Document Detail

Prolonged ischemic heart disease and coronary artery bypass - relation to contractile reserve.
MedLine Citation:
PMID:  11888757     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: A major effect of coronary artery bypass grafting (CABG) in patients with ischemic heart disease and impaired left ventricular (LV) contractile function is believed to be an improvement in LV function due to recovery of dysfunctional, but viable myocardium. However, recent studies have indicated a time limit for such a recovery. We therefore investigated the extent of viable myocardium in patients with impaired LV function due to ischemic heart disease after a prolonged strategy of medical treatment and its relation to changes in clinical variables after CABG. METHODS: Forty-five consecutive patients with a mean duration of ischemic heart symptoms of 9 years and LV ejection fraction (EF) <45% referred for CABG were included and LV extent of viable myocardium was measured preoperatively by glucose metabolism--blood flow positron emission tomography imaging and dobutamine stress echocardiography. Symptoms, exercise-capacity and LV function were evaluated before and 7 months after surgery in event-free survivors. RESULTS: LV extent of myocardial viability was <30% in most patients. In event-free survivors, LVEF decreased from 31+/-7 to 26+/-8% 7 months after CABG. The decrease in LVEF was correlated to the LV extent of myocardial metabolism--blood flow reverse mismatch. Most of the patients experienced an improvement in their angina pectoris, heart failure symptoms and exercise capacity after CABG; the overall 3-year survival was 77%. CONCLUSIONS: Patients with chronic ischemic heart disease and impairment of LV function, in whom an initial long-standing conservative treatment has been practiced, benefit from CABG, despite a lack of LV functional reserve.
Klaus F Kofoed; Regitze Bangsgaard; Steen Carstensen; Jesper H Svendsen; Peter R Hansen; Henrik Arendrup; Birger Hesse; Henning Kelbaek
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery     Volume:  21     ISSN:  1010-7940     ISO Abbreviation:  Eur J Cardiothorac Surg     Publication Date:  2002 Mar 
Date Detail:
Created Date:  2002-03-12     Completed Date:  2002-05-09     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  8804069     Medline TA:  Eur J Cardiothorac Surg     Country:  England    
Other Details:
Languages:  eng     Pagination:  417-23     Citation Subset:  IM    
Division of Cardiology, Medical Department B, The Heart Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
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MeSH Terms
Coronary Artery Bypass*
Dobutamine / diagnostic use
Heart / radionuclide imaging
Middle Aged
Myocardial Contraction / physiology
Myocardial Ischemia / mortality,  physiopathology*,  surgery*
Tomography, Emission-Computed
Ventricular Dysfunction, Left / physiopathology*
Reg. No./Substance:

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