Revascularisation for post-ischaemic heart failure: Myocardial viability affects survival

Background- Revascularisation for post-ischaemic heart failure (IHF) is a potential alternative to transplantation. We have previously demonstrated that the presence of a significant amount of viable dysfunctional myocardium (at least 8/16 left ventricular segments) is associated with significant improvements in left ventricular (LV) ejection fraction (EF) in patients (pts) with IHF 6 months following coronary artery bypass (CABG). The aim of this study was to assess the impact of revascularisation of viable myocardium on long-term survival. Methods-We studied 35 patients (31 male; mean age 58±7 years) with severe IHF (NYHA ≥ III), LVEF of 24±7% (range 10-35%; MUGA) and limited exercise capacity (Peak-VO ₂=15±4ml/kg/ min). 21/35 pts had no angina. Myocardial viability was assessed with quantitative positron emission tomography and the glucose analogue [ ¹⁸F]-2-fluoro-2-deoxy-D-glucose (FDG) (viable segment=FDG uptake ≥0.25 μmol/min gram) in all pts before CABG. Patients were divided into two groups: 1- with ≥ 8 viable dysfunctional segments (mean 12±2; range 8-15) and 2- with 2. Results-Two pts died peri-operatively (mortality 5.7%) and 7 pts during follow-up (mean 33±14 months). All deaths were due to cardiac causes. Kaplan-Meyer survival analysis showed 86% survival for group 1 vs 57% for group 2 (P=0.02). Cox proportional hazard analysis identified ≥8 viable segments (P=0.006), LVEF (P=0.002) and age (P=0.01) as independent predictors of survival. (Graph Presented) Conclusion- Revascularisation for IHF can be associated with good long-term survival, which is critically dependent upon the amount of viable myocardium.