673 Can resting 2D echocardiography identify patients with ischemic cardiomyopathy and low likelihood of functional improvement after revascularization?

Abstract

Background: To evaluate the potential of a simple and widely available technique such as 2-dimensional echocardiography to identify patients with ischemic cardiomyopathy and low likelihood of functional improvement after revascularization. Methods: Two-dimensional echocardiography was performed in 101 patients with left ventricular (LV) dysfunction due to chronic coronary artery disease, already scheduled for revascularization. Segmental wall motion abnormalities, wall motion score index (WMSI), end-diastolic wall thickness (EDWT), LV volumes and LV sphericity index (LVSI: DŁ) were evaluated. The LV ejection fraction (LVEF) was assessed by radionuclide ventriculography (RNV), before and 9 to 12 months after revascularization. An improvement in the LVEF > or = to 5% was considered clinically significant. Results: On the analysis 999 segments were severely dysfunctional (WMSI: 2.75±0.7); 149 (15%) had an EDWT or = to 140 ml had the best accuracy to identify patients that virtually never improve. LVEF improvement after revascularization was present only in 1 (4%) patient with ESV > or = to 140 ml as compared to 29 (41%) patients with ESV <140 ml (p<0.005). Conclusions: In patients with ischemic cardiomyopathy, the presence of severe LV enlargement significantly reduce the chance of functional improvement after revascularization. Hence, the assessment of LV volumes, by an extremely widespread diagnostic technique as 2-dimensional echocardiography at rest, can be an initial screening tool to identify patients in which further viability testing could be avoided.