Percutaneous coronary intervention in patients with ischemic cardiomyopathy and viable myocardium: A high dose dobutamine stress echocardiography study

Abstract

Background The treatment of patients with ischaemic cardiomyopathy is still problematic. The choice of revascularization of these patients – especially who have substantial viability – is not widely implemented due to confusion about its benefit. Objectives This work aimed to evaluate prospectively the response of left ventricular function to low as well as high dose dobutamine in patients with ischaemic cardiomyopathy showing substantial viability, with and without improved resting left ventricular ejection fraction after coronary angioplasty. Methods Fifty patients with ischaemic cardiomyopathy (LVEF ⩽40%) and substantial viability (⩾2 segments) underwent low and high dose dobutamine echocardiography before and 3 months after percutaneous coronary intervention. Patients were divided into group 1, patients with, and group 2, patients without significant improvement in resting LVEF (5% by echocardiography) after revascularisation. The response of LVEF during dobutamine stress echocardiography was compared in these two groups. Results Patients were matched for baseline characteristics except for the history of myocardial infarction which was more in group 2. The CCS functional class for angina and the NYHA functional class for heart failure were both improved after PCI in both groups but with a remarkable improvement in group 1. Myocardial viability increased much more in group 1 than group 2 after PCI (6.3 vs. 4 viable segments before and 6.8 vs. 4.4 viable segments respectively after, p 34% vs. 31%, 46% vs. 41% and 34% vs. 32% respectively, p So, the improvement in LVEF (⩾5%) was only found in group 1 and not in group 2. Conclusion The LV function was improved only in patients with improved resting LVEF and improved myocardial viability after PCI.