Relation between myocardial viability and outcomes of surgical revascularization in patients with heart failure and reduced ejection fraction
Cao Jian
Dang Haiming
Song Yue
Wu Lisong
Liu Dong
Huang Qi
Dong Ran
Abstract：Objective To explore the effect of myocardial viability on perioperative risk and medium to long-term survival rate without major adverse cardiovascular events (MACE) in patients with heart failure and reduced ejection fraction(HFrEF) undergoing coronary artery bypass grafting(CABG).Methods A total of 118 patients with heart failure and left ventricular ejection fraction(LVEF) ＜ 40％ were consecutively enrolled from January 2014 to December 2018 in Beijing Anzhen Hospital,Capital Medical University.LVEF was measured by transthoracic echocardiography before CABG.The ratio of viable myocardium to left ventricle was determined by myocardial perfusion imaging at rest and myocardial metabolism tomography via positron emission tomography.The patients were divided into high myocardial viability group(viable myocardium ratio≥ 10％,78 cases) and low myocardial viability group(viable myocardium ratio ＜ 10％,40 cases).Perioperative complications and mortality were observed.MACE-free survival rate was followed up.Results There were no significant differences in LVEF,left ventricular end-systolic volume index,left ventricular end-diastolic volume index between patients with or without high myocardial viability before surgery(all P ＞0.05),but high myocardial viability was associated with a high rate of previous intervention treatment [26.9％ (21/78) vs 25.0％ (10/40)] (P =0.05).The overall perioperative mortality was 6.8％ (8/118).Compared with patients with high myocardial viability,those with low myocardial viability had higher incidences of perioperative death and atrial fibrillation [12.5％ (5/40) vs 3.8％ (3/78),35.0％ (14/40) vs 14.1％ (11/78)],higher use rates of intra-aortic balloon pump and extracorporeal membrane oxygenation[75.0％ (30/40) vs 47.4％ (37/78),22.5％ (9/40) vs 1.3％ (1/78)],the differences were statistically significant(all P ＜ 0.05).The total follow-up time was (30 ± 12) months.The 12-,24-and 36-month MACE-free survival rates in the high myocardial viability group were significantly higher than those in the low myocardial viability group (96.9％ vs 88.6％,93.4％ vs 85.5％,79.4％ vs 68.2％,P =0.004).Conclusion Myocardial viability is an important factor that affects perioperative mortality and medium to long-term MACE-free survival in patients with HFrEF undergoing CABG.
Keywords：Coronary atherosclerotic heart diseaseMyocardial viabilityCoronary artery bypass graftingHeart failure with reduced ejection fraction
Publication Date：2019-01-01
Online Publishing Date：2026-09-14(First online date of this platform, not the publication date of the document)
Pages：5( 1783-1787 )