Myocardial viability and survival in ischemic left ventricular dysfunction

Robert O. Bonow, Gerald Maurer, Kerry L. Lee, Thomas A. Holly, Philip F. Binkley, Patrice Desvigne-Nickens, Jaroslaw Drozdz, Pedro S. Farsky, Arthur M. Feldman, Torsten Doenst, Robert E. Michler, Daniel S. Berman, Jose C. Nicolau, Patricia A. Pellikka, Krzysztof Wrobel, Nasri Alotti, Federico M. Asch, Liliana E. Favaloro, Lilin She, Eric J. Velazquez & 2 others Robert H. Jones, Julio A. Panza

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Abstract

Background: The assessment of myocardial viability has been used to identify patients with coronary artery disease and left ventricular dysfunction in whom coronary-artery bypass grafting (CABG) will provide a survival benefit. However, the efficacy of this approach is uncertain. methods: In a substudy of patients with coronary artery disease and left ventricular dysfunction who were enrolled in a randomized trial of medical therapy with or without CABG, we used single-photon-emission computed tomography (SPECT), dobutamine echocardiography, or both to assess myocardial viability on the basis of prespecified thresholds. results: Among the 1212 patients enrolled in the randomized trial, 601 underwent assessment of myocardial viability. Of these patients, we randomly assigned 298 to receive medical therapy plus CABG and 303 to receive medical therapy alone. A total of 178 of 487 patients with viable myocardium (37%) and 58 of 114 patients without viable myocardium (51%) died (hazard ratio for death among patients with viable myocardium, 0.64; 95% confidence interval [CI], 0.48 to 0.86; P = 0.003). However, after adjustment for other baseline variables, this association with mortality was not significant (P=0.21). There was no significant interaction between viability status and treatment assignment with respect to mortality (P = 0.53). conclusions: The presence of viable myocardium was associated with a greater likelihood of survival in patients with coronary artery disease and left ventricular dysfunction, but this relationship was not significant after adjustment for other baseline variables. The assessment of myocardial viability did not identify patients with a differential survival benefit from CABG, as compared with medical therapy alone.

Original languageEnglish (US)
Pages (from-to)1617-1625
Number of pages9
JournalNew England Journal of Medicine
Volume364
Issue number17
DOIs
StatePublished - Apr 28 2011

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Left Ventricular Dysfunction
Survival
Coronary Artery Bypass
Myocardium
Coronary Artery Disease
Therapeutics
Dobutamine
Mortality
Single-Photon Emission-Computed Tomography
Echocardiography
Confidence Intervals

ASJC Scopus subject areas

  • Medicine(all)

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Bonow, R. O., Maurer, G., Lee, K. L., Holly, T. A., Binkley, P. F., Desvigne-Nickens, P., ... Panza, J. A. (2011). Myocardial viability and survival in ischemic left ventricular dysfunction. New England Journal of Medicine, 364(17), 1617-1625. https://doi.org/10.1056/NEJMoa1100358

Myocardial viability and survival in ischemic left ventricular dysfunction. / Bonow, Robert O.; Maurer, Gerald; Lee, Kerry L.; Holly, Thomas A.; Binkley, Philip F.; Desvigne-Nickens, Patrice; Drozdz, Jaroslaw; Farsky, Pedro S.; Feldman, Arthur M.; Doenst, Torsten; Michler, Robert E.; Berman, Daniel S.; Nicolau, Jose C.; Pellikka, Patricia A.; Wrobel, Krzysztof; Alotti, Nasri; Asch, Federico M.; Favaloro, Liliana E.; She, Lilin; Velazquez, Eric J.; Jones, Robert H.; Panza, Julio A.

In: New England Journal of Medicine, Vol. 364, No. 17, 28.04.2011, p. 1617-1625.

Research output: Contribution to journalArticle

Bonow, RO, Maurer, G, Lee, KL, Holly, TA, Binkley, PF, Desvigne-Nickens, P, Drozdz, J, Farsky, PS, Feldman, AM, Doenst, T, Michler, RE, Berman, DS, Nicolau, JC, Pellikka, PA, Wrobel, K, Alotti, N, Asch, FM, Favaloro, LE, She, L, Velazquez, EJ, Jones, RH & Panza, JA 2011, 'Myocardial viability and survival in ischemic left ventricular dysfunction', New England Journal of Medicine, vol. 364, no. 17, pp. 1617-1625. https://doi.org/10.1056/NEJMoa1100358
Bonow RO, Maurer G, Lee KL, Holly TA, Binkley PF, Desvigne-Nickens P et al. Myocardial viability and survival in ischemic left ventricular dysfunction. New England Journal of Medicine. 2011 Apr 28;364(17):1617-1625. https://doi.org/10.1056/NEJMoa1100358
Bonow, Robert O. ; Maurer, Gerald ; Lee, Kerry L. ; Holly, Thomas A. ; Binkley, Philip F. ; Desvigne-Nickens, Patrice ; Drozdz, Jaroslaw ; Farsky, Pedro S. ; Feldman, Arthur M. ; Doenst, Torsten ; Michler, Robert E. ; Berman, Daniel S. ; Nicolau, Jose C. ; Pellikka, Patricia A. ; Wrobel, Krzysztof ; Alotti, Nasri ; Asch, Federico M. ; Favaloro, Liliana E. ; She, Lilin ; Velazquez, Eric J. ; Jones, Robert H. ; Panza, Julio A. / Myocardial viability and survival in ischemic left ventricular dysfunction. In: New England Journal of Medicine. 2011 ; Vol. 364, No. 17. pp. 1617-1625.
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abstract = "Background: The assessment of myocardial viability has been used to identify patients with coronary artery disease and left ventricular dysfunction in whom coronary-artery bypass grafting (CABG) will provide a survival benefit. However, the efficacy of this approach is uncertain. methods: In a substudy of patients with coronary artery disease and left ventricular dysfunction who were enrolled in a randomized trial of medical therapy with or without CABG, we used single-photon-emission computed tomography (SPECT), dobutamine echocardiography, or both to assess myocardial viability on the basis of prespecified thresholds. results: Among the 1212 patients enrolled in the randomized trial, 601 underwent assessment of myocardial viability. Of these patients, we randomly assigned 298 to receive medical therapy plus CABG and 303 to receive medical therapy alone. A total of 178 of 487 patients with viable myocardium (37{\%}) and 58 of 114 patients without viable myocardium (51{\%}) died (hazard ratio for death among patients with viable myocardium, 0.64; 95{\%} confidence interval [CI], 0.48 to 0.86; P = 0.003). However, after adjustment for other baseline variables, this association with mortality was not significant (P=0.21). There was no significant interaction between viability status and treatment assignment with respect to mortality (P = 0.53). conclusions: The presence of viable myocardium was associated with a greater likelihood of survival in patients with coronary artery disease and left ventricular dysfunction, but this relationship was not significant after adjustment for other baseline variables. The assessment of myocardial viability did not identify patients with a differential survival benefit from CABG, as compared with medical therapy alone.",
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T1 - Myocardial viability and survival in ischemic left ventricular dysfunction

AU - Bonow, Robert O.

AU - Maurer, Gerald

AU - Lee, Kerry L.

AU - Holly, Thomas A.

AU - Binkley, Philip F.

AU - Desvigne-Nickens, Patrice

AU - Drozdz, Jaroslaw

AU - Farsky, Pedro S.

AU - Feldman, Arthur M.

AU - Doenst, Torsten

AU - Michler, Robert E.

AU - Berman, Daniel S.

AU - Nicolau, Jose C.

AU - Pellikka, Patricia A.

AU - Wrobel, Krzysztof

AU - Alotti, Nasri

AU - Asch, Federico M.

AU - Favaloro, Liliana E.

AU - She, Lilin

AU - Velazquez, Eric J.

AU - Jones, Robert H.

AU - Panza, Julio A.

PY - 2011/4/28

Y1 - 2011/4/28

N2 - Background: The assessment of myocardial viability has been used to identify patients with coronary artery disease and left ventricular dysfunction in whom coronary-artery bypass grafting (CABG) will provide a survival benefit. However, the efficacy of this approach is uncertain. methods: In a substudy of patients with coronary artery disease and left ventricular dysfunction who were enrolled in a randomized trial of medical therapy with or without CABG, we used single-photon-emission computed tomography (SPECT), dobutamine echocardiography, or both to assess myocardial viability on the basis of prespecified thresholds. results: Among the 1212 patients enrolled in the randomized trial, 601 underwent assessment of myocardial viability. Of these patients, we randomly assigned 298 to receive medical therapy plus CABG and 303 to receive medical therapy alone. A total of 178 of 487 patients with viable myocardium (37%) and 58 of 114 patients without viable myocardium (51%) died (hazard ratio for death among patients with viable myocardium, 0.64; 95% confidence interval [CI], 0.48 to 0.86; P = 0.003). However, after adjustment for other baseline variables, this association with mortality was not significant (P=0.21). There was no significant interaction between viability status and treatment assignment with respect to mortality (P = 0.53). conclusions: The presence of viable myocardium was associated with a greater likelihood of survival in patients with coronary artery disease and left ventricular dysfunction, but this relationship was not significant after adjustment for other baseline variables. The assessment of myocardial viability did not identify patients with a differential survival benefit from CABG, as compared with medical therapy alone.

AB - Background: The assessment of myocardial viability has been used to identify patients with coronary artery disease and left ventricular dysfunction in whom coronary-artery bypass grafting (CABG) will provide a survival benefit. However, the efficacy of this approach is uncertain. methods: In a substudy of patients with coronary artery disease and left ventricular dysfunction who were enrolled in a randomized trial of medical therapy with or without CABG, we used single-photon-emission computed tomography (SPECT), dobutamine echocardiography, or both to assess myocardial viability on the basis of prespecified thresholds. results: Among the 1212 patients enrolled in the randomized trial, 601 underwent assessment of myocardial viability. Of these patients, we randomly assigned 298 to receive medical therapy plus CABG and 303 to receive medical therapy alone. A total of 178 of 487 patients with viable myocardium (37%) and 58 of 114 patients without viable myocardium (51%) died (hazard ratio for death among patients with viable myocardium, 0.64; 95% confidence interval [CI], 0.48 to 0.86; P = 0.003). However, after adjustment for other baseline variables, this association with mortality was not significant (P=0.21). There was no significant interaction between viability status and treatment assignment with respect to mortality (P = 0.53). conclusions: The presence of viable myocardium was associated with a greater likelihood of survival in patients with coronary artery disease and left ventricular dysfunction, but this relationship was not significant after adjustment for other baseline variables. The assessment of myocardial viability did not identify patients with a differential survival benefit from CABG, as compared with medical therapy alone.

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