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Functional outcome and quality of life after coronary artery bypass surgery in patients with severe heart failure and hibernated myocardium

Peovska, Irenaa; Maksimovic, Jelenaa; Vavlukis, Marijaa; Po Gorceva, Danielab; Majstorov, Venjaminb

Nuclear Medicine Communications: March 2008 - Volume 29 - Issue 3 - p 215-221
doi: 10.1097/MNM.0b013e3282f3add9
ORIGINAL ARTICLES
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Background Myocardial viability is an important parameter, predictive of improvement in left ventricular function after coronary artery bypass surgery (CABG). We wanted to define the relationship between the extent of hibernated myocardium and improvement in ejection fraction function and quality of life after CABG.

Methods Sixty-five consecutive patients with ischaemic cardiomyopathy (mean LVEF <40%) undergoing surgical revascularization were studied with 99mTc-sestamibi myocardial perfusion Gated SPECT imaging (MPI) to assess preoperative myocardial viability. Patients were divided into two groups, based on the extent of viable myocardium before CABG: group 1, 39 patients with more than four viable segments; and group 2, 26 patients with fewer than four viable segments. Regional and global ejection fraction function, heart failure symptoms and quality of life were measured before and 14±4 months after revascularization. We used bull's eye quantitative analysis of MPI scans and a 17-segment model of ejection fraction function and perfusion evaluation.

Results The number of viable segments per patient was directly related to the improvement in LVEF after revascularization (r=0.79, P<0.01). Patients with more than four viable segments representing 24% of the left ventricle yielded the sensitivity of 83% and specificity of 79%, respectively, for predicting improvement in LVEF. Furthermore, the presence of four or more viable segments predicted improvement in heart failure symptoms and quality of life after revascularization.

Conclusion The presence of more than four viable segments (24% of the left ventricle) on MPI in patients with ischaemic heart failure before CABG surgery is significantly correlated with the improvement in LVEF, heart failure symptoms and quality of life post-operatively.

Institutes for aHeart Diseases

bPathophysiology and Nuclear Medicine, University ‘St. Cyril and Methodius’, Skopje, Republic of Macedonia

Correspondence to Dr Irena Peovska, Institute for Heart Diseases, University ‘St. Cyril and Methodius’, Medical Faculty, ul. Vodnjanska 17, 1000 Skopje, Republic of Macedonia

Tel: +389 2 3225 895; fax: +389 3110 159;

e-mail: irena_peovska@yahoo.com

Received 7 September 2007 Revised 8 October 2007 Accepted 24 October 2007

© 2008 Lippincott Williams & Wilkins, Inc.