Volume 6, Number 16;  August 11, 2006

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Session Handout:

Readings:

Link Directly to Fulltext Article at Publisher

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Unique Identifier [PMID]: 16391157

Authors: Tarakji KG. Brunken R. McCarthy PM. Al-Chekakie MO. Abdel-Latif A. Pothier CE. Blackstone EH. Lauer MS.

Institution: Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, OH 44195, USA.

Title: Myocardial viability testing and the effect of early intervention in patients with advanced left ventricular systolic dysfunction.[see comment].

Source: Circulation. 113(2):230-7, 2006 Jan 17.

Abstract: BACKGROUND: The clinical value of revascularization and other procedures in patients with severe systolic heart failure is unclear. It has been suggested that assessing ischemia and viability by positron emission tomography (PET) with fluorodeoxyglucose (FDG) imaging may identify patients for whom revascularization may lead to improved survival. We performed a propensity analysis to determine whether there might be a survival advantage from revascularization. METHODS AND RESULTS: We analyzed the survival of 765 consecutive patients (age 64+/-11 years, 80% men) with advanced left ventricular systolic dysfunction (ejection fraction < or =35%) and without significant valvular heart disease who underwent PET/FDG study at the Cleveland Clinic between 1997 and 2002. Early intervention was defined as any cardiac intervention (surgical or percutaneous) within the first 6 months of the PET/FDG study. In the entire cohort, 230 patients (30%) underwent early intervention (188 [25%] had open heart surgery, most commonly coronary artery bypass grafting, and 42 [5%] had percutaneous revascularization); 535 (70%) were treated medically. Using 39 demographic, clinical and PET/FDG variables, we were able to propensity-match 153 of the 230 patients with 153 patients who did not undergo early intervention. Among the propensity-matched group, there were 84 deaths during a median of 3 years follow-up. Early intervention was associated with a markedly lower risk of death (3-year mortality rate of 15% versus 35%, propensity adjusted hazard ratio 0.52, 95% CI 0.33 to 0.81, P=0.0004). CONCLUSIONS: Among systolic heart failure patients referred for PET/FDG, early intervention may be associated with improved survival irrespective of the degree of viability.

Publication Type: Journal Article.

Link Directly to Fulltext Article at Science Direct

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Unique Identifier [PMID]: 16098417

Authors: Chareonthaitawee P. Gersh BJ. Araoz PA. Gibbons RJ.

Institution: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota 55905, USA. chareonthaitawee.panithaya@mayo.edu

Title: Revascularization in severe left ventricular dysfunction: the role of viability testing. [Review] [53 refs]

Source: Journal of the American College of Cardiology. 46(4):567-74, 2005 Aug 16.

Abstract: Revascularization is a treatment option for moderate-to-severe ischemic cardiomyopathy. Limitations of the current literature, lack of completed randomized trials, and higher periprocedural risks create significant uncertainty about the optimal treatment strategy. This review focuses on the available literature describing the effect of revascularization on outcome and the role of noninvasive viability testing. It attempts to identify a subset of patients likely to benefit from therapy. [References: 53]

Publication Type: Journal Article. Review.

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Unique Identifier [PMID]: 11403503

Authors: Soto JR. Beller GA.

Institution: Department of Medicine, University of Virginia Health System, Charlottesville 22908-0158, USA.

Title: Clinical benefit of noninvasive viability studies of patients with severe ischemic left ventricular dysfunction. [Review] [55 refs]

Source: Clinical Cardiology. 24(6):428-34, 2001 Jun.

Abstract: The population of patients who have congestive heart failure of ischemic origin is large and growing. It imposes a heavy burden on human suffering and economic costs such as the chronic use of costly medications, recurrent hospital admissions, and, eventually, death or the necessity of heart transplantation. Therefore, the development of methods for detecting viable myocardium may allow the accurate selection of those patients with coronary artery disease with severe left ventricular dysfunction who are most likely to benefit from revascularization, but also excludes patients who are unlikely to obtain any improvement with revascularization techniques. The presence of reversible dysfunctional myocardium that may improve after revascularization implies the concepts of stunned and hibernating myocardium. Recent evidence suggests that hibernation may not be a stable condition since it might evolve toward an irreversible dysfunction if it is not revascularized at the right moment. The techniques available for viability studies are single-photon emission computed tomography using thallium-201 or compounds labeled with technetium-99m, positron emission tomography, and dobutamine stress echocardiography. Newer and promising techniques are magnetic resonance imaging and contrast echocardiography, whose definitive roles are not clear yet. There is abundant evidence from several important studies showing that patients with a significant amount of viable myocardium have a poor outcome if they are treated medically. Conversely, if these patients are revascularized, their outcomes improve and their symptoms significantly decrease, with less necessity of medication, fewer admissions to the hospital, and even in some cases avoiding heart transplantation. On the other hand, patients with poor or no viability who are revascularized do not obtain significant benefit. [References: 55] Publication Type: Journal Article. Review.

Link Directly to Fulltext Article at Science Direct

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Unique Identifier [PMID]: 11276916

Authors: Bax JJ. Poldermans D. Elhendy A. Boersma E. Rahimtoola SH.

Institution: Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.

Title: Sensitivity, specificity, and predictive accuracies of various noninvasive techniques for detecting hibernating myocardium.

Source: Current Problems in Cardiology. 26(2):141-86, 2001 Feb.

Publication Type: Journal Article. Meta-Analysis.

Resident Report / Department of Medicine & Grady Branch Library

Emory University School of Medicine

2006 Edition

Participating Faculty:  Carlos Del Rio MD  / Joyce Doyle MD / Lorenzo Difrancesco MD / Joel Mermis MD / Maunank Shah MD

Contact: Karl Woodworth