Ischemic cardiomyopathy (ICM) is a disease with high morbidity and mortality. There are several published studies on the evolution and prognosis of patients with ICM. However, reports on the therapeutic management in clinical practice are scarce. The aim of this study was to analyze coronary revascularization (CR) performance in patients with ICM and suitable coronary anatomy according to myocardial perfusion stress-rest gated SPECT results.
Eighty-seven consecutive patients (mean age, 62.4 y; 20 women), with ischemic heart disease, left ventricular ejection fraction of 40% or less, coronary anatomy suitable for CR, and without previous CR, were evaluated by means of stress-rest gated SPECT.
Sixty-four percent of patients had scintigraphic criteria of viability and 62.1% showed scintigraphic ischemia in stress-rest gated SPECT. Forty-five percent of patients were revascularized, and the remainder received medical treatment only. Coronary revascularization was more frequent in patients with scintigraphic viability (P = 0.012), in those with scintigraphic ischemia (P = 0.007), and in those with low left ventricular end-systolic volume (P = 0.006). Cox regression analysis identified multivessel disease [hazard ratio (HR), 3.3; 95% confidence interval (CI), 4–7.8], summed difference score greater than 4 (HR, 3.9; 95% CI, 1.5–9.8), and left ventricular end-systolic volume less than 120 mL (HR, 3.2; 95% CI, 1.3–8.2) as the best independent predictors of CR treatment.
In patients with ICM and suitable coronary arteries who are able to perform a stress myocardial perfusion–gated SPECT, the presence of multivessel disease and myocardial ischemia and the absence of severely increased left ventricular volume were associated to a decision of CR.
From the *Servei de Cardiologia, Àrea del Cor, †Servei de Medicina Nuclear, and ‡Servei de Cirurgia Cardiaca, Hospital Universitari Vall d’Hebron, Universitat Autónoma de Barcelona, Barcelona, Spain.
Received for publication December 17, 2011; revision accepted May 30, 2012.
Conflicts of interest and sources of funding: This study was partially funded by grants from Fundación Carolina and the Redes temáticas de investigación cooperativa, Instituto Carlos III (Red C03/01, RECAVA).
Reprints: Jaume Candell-Riera, MD, PhD, FESC, Servei de Cardiologia, Àrea del Cor, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Paseo Vall d’Hebron 119-129, 08035 Barcelona, Spain. E-mail: firstname.lastname@example.org.