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European Heart Journal 2001 22(10):837-844; doi:10.1053/euhj.2000.2322
Copyright © 2001 by the European Society of Cardiology.
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The prognostic value of myocardial viability recognized by low dose dipyridamole echocardiography in patients with chronic ischaemic left ventricular dysfunction

R Sicaria,f1, A Ripolia, E Picanoa, A.C Borgesb, A Vargac, W Mathiasd,e, L Cortigianif, R Bigig, J Heymanh, S Polimenoi, O Silvestrii, V Gimenezj, P Casok, S Severinok, A Djordjevic-Dikicl, M Ostojicl, C Baldim, G Seveson and N Petix on behalf of the VIDA (Viability Identification with Dipyridamole Administration) Study Groupo

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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