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POSTER PRESENTATION Open Access
Myocardial viability in preserved or mildly impaired
left ventricular function prior to revascularization -
findings from a 3 year experience
Hannah Douglas
1*
, Ben Cole
1
, Chin Munn Soong
1
, Paul Horan
1
, Lana Dixon
1
, Nicola Johnston
1
, Mark Harbinson
2
From 18th Annual SCMR Scientific Sessions
Nice, France. 4-7 February 2015
Background
Viability testing prior to revascularization in ischaemic
cardiomyopathy has courted controversy in the litera-
ture ov er recent years. Viability assessment prior to
revascularization at our institution is largely requested
for patients with severely impaired left ventricles (LV).
This study however aims to review the outcomes of the
patients with preserved or mildly impaired LV function
who underwent cardiac magnetic resonance imaging
(CMR) for viability assessment during consideration for
revascularization and to evaluate its use in this group.
Methods
Patients undergo ing CMR scans to assess viability prior
to coronary artery revasculariza tion were identified from
January 2011 until June 2013. Demographics, viability
and outcome data were collected for all.
Results
Viability assessments were undertaken in 256 patients
who were referred for revascularization of coronary
artery disease by either percutaneous or surgical meth-
ods. Of these patients 71 (27.7%) were found to have
preserved or mildly impaired LV function, defined by an
ejection fraction greater than 45% (72% male, mean age
66±12.8 years). Adenosine stress perfusion was per-
formed in 25.4%. Ultimately 76% were revascularized
(38% underwent coronary artery bypass grafting (CABG)
while 38% had percutaneous coronary intervention
(PCI)). The remaining 24% were turned down for revas-
cularization. The reason not to revascularize in 11.7% of
cases was LAD territory nonviability. Other reasons
were independent of the viability findings and included
poor target vessels, co-morbidities and patient decision.
Mean LV me asurements within each group were as fol-
lows: ejection fraction CABG 56.67±7.58%, PCI 57.41
±8.58%, medical management 59.4±19.65% (p=0.58)
LVEDV CABG 87.74±19.37mls, PCI 85.22±20.62mls,
medical management 80.41±16.14mls (p=0.47). The
number of non-viable segments within each group was:
CABG 2.15±1.99, PCI 2.15±2.13 and medically managed
2.41±2.06 (p= 0.90). The nonviable segments were in
LAD t erritory in: CABG 22.2%, PCI 33.3% and medical
management 29.4% (p=0.66). Median follow up was 2.4
years. Outcome data was as follows; MACE: CABG
14.8%, PCI 7.4% and medical management 11.8%
(p=0.69); death: CABG 11.1%, PCI 7.4%, with no
reported deaths in the medical management group
(p=0.37); revascularization: CABG 3.7%, PCI 11.1% and
medical management 11.8% (p= 0.53) and cardiac rehos-
pitalisation: CABG 14.8%, PCI 3.7% and medical man-
agement 11.8% (p=0.37).
Conclusions
LV function and volume measurements and the number
and t erritory of nonviable segments in preserved or
mildly impaired left ventricular function was not signifi-
cantly different between revascularized and medically
managed patients. The rates of events or death did not
differ significantly. Therefore CMR for viability assess-
ment has not been shown to be a useful tool in guiding
revascularization for patients with preserved or mildly
impaired ventricles. We propose that stress perfusion
without viability would improve the utility of CMR in
this group of patients.
1
Cardiology, Belfast Heart Centre, Belfast, UK
Full list of author information is available at the end of the article
Douglas et al. Journal of Cardiovascular Magnetic
Resonance 2015, 17(Suppl 1):P133
http://www.jcmr-online.com/content/17/S1/P133
© 2015 Douglas et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons
Attribu tion License (http://creativecommons.org/licenses/by/4.0), which perm its unrestricted use, distributio n, and reproduction in
any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://
creativecommons.org/public domain/zero/1.0/) applies to the data m ade available in this article, unless otherw ise stated.
Funding
N/A.
Authors’ details
1
Cardiology, Belfast Heart Centre, Belfast, UK.
2
Queen’s University, Belfast, UK.
Published: 3 February 2015
doi:10.1186/1532-429X-17-S1-P133
Cite this article as: Douglas et al.: Myocardial viability in preserved or
mildly impaired left ventricular function prior to revascularization -
findings from a 3 year experience. Journal of Cardiovascular Magnetic
Resonance 2015 17(Suppl 1):P133.
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Douglas et al. Journal of Cardiovascular Magnetic
Resonance 2015, 17(Suppl 1):P133
http://www.jcmr-online.com/content/17/S1/P133
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