Myocardial Recovery In Patients Research Articles

Predictive power of late gadolinium enhancement for myocardial recovery in chronic ischaemic heart failure: a HEART sub-study.

The amount of myocardial scar measured by late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) imaging predicts regional recovery in wall motion following revascularization. Previous studies have been conducted in patients with a relatively recent myocardial insult and relatively preserved left ventricular (LV) function. In this sub-study of a clinical trial, the predictive value of LGE, and other CMR-derived data, for myocardial recovery in patients with chronic severe ischaemic cardiomyopathy was assessed. Twenty-two patients with severe LV impairment of ischaemic origin were enrolled as a sub-study of a trial that randomly assigned patients to revascularization or not in addition to guideline-indicated pharmacological therapy. Patients underwent a CMR study at baseline and 6 months. Scans were qualitatively and quantitatively assessed for wall motion, rest/stress myocardial perfusion, and LGE. The median duration of heart failure was 13 (inter-quartile range 5-21) months. Patients had severe LV dilatation [end-diastolic volume (EDV) 280 ± 77 mL] and reduction in LV ejection fraction (LVEF) (29 ± 10%). The percentage scar burden by LGE was 17 ± 9%. Patient characteristics of those undergoing revascularization (n = 7) or not (n = 14) were similar. Myocardial perfusion reserve index (MPRI) improved following revascularization (MPRI 1.17 vs. 1.57, P < 0.0001) but not following medical therapy (1.39 vs. 1.32, P = 0.54). However, LVEF improved in patients whether or not they had revascularization. In the revascularization group, 14% of dysfunctional segments with LGE <25% and 22% of dysfunctional segments with LGE <50% had improved contractile function. However, the transmural extent of LGE did not predict contractile recovery following revascularization or pharmacological therapy (P = 0.19, P = 0.42). LVEDV improved overall (280 ± 77 to 269 ± 83 mL, P = 0.05); improvement was associated with heart failure duration (P = 0.04). In patients with chronic severe LV impairment of ischaemic origin, duration of heart failure is a better predictor of recovery than transmural extent of LGE, following medical therapy or successful revascularization. This suggests that the extent of myocardial remodelling is more important for LV recovery than the presence and extent of prior infarction alone and that LGE should not be the sole determinant of treatment method in severe LV systolic dysfunction of ischaemic origin.

Radionuclide imaging of cardiac sympathetic innervation in heart failure: unlocking untapped potential

Heart failure (HF) is associated with sympathetic overactivity, which contributes to disease progression and arrhythmia development. Cardiac sympathetic innervation imaging can be performed using radiotracers that are taken up in the presynaptic nerve terminal of sympathetic nerves. The commonly used radiotracers are (123)I-metaiodobenzylguanidine ((123)I-mIBG) for planar and single-photon emission computed tomography imaging, and (11)C-hydroxyephedrine for positron emission tomography imaging. Sympathetic innervation imaging has been used in assessing prognosis, response to treatment, risk of ventricular arrhythmias and sudden death and prediction of response to cardiac resynchronization therapy in patients with HF. Other potential applications of these techniques are in patients with chemotherapy-induced cardiomyopathy, predicting myocardial recovery in patients with left ventricular assist devices, and assessing reinnervation following cardiac transplantation. There is a lack of standardization with respect to technique of (123)I-mIBG imaging that needs to be overcome for the imaging modality to gain popularity in clinical practice.

PM146 The value of fractional flow reserve in predicting myocardial recovery in patients with ST elevation myocardial infarction

PM146 The value of fractional flow reserve in predicting myocardial recovery in patients with ST elevation myocardial infarction

Plasma Fatty Acid Levels in Children during Extracorporeal Membrane Oxygenation Support—A Pilot Study

Plasma fatty acids levels are markedly elevated in patients with myocardial ischemic–reperfusion injury including those after cardiopulmonary bypass (CPB). High levels of fatty acids have detrimental effects on myocardial function. Extracorporeal membrane oxygenation (ECMO) is like CPB, but much longer, to provide a life-saving support for patients with cardiac arrest. We measured plasma fatty acid levels in children during ECMO support. Five children (aged .3–36 months, median 20 months) receiving venoarterial ECMO support after cardiac arrest in 2010 and 2011 were enrolled. The study was initiated at 32–56 hours after the start of ECMO support as a result of the complicated clinical scenario. Fatty acids were measured at 8-hour intervals for 1–3 days. The dosage of inotropes and vasoactive agents was recorded concurrently. The duration of ECMO ranged from 70 to 240 hours (median 177 hours). Four patients were successfully weaned off ECMO support. One died after termination of ECMO. Levels of fatty acids were elevated compared with the normal values. Overall, fatty acid levels continuously decreased over time (p &lt; .0001), the mean being 1.03 ± .33 mmol/L in 30–50 hours, 1.01 ± .57 in 50–70 hours, .81 ± .32 in 70–90 hours, and .63 ± .23 hours. No correlation was found between fatty acid levels and other clinical variables, including age, dosage of inotropes and vasoactive agents, or ECMO duration. Plasma fatty acids levels are elevated in children during ECMO support and continuously decrease over time. Fatty acid levels may be markedly higher in the immediate hours after the initiation of ECMO. Data from more patients are needed to understand the profiles of fatty acids and the correlations with clinical variables. Metabolic manipulations to decrease fatty acids might improve myocardial recovery in patients undergoing ECMO support.

TCT-250 Left Ventricular End-Diastolic Pressure Predicts Early Myocardial Recovery in Patients with Acute Myocardial Infarction Undergoing Percutaneous Coronary Intervention

Little is known regarding the various clinical predictors of myocardial recovery in patients presenting with acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI). Elevated left ventricular end-diastolic pressure (LVEDP) is commonly observed during AMI, but few

Genomics of Myocardial Recovery in Patients with Mechanical Circulatory Support

Purpose Ventricular assist devices (VAD) are implanted in patients for bridging to heart transplantation (BTT) or nowadays in an increasing number of cases for destination therapy. However, about 2% of the patients develop spontaneously myocardial recovery for unknown reasons (BTR). Currently, myocardial recovery is not predictable, since reliable biomarkers are lacking. The aim of our study was the identification of novel biomarkers for myocardial recovery. Methods and Materials Total-RNA from left ventricular (LV) samples of 7 rejected donor hearts (NF), and LV-apex samples of 7 BTR- and 7 BTT-patients from VAD-implantation were isolated. NF-, BTR-, BTT-patients were matched according to age, gender and etiology. We analysed the myocardial transcriptome using Affymetrix-chips for the identification of secretory proteins. Differentially expressed transcripts were confirmed by real time RT-PCR. Expression profiling was evaluated by principal component analysis (PCA) and target gene identification. Transcripts of secretory proteins were analysed by enzyme linked immunosorbant assay (ELISA) for differences in the plasma at the time VAD-implantation. Results The principal component analysis (PCA) did not reveal clear separation of the HF samples. However, transcripts related to the immune system like plasma TNF-alpha stimulated gene 14 (TSG14) and interferon inducible protein 10kD (CXCL10) are by trend increased in BTR-samples compared to controls. Of note, TSG14 and CXCL10 were not different between BTR and BTT patients. However, both proteins were significantly elevated in VAD-patients before device implantation. Conclusions Molecular differences in the myocardium of patients with and without myocardial recovery are small. However, the identified transcripts such as TSG14 or CXCL14 related to immune-modulatory functions may indicate an uncomplete cardiac remodelling in patients weaned from the device. Both markers are significantly increased in heart failure patients.

Is Myocardial Recovery Possible and How Do You Measure It?

Medical and device therapies that reduce heart failure morbidity and mortality also lead to decreased left ventricular volume and mass, and a more normal elliptical shape of the ventricle. These are due to changes in myocyte size, structure, and organization that have been referred to collectively as "reverse remodeling." Moreover, there are subsets of patients whose hearts have undergone reverse remodeling following mechanical circulatory support with a ventricular assist device (VAD), who are able to be weaned from their VADs, which has been referred to as "myocardial recovery." Although the term myocardial recovery has been used to describe the reversal of various aspects of the heart failure phenotype following medical and device therapy, there is no consensus with regard to what constitutes myocardial recovery; moreover, the methodology for identifying myocardial recovery in patients is unclear. These topics will be discussed in the current review.

Usefulness of cardiac biomarkers to predict cardiac recovery in patients on extracorporeal membrane oxygenation support for refractory cardiogenic shock

BackgroundNo prognostic markers of myocardial recovery in patients with refractory cardiogenic shock requiring circulatory support are known, but early identification of patients who will not recover might provide an opportunity to change the treatment strategy to improve outcome. Because N-terminal fragment of the B-type natriuretic peptide, troponin Ic, midregional fragment of the proatrial natriuretic peptide, proadrenomedullin, and copeptin are prognostic markers in patients with cardiac failure, we hypothesized that, among patients with refractory cardiogenic shock of potentially reversible cause supported with extracorporeal membrane oxygenation (ECMO), the kinetics of these markers might help identify patients who would recover. MethodsThis was a prospective, observational, single-center study in a medical-surgical intensive care unit. Among 41 consecutive patients with refractory cardiogenic shock of potentially reversible cause receiving ECMO support, 18 recovered and were successfully weaned off the machine. Blood N-terminal fragment of the B-type natriuretic peptide, troponin Ic, midregional fragment of the proatrial natriuretic peptide, proadrenomedullin, and copeptin concentrations were determined on days 1, 3, and 7 post-ECMO. ResultsNeither the absolute values of those biomarkers at days 1, 3, or 7 nor their kinetics during the first week differed between patients weaned or not. Areas under the receiver operating characteristic curves (95% confidence interval) of the day 1-to-day 3 biomarker changes for predicting cardiac recovery were 0.54 (0.36-0.71), 0.61 (0.43-0.78), 0.61 (0.42-0.77), 0.56 (0.38-0.73), and 0.61 (0.43-0.78), respectively. ConclusionIn patients with refractory cardiogenic shock of potentially reversible cause receiving ECMO support, early measurements of cardiac biomarkers are not useful for identifying those who would recover.

Abstract 9970: Combined Clenbuterol and Metoprolol Therapy Improves Cardiac Function and Calcium Handling in a Rodent Model of Heart Failure, but Does Not Prevent Myocardial Atrophy or Enhance Myocyte Recovery Associated with Mechanical Unloading

Clenbuterol (CL) a β 2 -AR agonist has been successfully employed alongside β 1 -AR blockade in combination with left ventricular assist devices (LVAD) to prevent myocardial atrophy, and promote myocardial recovery in patients with severe heart failure (HF). CL is known to have beneficial effects on excitation contraction (EC) coupling in HF and during mechanical unloading (MU) in animal models. However, CL-induced cardiac hypertrophy and tachycardia have discouraged its use in clinical HF therapy. We compared the chronic effects (4 wks) of CL (2mg/kg/day) and metoprolol (M) (200mg/kg/day) alone and in combination with MU (heterotopic abdominal transplantation) on heart/cardiomyocyte size, function and cellular EC coupling in a rat model of HF (LAD ligation). CL improved ejection fraction compared to untreated HF group, an effect further augmented by M (EF (%): HF 36.2 ± 2.3, p&lt;0.01 vs CL 40.78 ± 2.1, p&lt;0.001 vs M+CL 44.3 ± 2.3 (all groups n=8). CL caused a rise in heart rate (HR) but, when combined with M, HR was reduced (both groups p&lt;0.01 vs HF). CL caused cardiac hypertrophy whereas combined M+CL did not (heart weight:body weight ratio (g/g x 1000)): HF 3.6 ± 0.28, p&lt; 0.05 vs CL 4.2 ± 0.38, Μ+CL 3.6 ± 0.24, p&gt;0.05 vs HF (all groups n=8). Both groups failed to prevent MU-induced myocyte atrophy, but myocyte size was greater in MU+CL group compared with MU+M+CL (cell volume measured by di-8-ANNEPS staining and confocal microscopy (µm3)): MU+ CL 30025 ± 8562, p&lt;0.001 vs MU + M+CL 18750 ± 7500, (both groups n= 50). Myocyte Ca 2+ cycling was studied using the fluorescent dye Indo-1 AM. Ca 2+ transient amplitude was elevated in M+CL group but was not affected by CL (ratio units): HF 0.14 ± 0.06, p&lt;0.001 vs M+CL 0.19 ± 0.09 (both groups n=26). CL alone and M + CL augmented sarcoplasmic reticulum Ca2 + content equally (ratio units): CL 0.20 ± 0.04, M + CL 0.22 ± 0.06, both groups p&lt;0.01 vs HF, (all groups n=20). MU alone normalised HF cardiomyocyte EC parameters with no additional benefit derived by M+CL therapy. We show that combination of CL and M enhances whole heart function and cellular EC coupling in HF without increase in heart size or HR, but does not affect the consequences of MU on cell size and function. Whether such effects can be exploited in the treatment of HF patients requires further studies.

Aortic Valve Opening at Hospital Discharge After HeartMate II Left Ventricular Assist Device Implantation Is Associated With Improved Renal Function at 3 Months

Background: While novel therapies may assist in myocardial recovery in patients maintained on LVassist devices (LVADs), it is not clear how best to measure intrinsic cardiac contractile function in the unloaded state. We sought to determine if global and regional cardiac strain measured by echocardiographic deformation imaging could be accurately and reproducibly measured in LVAD patients, and to determine the relationship between these measures and estimates of myocardial metabolism and blood flow by positron emission tomography (PET). Objective: To describe the interrelation between measures of cardiac function and structure, myocardial blood flow and metabolism in patients with advanced heart disease living on left ventricular assist devices. Methods: 7 Patients with end-stage heart failure (4 ischemic, 3 nonischemic) on LVAD support were prospectively evaluated using both PET and ECHO, imaged on the same day, at the same VAD settings. Regional circumferential strain, myocardial blood flow, and glucose metabolism were assessed in mid-short axis slices at the level of the papillary muscles and related. Results: Mid-ventricular global strain was low in all patients, but it was lower in patients with CAD versus non-ischemic patients (-4.6% 6 0.4 vs. -7.3% 6 2.9, p50.054; normal 5 O -23%). Despite 4 patients labelled with ischemic cardiomyopathy, only 1 had a definite region of infarction on PET. Regional strain correlated well with myocardial perfusion (r5 -0.89, p50.01) and metabolism (r5 -0.843, p50.03) in the CAD patient with an infarcted region (Figure 1), but not in CAD patients without MI or in non-ischemic patients.

Assessment of Intrinsic Cardiac Function, Myocardial Blood Flow and Metabolism in Patients Supported on Mechanical Circulatory Assist Devices

While novel therapies may assist in myocardial recovery in patients maintained on LV assist devices (LVADs), it is not clear how best to measure intrinsic cardiac contractile function in the unloaded state. We sought to determine if global and regional cardiac strain measured by echocardiographic deformation imaging could be accurately and reproducibly measured in LVAD patients, and to determine the relationship between these measures and estimates of myocardial metabolism and blood flow by positron emission tomography (PET).

Is Bridge to Recovery More Likely With Pulsatile Left Ventricular Assist Devices Than With Nonpulsatile-Flow Systems?

Weaning from left ventricular assist devices (LVADs) after myocardial recovery in patients with idiopathic dilated cardiomyopathy is a clinical option. With the broad application of continuous-flow pumps, we observed a decrease in the numbers of possible LVAD explanations due to myocardial recovery in these particular patients. We investigated this phenomenon and its causes. Between July 1992 and December 2009, 387 patients (age, 0.1 to 82 years) with idiopathic dilated cardiomyopathy underwent LVAD implantation at our institution. Patients were divided into two groups depending on whether they were weaned from the LVAD (group A) or not (group B). Univariate and multivariate analyses were performed on 24 different factors with a possible influence on myocardial recovery. In 34 patients, LVAD removal due to myocardial recovery was performed with long-term stable cardiac function (weaning rate, 8.8%). Patients with a pulsatile-flow LVAD had an almost threefold chance for myocardial recovery (odds ratio, 2.719; 95% confidence interval, 1.182 to 6.254) than patients who received continuous-flow devices. Younger patients had significantly higher recovery rates than older patients (odds ratio, 1.036; 95% confidence interval, 1.016 to 1.057). Pulsatile-flow LVADs and young age were important factors for myocardial recovery in idiopathic dilated cardiomyopathy patients in our analysis. Further studies should investigate whether pulsatility in itself or the different degrees of left ventricular unloading by the two types of systems play a role in myocardial recovery.

Ivabradine and Mechanical Unloading Increase Sarcoplasmic Reticulum Calcium Content in a Rodent Model of Heart Failure

Improvements in Ca2+ handling, and sarcoplasmic reticulum (SR) Ca2+ regulation in particular, are associated with myocardial recovery in patients with end stage heart failure (HF) treated with left ventricular assist devices (LVAD). Ivabradine (IV), a novel heart rate reducing agent has been shown to have positive Ca2+ regulatory effects in rodent HF, and is used in human HF therapy; however, the effects of IV during LVAD treatment have not been studied.We studied the chronic effects of IV on cellular Ca2+ handling during mechanical unloading (MU) of HF hearts. HF was induced by left coronary artery ligation and was characterized by reduced ejection fraction (EF), smaller Ca2+ transient amplitude (CaT) and reduced SR Ca2+ content compared to age matched sham operated animals (SH). MU (4 weeks) was achieved by heterotopic abdominal heart transplantation and IV (10mg/kg/day) was administered for 4 weeks. Isolated ventricular myocytes were loaded with Indo-1 AM and field stimulated at 1 Hz.CaT was significantly elevated in the MU+IV group (indo-1 ratio units): MU+IV: 0.25 ± 0.06 (n=45) p< 0.001 vs MU: 0.18 ± 0.05 (n=40), and p<0.001 vs SH: 0.17 ± 0.05 (n=45)). IV augmented SR Ca2+ content in combination with MU compared with MU alone and to a level even greater than SH: SR Ca2+ content (indo-1 ratio units): MU+IV: 0.27 ± 0.07 (n=45) p< 0.05 vs MU: 0.24 ± 0.05 (n=40), and p<0.001 vs SH: 0.22 ± 0.07 (n=45))Our results show that IV treatment combined with mechanical unloading induces a larger increase of Ca2+ transient amplitude and SR Ca2+ content compared with mechanical unloading alone. These effects may be exploited to enhance myocardial recovery in patients receiving LVAD therapy for HF.

Myocardial Recovery in Patients with Chronic Heart Failure: Is It Real?

Patients with chronic advanced heart failure unloaded by left ventricular assist devices can show improvement in their myocardial function and some can show "reverse remodeling" to the extent that their myocardial function improves sufficiently for the device to be removed. Furthermore, recent data suggest that combining mechanical support with adjuvant drug therapy can increase the rate and proportion of recovery as well as its durability. This article will review the evidence for myocardial recovery in patients with chronic heart failure and whether it is a "real" phenomenon.

561: The Effects of Clenbuterol on the Left Ventricular Wall Thickness and Function in Patients Recovered on Left Ventricular Assist Device (LVAD)

Previous animal studies have suggested the potential use of clenbuterol in conjunction with a pharmacological reverse remodelling regimen to induce myocardial recovery in patients with LVAD. The aim of this study is to retrospectively evaluate the effects of clenbuterol on the left ventricular (LV) wall thickness and function in patients who had recovered on LVAD and drug combination therapy.

Effect of arterial oxygen tension during reperfusion on myocardial recovery in patients undergoing valvular heart surgery

BackgroundValvular heart surgery (VHS) utilizing cardiopulmonary bypass (CPB) is inevitably associated with ischemic-reperfusion injury, which is known to depend on oxygen tension during reperfusion. The aim of this study was to evaluate the effect of arterial oxygen tension during reperfusion on myocardial recovery in patients undergoing VHS.MethodsFifty-six patients undergoing isolated VHS were randomly exposed to an oxygen fraction of 0.7 (hyperoxic group, n = 28) or 0.5 (normoxic group, n = 28) during reperfusion. All patients received an oxygen fraction of 0.7 during CPB. In the normoxic group, the oxygen fraction was lowered to 0.5 from the last warm cardioplegia administration to 1 minute after aortic unclamping, and was then raised back to 0.7. Hemodynamic data were measured after induction of anesthesia, weaning from CPB, and sternum closure. The frequency of cardiotonic medications used during and after weaning from CPB, and the short-term outcomes during the hospital stay were also assessed.ResultsThe frequency of vasopressin and milrinone use during weaning from CPB, but not norepinephrine, was significantly less in the normoxic group. The post-operative cardiac enzyme levels and short-term outcomes were not different between the groups.ConclusionsNormoxic reperfusion from the last cardioplegia administration to 1 minute after aortic unclamping in patients undergoing VHS resulted in significantly less frequent use of vasopressin and inotropics during weaning from CPB than hyperoxic reperfusion, although it did not affect the post-operative myocardial enzyme release or short-term prognosis.

514: Echocardiographic Evaluation of Flow across HeartMate II Axial Flow LVADs at Varying Low Speeds

Assessment of myocardial recovery in patients with non-pulsatile LVADs involves speed reduction to a degree where there is minimal contribution from the pump into the circulation during assessment. To date we have used 6000rpm to assess recovery in HeartMate II LVAD patients. The aims of this study were to study reverse flow and to assess whether 6000rpm was a safe and sufficient speed to assess recovery.

Extracorporeal Membrane Oxygenation for Primary Allograft Failure

Objective Herein we have reported our experience concerning the usefulness of extracorporeal membrane oxygenation (ECMO) in heart transplant patients. Patients and Methods Between July 2002 and March 2007, 11 heart transplant patients, namely, 8 men and 3 women of overall mean age of 49.4 ± 13.9 years (range, 19–62 years) with primary graft failure underwent ECMO implantation. Two patients had pulmonary hypertension; 3 had been transplanted with hearts from marginal donors. At the time of implantation, all were in severe cardiogenic shock despite maximal inotropic support. In 6 patients, the ECMO was implanted centrally in the operating room when there was failure of weaning of cardiopulmonary bypass. Among the 5 remaining patients, ECMO was implanted peripherally in the intensive care unit, during the first 60 hours, including 3 cases of hemodynamic instability and 1 of irreversible cardiac graft arrest. The last patient was implanted on day 30 after transplantation because of acute rejection. Results Mean pump outflow was 2.7 ± 0.4 L/min/m 2. One patient died on circulatory support due to a cerebral hemorrhage. Ten patients were weaned from ECMO after a mean duration of 9.1 ± 6.9 days (range, 1–18 days). All of them were successfully discharged. No retransplantation occurred. Conclusion Rapid operating room or bedside placement of ECMO allowed stabilization of hemodynamics with potential myocardial recovery in patients with cardiac graft failure.

Explantation of INCOR Left Ventricular Assist Device After Myocardial Recovery

Myocardial recovery in patients supported by the INCOR left ventricular assist device (LVAD; Berlin Heart GmbH, Berlin, Germany) is seen in 5% of patients on this device worldwide. We describe improved surgical techniques for INCOR LVAD explantation. The outcome of INCOR LVAD implantation at our center and the operative techniques of device explantation were studied. The patients weaned from the device were followed up. Out of 121 patients supported by the device, five (4.1 %) were weaned from the device, whereas 34 patients (28.1 %) underwent heart transplantation. In explantation surgery, the inflow cannula was removed (one case) or remained in the left ventricle after occlusion with an inflow cannula plug, with transection of the inflow cannula at its curve (two cases) or without transection (two cases). When the inflow cannula was occluded without the support of cardiopulmonary bypass (two cases), operative time (180 min and 210 min) was shorter than that with other explantation procedures. After mean follow-up of 2.4 years (range two months-four years) after device explantation, all five patients are alive, have not required heart transplantation and are in New York Heart Association class I (one case) or class II (four cases). After weaning from the device, no cerebrovascular complication was observed in any of the five patients. There is a possibility of weaning after INCOR implantation and surgical techniques for the removal of the INCOR LVAD should be further developed.

The value of fractional and coronary flow reserve in predicting myocardial recovery in patients with previous myocardial infarction

The aim of the study was to evaluate the relation between fractional flow reserve (FFR) and simultaneously evaluated coronary flow reserve by thermodilution (CFRthermo), with the improvement of left ventricular (LV) function in patients with previous myocardial infarction (MI) undergoing percutaneous coronary intervention (PCI). Study population consisted of 46 patients (mean age 53 +/- 7 years; 36 male) with previous MI and significant coronary stenosis undergoing PCI of infarct-related coronary artery. In all patients, we evaluated FFR and CFRthermo by single pressure/thermo wire during maximal hyperaemia before and immediately after PCI. We performed echocardiographic assessment of LV ejection fraction before and 6 months after PCI. Dobutamine stress echocardiography test was also performed before PCI. LV functional improvement was observed in 33/46 (72%) of patients. In patients with LV functional recovery in comparison with patients with no recovery, there was a significant difference in FFR before PCI (0.56 +/- 0.14 vs. 0.70 +/- 0.07, P < 0.001), improvement of FFR (0.35 +/- 0.14 vs. 0.21 +/- 0.07, P < 0.001), improvement of CFRthermo (1.3 +/- 0.6 vs. 0.5 +/- 0.3, P < 0.001), and CFRthermo after PCI (2.6 +/- 0.7 vs. 2.0 +/- 0.4, P < 0.001). When only parameters evaluated before PCI were taken into account, FFR before angioplasty (P = 0.001) and dobutamine-assessed viability (P = 0.006) were the most significant multivariate predictors of myocardial recovery. When all significant univariate parameters were evaluated, the most significant independent predictors for improvement in myocardial function were the improvement of CFRthermo during angioplasty (P < 0.001) and FFR before angioplasty (P = 0.002). Simultaneous evaluation of FFR and CFRthermo provide significant complementary data on the improvement in myocardial function in patients with previous MI. However, the evaluation of FFR before angioplasty identifies viable myocardium that may recover following revascularization and may be used as an alternative to non-invasive testing.