Copyright © 2001 by the European Society of Cardiology.
The prognostic value of myocardial viability recognized by low dose dipyridamole echocardiography in patients with chronic ischaemic left ventricular dysfunction
a CNR Institute of Clinical Physiology, Pisa, Italy
b Charité, Berlin, Germany
c Albert Szent-Gyorgyi University Medical School, Szeged, Hungary
d Hospital Unicor, Sao Paulo, Brazil
e San Paulo School of Medicine, Sao Paulo, Brazil
f Divisione di Cardiologia, Ospedale di Lucca, Lucca, Italy
g Regional Hospital, Sondalo, Italy
h Ospedale di Rho, Rho, Italy
i Ospedale Caldarelli, Napoli, Italy
j Sao Paulo, Brazil
k Ospedale Monaldi, Napoli, Italy
l University Institute for Cardiovascular Diseases, Clinical Center of Serbia, Belgrade, Yugoslavia
m Divisione di Cardiologia, Salerno, Italy
n Ospedale di Legnano, Italy
o Ospedale S. Giuseppe, Empoli, Italy
Abstract
Aims The aim of this study was to assess the prognostic value of myocardial viability recognized as a contractile response to vasodilator stimulation in patients with left ventricular dysfunction in a large scale, prospective, multicentre, observational study.
Methods and Results Three hundred and seven patients (mean age 60±10 years) with angiographically proven coronary artery disease, previous (>3 months) myocardial infarction and severe left ventricular dysfunction (ejection fraction <35%; mean ejection fraction: 28±7%) were enrolled in the study. Each patient underwent low dose dipyridamole echo (0·28mg.kg–1in 4min). Myocardial viability was identified as an improvement of 
0·20 in the wall motion score index. By selection, all patients were followed up for a median of 36 months. One-hundred and twenty-four were revascularized either by coronary artery bypass grafting (n=83) or coronary angioplasty (n=41). The only end-point analysed was cardiac death. In the revascularized group, cardiac death occurred in one of the 41 patients with and in 16 of the 83 patients without a viable myocardium (2·4% vs 19·3%,P <0·01). Outcome, as estimated by Kaplan–Meier survival, was better for patients with, compared to patients without, a viable myocardium, who underwent coronary revascularization (97·6 vs 77·4%,P =0·01). Using a Cox proportional hazards model, the presence of myocardial viability was shown to exert a protective effect on survival (chi-square 4·6, hazard ratio 0·1, 95% CI 0·01–0·8,P <0·03). The survival rate in medically treated patients was lower than in revascularized patients irrespective of the presence of a viable myocardium (79·7% vs 86·2,P =ns).
Conclusion In severe left ventricular ischaemic dysfunction, myocardial viability, as assessed by low dose dipyridamole echo, is associated with improved survival in revascularized patients.
Key Words: Dipyridamole stress echocardiography, myocardial viability, prognosis, revascularization
f1 Correspondence: Rosa Sicari, MD, PhD, CNR, Institute of Clinical Physiology, Via Savi 8, 56100 Pisa, Italy.
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