Prognostic implications of myocardial contractile reserve in patients with coronary artery disease and left ventricular dysfunction
OBJECTIVES This study was performed to assess the prognostic implications of myocardial contractile reserve (MCR) in patients with coronary artery disease (CAD) and left ventricular (LV) dysfunction. BACKGROUND MCR during dobutamine stress echocardiography (DSE) identifies viable myocardium that may...
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| Veröffentlicht in: | Journal of the American College of Cardiology 1999-09, Vol.34 (3), p.730-738 |
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| creator | Chaudhry, Farooq A Tauke, Jason T Alessandrini, Renato S Vardi, Gil Parker, Michele A Bonow, Robert O |
| description | OBJECTIVES
This study was performed to assess the prognostic implications of myocardial contractile reserve (MCR) in patients with coronary artery disease (CAD) and left ventricular (LV) dysfunction.
BACKGROUND
MCR during dobutamine stress echocardiography (DSE) identifies viable myocardium that may improve in function after revascularization. Whether revascularization influences prognosis of patients with MCR has not been determined.
METHODS
We performed DSE in 80 patients with CAD and LV dysfunction (ejection fraction ≤40%). Viable myocardium was defined in dysfunctional myocardial segments as enhanced thickening and contraction during low-dose dobutamine (5 to 10 mcg/kg/min). Serial prospective follow-up was obtained in all patients (mean follow-up 2.2 ± 1.1 years).
RESULTS
Among 52 patients treated medically, there were 20 cardiac deaths. By multivariate analysis, the number of dysfunctional segments demonstrating MCR was the strongest predictor of survival (p < 0.03). Patients with MCR had better initial survival during medical therapy than did those without MCR, but this survival advantage was not maintained beyond three years. In contrast, survival was excellent in patients with MCR who underwent myocardial revascularization. Among 58 patients with MCR in ≥5 myocardial segments, survival at three years was 93 ± 6% in the 24 patients who were revascularized but only 49 ± 15% in the 34 treated medically (p < 0.02).
CONCLUSIONS
Myocardial contractile reserve is a significant predictor of survival in patients with CAD and LV dysfunction undergoing medical therapy. Although patients with MCR have an initial survival advantage, this advantage is lost over the course of three years. In contrast, survival in patients with significant MCR is enhanced by revascularization. |
| doi_str_mv | 10.1016/S0735-1097(99)00252-1 |
| format | Article |
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This study was performed to assess the prognostic implications of myocardial contractile reserve (MCR) in patients with coronary artery disease (CAD) and left ventricular (LV) dysfunction.
BACKGROUND
MCR during dobutamine stress echocardiography (DSE) identifies viable myocardium that may improve in function after revascularization. Whether revascularization influences prognosis of patients with MCR has not been determined.
METHODS
We performed DSE in 80 patients with CAD and LV dysfunction (ejection fraction ≤40%). Viable myocardium was defined in dysfunctional myocardial segments as enhanced thickening and contraction during low-dose dobutamine (5 to 10 mcg/kg/min). Serial prospective follow-up was obtained in all patients (mean follow-up 2.2 ± 1.1 years).
RESULTS
Among 52 patients treated medically, there were 20 cardiac deaths. By multivariate analysis, the number of dysfunctional segments demonstrating MCR was the strongest predictor of survival (p < 0.03). Patients with MCR had better initial survival during medical therapy than did those without MCR, but this survival advantage was not maintained beyond three years. In contrast, survival was excellent in patients with MCR who underwent myocardial revascularization. Among 58 patients with MCR in ≥5 myocardial segments, survival at three years was 93 ± 6% in the 24 patients who were revascularized but only 49 ± 15% in the 34 treated medically (p < 0.02).
CONCLUSIONS
Myocardial contractile reserve is a significant predictor of survival in patients with CAD and LV dysfunction undergoing medical therapy. Although patients with MCR have an initial survival advantage, this advantage is lost over the course of three years. In contrast, survival in patients with significant MCR is enhanced by revascularization.</description><identifier>ISSN: 0735-1097</identifier><identifier>EISSN: 1558-3597</identifier><identifier>DOI: 10.1016/S0735-1097(99)00252-1</identifier><identifier>PMID: 10483954</identifier><identifier>CODEN: JACCDI</identifier><language>eng</language><publisher>New York, NY: Elsevier Inc</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Biological and medical sciences ; Cardiology. Vascular system ; Cardiotonic Agents - administration & dosage ; Chronic Disease ; Coronary Disease - diagnostic imaging ; Coronary Disease - physiopathology ; Coronary Disease - therapy ; Coronary heart disease ; Dobutamine - administration & dosage ; Echocardiography - methods ; Echocardiography - statistics & numerical data ; Female ; Follow-Up Studies ; Heart ; Humans ; Infusions, Intravenous ; Male ; Medical sciences ; Middle Aged ; Myocardial Contraction - physiology ; Prognosis ; Prospective Studies ; Ventricular Dysfunction, Left - diagnostic imaging ; Ventricular Dysfunction, Left - physiopathology ; Ventricular Dysfunction, Left - therapy</subject><ispartof>Journal of the American College of Cardiology, 1999-09, Vol.34 (3), p.730-738</ispartof><rights>1999 American College of Cardiology</rights><rights>1999 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c471t-db6a0fe7efb6673179a83fc2e552895767484c095a94f11e96a4cc9fd9624b7a3</citedby><cites>FETCH-LOGICAL-c471t-db6a0fe7efb6673179a83fc2e552895767484c095a94f11e96a4cc9fd9624b7a3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0735109799002521$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=1932517$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/10483954$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Chaudhry, Farooq A</creatorcontrib><creatorcontrib>Tauke, Jason T</creatorcontrib><creatorcontrib>Alessandrini, Renato S</creatorcontrib><creatorcontrib>Vardi, Gil</creatorcontrib><creatorcontrib>Parker, Michele A</creatorcontrib><creatorcontrib>Bonow, Robert O</creatorcontrib><title>Prognostic implications of myocardial contractile reserve in patients with coronary artery disease and left ventricular dysfunction</title><title>Journal of the American College of Cardiology</title><addtitle>J Am Coll Cardiol</addtitle><description>OBJECTIVES
This study was performed to assess the prognostic implications of myocardial contractile reserve (MCR) in patients with coronary artery disease (CAD) and left ventricular (LV) dysfunction.
BACKGROUND
MCR during dobutamine stress echocardiography (DSE) identifies viable myocardium that may improve in function after revascularization. Whether revascularization influences prognosis of patients with MCR has not been determined.
METHODS
We performed DSE in 80 patients with CAD and LV dysfunction (ejection fraction ≤40%). Viable myocardium was defined in dysfunctional myocardial segments as enhanced thickening and contraction during low-dose dobutamine (5 to 10 mcg/kg/min). Serial prospective follow-up was obtained in all patients (mean follow-up 2.2 ± 1.1 years).
RESULTS
Among 52 patients treated medically, there were 20 cardiac deaths. By multivariate analysis, the number of dysfunctional segments demonstrating MCR was the strongest predictor of survival (p < 0.03). Patients with MCR had better initial survival during medical therapy than did those without MCR, but this survival advantage was not maintained beyond three years. In contrast, survival was excellent in patients with MCR who underwent myocardial revascularization. Among 58 patients with MCR in ≥5 myocardial segments, survival at three years was 93 ± 6% in the 24 patients who were revascularized but only 49 ± 15% in the 34 treated medically (p < 0.02).
CONCLUSIONS
Myocardial contractile reserve is a significant predictor of survival in patients with CAD and LV dysfunction undergoing medical therapy. Although patients with MCR have an initial survival advantage, this advantage is lost over the course of three years. In contrast, survival in patients with significant MCR is enhanced by revascularization.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Biological and medical sciences</subject><subject>Cardiology. Vascular system</subject><subject>Cardiotonic Agents - administration & dosage</subject><subject>Chronic Disease</subject><subject>Coronary Disease - diagnostic imaging</subject><subject>Coronary Disease - physiopathology</subject><subject>Coronary Disease - therapy</subject><subject>Coronary heart disease</subject><subject>Dobutamine - administration & dosage</subject><subject>Echocardiography - methods</subject><subject>Echocardiography - statistics & numerical data</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Heart</subject><subject>Humans</subject><subject>Infusions, Intravenous</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Myocardial Contraction - physiology</subject><subject>Prognosis</subject><subject>Prospective Studies</subject><subject>Ventricular Dysfunction, Left - diagnostic imaging</subject><subject>Ventricular Dysfunction, Left - physiopathology</subject><subject>Ventricular Dysfunction, Left - therapy</subject><issn>0735-1097</issn><issn>1558-3597</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1999</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqF0E2LFDEQgOEgijuu_gQlBxE9tCbdnU7nJLL4BQsK6jnUVFc00p2MSXpkzv5xMzuDevNUl6fy8TL2UIrnUsjhxSehO9VIYfRTY54J0aq2kbfYRio1Np0y-jbb_CEX7F7O34UQwyjNXXYhRT92RvUb9utjil9DzMUj98tu9gjFx5B5dHw5RIQ0eZg5xlASYPEz8USZ0p64D3xXMYWS-U9fvlWUYoB04JAK1TH5TJCJQ5j4TK7wfbXJ4zpD4tMhuzXg8bL77I6DOdOD87xkX968_nz1rrn-8Pb91avrBnstSzNtBxCONLntMOhOagNj57AlpdrRKD3ofuxRGAWmd1KSGaBHNG4yQ9tvNXSX7Mnp3F2KP1bKxS4-I80zBIprtvpYUY5DheoEMcWcEzm7S36pP7NS2GN9e1PfHtNaY-xNfSvr3qPzBet2oemfrVPuCh6fAWSE2SUI6PNfZ7r6AF3ZyxOjWmPvKdmMtTPS5BNhsVP0_3nJb-_ipOY</recordid><startdate>19990901</startdate><enddate>19990901</enddate><creator>Chaudhry, Farooq A</creator><creator>Tauke, Jason T</creator><creator>Alessandrini, Renato S</creator><creator>Vardi, Gil</creator><creator>Parker, Michele A</creator><creator>Bonow, Robert O</creator><general>Elsevier Inc</general><general>Elsevier Science</general><scope>6I.</scope><scope>AAFTH</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>19990901</creationdate><title>Prognostic implications of myocardial contractile reserve in patients with coronary artery disease and left ventricular dysfunction</title><author>Chaudhry, Farooq A ; Tauke, Jason T ; Alessandrini, Renato S ; Vardi, Gil ; Parker, Michele A ; Bonow, Robert O</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c471t-db6a0fe7efb6673179a83fc2e552895767484c095a94f11e96a4cc9fd9624b7a3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1999</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Biological and medical sciences</topic><topic>Cardiology. Vascular system</topic><topic>Cardiotonic Agents - administration & dosage</topic><topic>Chronic Disease</topic><topic>Coronary Disease - diagnostic imaging</topic><topic>Coronary Disease - physiopathology</topic><topic>Coronary Disease - therapy</topic><topic>Coronary heart disease</topic><topic>Dobutamine - administration & dosage</topic><topic>Echocardiography - methods</topic><topic>Echocardiography - statistics & numerical data</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Heart</topic><topic>Humans</topic><topic>Infusions, Intravenous</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Myocardial Contraction - physiology</topic><topic>Prognosis</topic><topic>Prospective Studies</topic><topic>Ventricular Dysfunction, Left - diagnostic imaging</topic><topic>Ventricular Dysfunction, Left - physiopathology</topic><topic>Ventricular Dysfunction, Left - therapy</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Chaudhry, Farooq A</creatorcontrib><creatorcontrib>Tauke, Jason T</creatorcontrib><creatorcontrib>Alessandrini, Renato S</creatorcontrib><creatorcontrib>Vardi, Gil</creatorcontrib><creatorcontrib>Parker, Michele A</creatorcontrib><creatorcontrib>Bonow, Robert O</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of the American College of Cardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Chaudhry, Farooq A</au><au>Tauke, Jason T</au><au>Alessandrini, Renato S</au><au>Vardi, Gil</au><au>Parker, Michele A</au><au>Bonow, Robert O</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Prognostic implications of myocardial contractile reserve in patients with coronary artery disease and left ventricular dysfunction</atitle><jtitle>Journal of the American College of Cardiology</jtitle><addtitle>J Am Coll Cardiol</addtitle><date>1999-09-01</date><risdate>1999</risdate><volume>34</volume><issue>3</issue><spage>730</spage><epage>738</epage><pages>730-738</pages><issn>0735-1097</issn><eissn>1558-3597</eissn><coden>JACCDI</coden><abstract>OBJECTIVES
This study was performed to assess the prognostic implications of myocardial contractile reserve (MCR) in patients with coronary artery disease (CAD) and left ventricular (LV) dysfunction.
BACKGROUND
MCR during dobutamine stress echocardiography (DSE) identifies viable myocardium that may improve in function after revascularization. Whether revascularization influences prognosis of patients with MCR has not been determined.
METHODS
We performed DSE in 80 patients with CAD and LV dysfunction (ejection fraction ≤40%). Viable myocardium was defined in dysfunctional myocardial segments as enhanced thickening and contraction during low-dose dobutamine (5 to 10 mcg/kg/min). Serial prospective follow-up was obtained in all patients (mean follow-up 2.2 ± 1.1 years).
RESULTS
Among 52 patients treated medically, there were 20 cardiac deaths. By multivariate analysis, the number of dysfunctional segments demonstrating MCR was the strongest predictor of survival (p < 0.03). Patients with MCR had better initial survival during medical therapy than did those without MCR, but this survival advantage was not maintained beyond three years. In contrast, survival was excellent in patients with MCR who underwent myocardial revascularization. Among 58 patients with MCR in ≥5 myocardial segments, survival at three years was 93 ± 6% in the 24 patients who were revascularized but only 49 ± 15% in the 34 treated medically (p < 0.02).
CONCLUSIONS
Myocardial contractile reserve is a significant predictor of survival in patients with CAD and LV dysfunction undergoing medical therapy. Although patients with MCR have an initial survival advantage, this advantage is lost over the course of three years. In contrast, survival in patients with significant MCR is enhanced by revascularization.</abstract><cop>New York, NY</cop><pub>Elsevier Inc</pub><pmid>10483954</pmid><doi>10.1016/S0735-1097(99)00252-1</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Adult Aged Aged, 80 and over Biological and medical sciences Cardiology. Vascular system Cardiotonic Agents - administration & dosage Chronic Disease Coronary Disease - diagnostic imaging Coronary Disease - physiopathology Coronary Disease - therapy Coronary heart disease Dobutamine - administration & dosage Echocardiography - methods Echocardiography - statistics & numerical data Female Follow-Up Studies Heart Humans Infusions, Intravenous Male Medical sciences Middle Aged Myocardial Contraction - physiology Prognosis Prospective Studies Ventricular Dysfunction, Left - diagnostic imaging Ventricular Dysfunction, Left - physiopathology Ventricular Dysfunction, Left - therapy |
| title | Prognostic implications of myocardial contractile reserve in patients with coronary artery disease and left ventricular dysfunction |
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