Myocardial viability and cardiac dyssynchrony as strong predictors of perioperative mortality in high-risk patients with ischemic cardiomyopathy having coronary artery bypass surgery

Objective Myocardial viability and left ventricular dyssynchrony are important predictors of long-term outcomes in patients with ischemic left ventricular dysfunction. The objective of this study was to test the hypothesis that assessment of myocardial viability and left ventricular dyssynchrony will predict perioperative mortality in high-risk patients with ischemic left ventricular dysfunction having coronary artery bypass surgery. Methods The study consisted of 79 consecutive patients with ischemic cardiomyopathy (age 65 ± 9 years; 81% men; ejection fraction 30% ± 6%) and logistic European system for cardiac operative risk evaluation > 10% having coronary artery bypass surgery. Myocardial viability was assessed by delayed contrast-enhanced magnetic resonance imaging. Left ventricular dyssynchrony was calculated using tissue Doppler from measurements of regional electromechanical coupling times in left ventricular basal segments before coronary artery bypass surgery. Results Twenty (25.3%) patients died within 30 days following coronary artery bypass surgery. Survivors (n = 59) showed a larger extent of viable myocardium (6.9 ± 3.6 viable segments vs 3.4 ± 3.3 viable segments, P < .001) and smaller left ventricular dyssynchrony (75 ± 5 ms vs 179 ± 83 ms, P < .001) than nonsurvivors. The presence of significant dyssynchrony (≥105 ms) and absence of myocardial viability (