Ischaemia change with revascularisation versus medical therapy in reduced ejection fraction.
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OBJECTIVE: Nuclear imaging data demonstrate that revascularisation leads to favourable effects on ischaemia burden and improved outcomes compared with medical therapy (MT). In patients with heart failure (HF), the effects of MT versus revascularisation on ischaemia change and its independent prognostic significance requires investigation. METHODS: From the Duke Databank, we performed a retrospective analysis of 278 consecutive patients with coronary artery disease (CAD) and ejection fraction (EF) ≤40%, who underwent 2 serial myocardial perfusion scans between 1993 and 2009. Ischaemia change was calculated for patients undergoing MT alone, or revascularisation. Cox proportional hazards regression modelling was used to identify factors associated with death/myocardial infarction (MI). RESULTS: The magnitude of ischeamia reduction was greater with revascularisation than with MT alone (median change of -6% vs 0%, p<0.001). With revascularisation, more patients experienced ≥5% ischaemia reduction compared with MT (52% vs 25%, p<0.01) and a similar percentage experienced ≥5% ischaemia worsening (13% vs 18%, p=0.37). After risk adjustment, ≥5% ischaemia worsening was associated with decreased death/MI (HR=0.58; 95% CI 0.36 to 0.96). CONCLUSIONS: In patients with HF with CAD, revascularisation improves long-term ischaemia burden compared with MT. Ischaemia worsening on nuclear imaging was associated with reduced risk of death/MI, potentially related to development of ischaemic viable myocardium as opposed to scar tissue.
Published Version (Please cite this version)10.1136/openhrt-2015-000284
Publication InfoBorges-Neto, Salvador; Farzaneh-Far, A; Fiuzat, M; Mentz, Robert John; O'Connor, Christopher M; & Shaw, LK (2015). Ischaemia change with revascularisation versus medical therapy in reduced ejection fraction. Open Heart, 2(1). pp. e000284. 10.1136/openhrt-2015-000284. Retrieved from http://hdl.handle.net/10161/16136.
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Professor of Radiology
Expertise: 1. Diagnostic and Prognostic Utility of Cardiovascular Nuclear Medicine in Heart Disease. 2. The Role of Cardiac PET/CT in Cardiac Sarcoidosis and Ischemic Heart Disease. 3. The Role of Nuclear Cardiology in Diagnosis and Management of Amyloidosis. 4. Left Ventricular Dyssynchrony Evaluation by GSPECT. I am a Professor of Radiology (Nuclear Medicine) and Internal Medicine at Duke University Medical Center. I also serve as
Assistant Consulting Professor in the Department of Medicine
Adjunct Associate Professor in the Department of Medicine
Associate Professor of Medicine
I am a cardiologist with a clinical and research interest in heart failure, including advanced therapies such as cardiac transplantation and mechanical assist devices or “heart pumps." I became a heart failure cardiologist in order to help patients manage their chronic disease over many months and years. I consider myself strongly committed to compassionate patient care with a focus on quality of life and patient preference.My research interests are focused on treating co-morbi
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