Ischaemia change with revascularisation versus medical therapy in reduced ejection fraction.
Abstract
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.
Type
Journal articlePermalink
https://hdl.handle.net/10161/16136Published Version (Please cite this version)
10.1136/openhrt-2015-000284Publication Info
Mentz, Robert J; Fiuzat, Mona; Shaw, Linda K; Farzaneh-Far, Afshin; M O'Connor, Christopher;
& Borges-Neto, Salvador (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 https://hdl.handle.net/10161/16136.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
Salvador Borges-Neto
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
Afshin Farzaneh-Far
Assistant Consulting Professor in the Department of Medicine
Mona Fiuzat
Adjunct Associate Professor in the Department of Medicine
Robert John Mentz
Associate Professor of Medicine
I am a cardiologist with a clinical and research interest in heart failure (going
from Failure to Function), including advanced therapies such as cardiac transplantation
and mechanical assist devices or “heart pumps." I serve our group as Chief of
the Heart Failure Section. 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
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