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Relationship Between Preoperative Viability and Postoperative Improvement in LVEF and Heart Failure Symptoms

Department of Cardiology, Leiden University Medical Center, Leiden; Departments of Cardiology and Nuclear Medicine, Free University Hospital Amsterdam, Amsterdam; Departments of Cardiology, Nuclear Medicine, Clinical Epidemiology, and Statistics, ThoraxCenter Rotterdam, Rotterdam; Department of Cardiology, Medical Center Alkmaar, Alkmaar, The Netherlands; and Department of Cardiology, Istituto di Cardiologia, Udine, Italy

View larger version (16K): [in a new window]   FIGURE 1. Pie chart showing distribution of various patterns on SPECT in the 346 dysfunctional, revascularized segments.

View larger version (13K): [in a new window]   FIGURE 2. Scatterplot showing significant relationship between number of viable segments on SPECT and improvement in LVEF after revascularization (y = 4.1 + 2.4x, r = 0.79, P < 0.001).

View larger version (15K): [in a new window]   FIGURE 3. ROC curve analysis showing that cutoff level of four dysfunctional but viable segments yielded highest sensitivity and specificity to predict functional outcome on patient basis.

View larger version (20K): [in a new window]   FIGURE 4. Scatterplot of changes in LVEF after surgery grouped according to extent of preoperative viability. Mean preoperative LVEF was not significantly different in the three groups. Group A = less than three viable segments; Group B = between three and five viable segments; Group C = six or more viable segments; rev = revascularization.

View larger version (22K): [in a new window]   FIGURE 5. Change in NYHA classification of patients after surgery; patients are grouped according to extent of preoperative viability. Mean preoperative NYHA score was comparable in the three groups. Group A = less than three viable segments; Group B = between three and five viable segments; Group C = six or more viable segments; rev = revascularization.