline, 62% of patients showed non-restrictive filling (non-RF) pattern, and 38% restrictive filling (RF) pattern. After revascularization, along with improvement in systolic function (EF 43 +/- 10%, WMSI 1.78 +/- 0.47, P = 0.0002 for both), diastolic filling improved in most patients, with only three patients still exhibiting RF pattern (P = 0.016); furthermore, E' velocity increased (32 +/- 42%, P = 0.0028) and E/E' decreased (-19 +/- 31%, P = 0.0378) compared with baseline. Left ventricular filling pressure also decreased, from 17.5 +/- 6.8 to 13.1 +/- 6.5 mmHg (P = 0.005). Improvement of diastolic function by TDI was related to the extent of viability at baseline (P = 0.0098) and to LV reverse remodelling after revascularization (P = 0.0092). CONCLUSION: In patients with ischaemic cardiomyopathy, LV diastolic filling may largely improve after revascularization. Improvement of diastolic dysfunction is related to the amount of viable tissue and it may represent an additional advantage of revascularizing dyssinergic but viable myocardium.
Authors:
Erberto Carluccio; Paolo Biagioli; Gianfranco Alunni; Adriano Murrone; Valeria Leonelli; Paola Pantano; Gabriella Vincenti; Claudio Giombolini; Temistocle Ragni; Gianpaolo Reboldi; Federico Gentile; Giuseppe Ambrosio
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2009-04-23
Journal Detail:
Title:  European heart journal     Volume:  30     ISSN:  1522-9645     ISO Abbreviation:  Eur. Heart J.     Publication Date:  2009 Jun 
Date Detail:
Created Date:  2009-06-15     Completed Date:  2009-07-28     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8006263     Medline TA:  Eur Heart J     Country:  England    
Other Details:
Languages:  eng     Pagination:  1501-9     Citation Subset:  IM    
Affiliation:
Division of Cardiology, University of Perugia, Ospedale Silvestrini, S. Andrea delle Fratte, Perugia, Italy.
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MeSH Terms
Descriptor/Qualifier:
Aged
Cardiomyopathy, Dilated / physiopathology*,  surgery,  ultrasonography
Cardiotonic Agents / administration & dosage
Diastole / physiology
Dobutamine / administration & dosage
Echocardiography
Female
Humans
Male
Middle Aged
Myocardial Ischemia / physiopathology*,  surgery*,  ultrasonography
Myocardial Revascularization*
Prognosis
Stroke Volume / physiology
Systole / physiology
Ventricular Dysfunction, Left / physiopathology*,  surgery,  ultrasonography
Chemical
Reg. No./Substance:
0/Cardiotonic Agents; 34368-04-2/Dobutamine

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