Author + information
- Received February 28, 2005
- Revision received June 7, 2005
- Accepted June 13, 2005
- Published online October 4, 2005.
- Alessandro Desideri, MD, FACC⁎,⁎ (, )
- Lauro Cortigiani, MD⁎,
- Alejandra Ines Christen, MD⁎,
- Sebastian Coscarelli, MD⁎,
- Dario Gregori, PhD†,
- Pierluigi Zanco, MD‡,
- Roman Komorovsky, MD⁎ and
- Jeroen J. Bax, MD§
- ↵⁎Reprint requests and correspondence:
Dr. Alessandro Desideri, Cardiovascular Research Foundation, S. Giacomo Hospital, 31033 Castelfranco Veneto (TV), Italy.
Objectives The purpose of this study was to assess the determinants of mortality in a large group of patients with ischemic cardiomyopathy who are treated medically and the impact of the extent of viable tissue on prognosis.
Background Whether the presence of viability drives mortality in patients with ischemic cardiomyopathy who are treated medically and whether the extent of viability is important are issues that are currently unclear.
Methods Two hundred sixty-one patients with ischemic cardiomyopathy underwent positron emission tomography (PET) for assessment of viability. Prospective follow-up was obtained.
Results Ninety-four patients were revascularized and 167 were not. The cardiac death rate was significantly less in the revascularized patients as compared with medically treated patients (13% vs. 24%, p < 0.05). In the revascularized patients, there was a trend toward better survival in patients with viable myocardium as compared with nonviable myocardium (3.5-year survival, 85% and 75% respectively, p = NS). In the medically treated group, age (hazard ratio [HR] 2.1, 95% confidence interval [CI] 1.2 to 3.7), presence of left bundle branch block (HR 3.4, 95% CI 1.6 to 7.2) and extent of perfusion-metabolism mismatch on PET (HR 1.36, 95% CI 1.1 to 1.6) predicted cardiac death during a median follow-up period of 2.1 years. The risk of cardiac death was not significantly increased when the extent of mismatch was ≤20% (HR 0.97, 95% CI 0.46 to 2.05) but was significantly increased when the extent of mismatch was >20% (HR 3.21, 95% CI 1.38 to 7.49).
Conclusions Medically treated patients with ischemic cardiomyopathy and large areas of viable myocardium on PET are at high risk for cardiac death.
The study was supported by the Cardiovascular Research Foundation research fellowship program.
- Received February 28, 2005.
- Revision received June 7, 2005.
- Accepted June 13, 2005.
- American College of Cardiology Foundation