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Low dose wall motion score predicts the short and long-term benefit of surgical revascularization in patients with ischemic left ventricular dysfunction

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Abstract

We investigated the influence of the extent of viability using low dose dobutamine wall motion score index (WMS) on the survival benefit of surgical revascularization (CABG) versus medical therapy. In the STICH trial, viability assessment was not helpful in determining the benefit of CABG. However, the extent of viable myocardium with contractile function was not assessed in the trial. Dobutamine echocardiography was performed in 250 patients with ischemic left ventricular dysfunction (125-medically treated, 125-CABG). The mean ejection fraction (EF) was 32% in both groups. WMS during low dose dobutamine infusion was used to classify patients into groups with extensive (WMS < 2.00), intermediate (WMS 2.00–2.49), and limited (WMS ≥ 2.50) viability. Survival free of cardiac death was assessed at 2 years and for the complete duration of follow-up. There were 44 (35.2%) and 67 (53.6%) cardiac deaths in the revascularized and medically treated patients respectively (follow-up of 5.7 ± 5.8 years). Revascularized and medically treated patients with extensive viability had similar 2-year survival (p = 0.567) but revascularized patients had improved long-term survival (p = 0.0001). In those with intermediate viability, revascularization improved both 2 year (p = 0.014) and long-term survival (p = 0.0001). In patients with limited viability, 2-year survival was worse in revascularized patients (p = 0.04) and long-term survival was similar (p = 0 .25) in revascularized and medically treated groups. Patients with extensive and intermediate amounts of viability have improved survival with CABG but those with limited viability have poorer short-term outcome and no long-term benefit.

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Abbreviations

ACEI:

Angiotensin converting enzyme inhibitor

CABG:

Surgical revascularization

CAD:

Coronary artery disease

CHF:

Congestive heart failure

EF:

Ejection fraction

LAD:

Left anterior descending

LV:

Left ventricular

WMS:

Wall motion score

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Authors and Affiliations

  1. Department of Cardiology, West Virginia University, Morgantown, WV, 26505, USA

    Yasir Abdul Ghaffar

  2. Department of Cardiology, Henry Ford Hospital, Detroit, MI, 48020, USA

    Waddah Maskoun

  3. OhioHealth Heart & Vascular Physicians, Marion, OH, 43302, USA

    Nowwar G. Mustafa

  4. Indiana University School of Medicine, IU Health Methodist Hospital, Indianapolis, IN, 46202, USA

    Harvey Feigenbaum & Stephen G. Sawada

  5. Krannert Institute of Cardiology, 1801 N. Senate Blvd, M.P.C. II, Suite D4000, Indianapolis, IN, 46202, USA

    Stephen G. Sawada

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  1. Yasir Abdul Ghaffar
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  2. Waddah Maskoun
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  3. Nowwar G. Mustafa
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  4. Harvey Feigenbaum
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  5. Stephen G. Sawada
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Correspondence to Stephen G. Sawada.

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Abdul Ghaffar, Y., Maskoun, W., Mustafa, N.G. et al. Low dose wall motion score predicts the short and long-term benefit of surgical revascularization in patients with ischemic left ventricular dysfunction. Int J Cardiovasc Imaging 35, 1651–1659 (2019). https://doi.org/10.1007/s10554-019-01614-9

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  • DOI: https://doi.org/10.1007/s10554-019-01614-9

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