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Eur J Cardiothorac Surg 2002;22:426-430
© 2002 Elsevier Science NL
a Unità Operativa di Cardiologia, Ospedale di Pieve di Cadore, ASL 1 Belluno, Italy
b Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
c Divisione di Cardiochirurgia, Ospedale Maggiore di Trieste, Trieste, Italy
d Servizio di Medicina Nucleare, Ospedale S. Martino, ASL 1 Belluno, Italy
e Unità di Emodinamica, Divisione di Cardiologia, Azienda Ospedaliera Pordenonese, Pordenone, Italy
f Divisione di Cardiologia, Ospedale S. Martino, ASL 1 Belluno, Italy
Received 14 February 2002; received in revised form 20 May 2002; accepted 4 June 2002.
* Corresponding author. Tel.: +31-71-5262020; fax: +31-71-5266809
e-mail: jbax{at}knoware.nl
Objectives: To evaluate the impact of viability/ischemia before revascularization on improvement in systolic performance, reverse remodeling, symptoms and long-term prognosis post-revascularization. Methods: Fifty patients underwent thallium-201 imaging before revascularization to assess stress-induced ischemia and viability (‘jeopardized myocardium’). Left ventricular (LV) ejection fraction (EF), LV end-systolic volume index (LVESVI) and LV end-diastolic volume index (LVEDVI) were determined before and 3 months post-revascularization. Graft/vessel patency was controlled by repeat angiography. Long-term follow-up data (New York Heart Association (NYHA) class, hard events) were acquired up to 3 years. Results: Patients with 
5 jeopardized segments on thallium-201 imaging demonstrated improvement of LVEF at 3 months (from 35±6 to 43±6%, P<0.001), with reverse remodeling (LVESVI decreased from 68±16 to 52±14 ml/m2, P<0.001; LVEDVI decreased from 103±21 to 91±18 ml/m2, P<0.001), and improved in NYHA class with excellent long-term prognosis (0% event rate). Conversely, patients with <5 jeopardized segments failed to improve in LVEF (34±4 vs. 33±7%, NS), and exhibited ongoing remodeling (LVESVI increased from 70±14 to 78±23 ml/m2, P<0.001; LVEDVI increased from 106±19 to 116±25 ml/m2, P<0.001), without improvement in NYHA class, and worse long-term prognosis (29% event rate). Conclusion: Patients with jeopardized myocardium benefit from revascularization with improvement in LVEF, reverse remodeling, improvement in NYHA class and favorable long-term prognosis.
Key Words: Viable myocardium • Heart failure • Nuclear imaging • Remodeling
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