Evaluation of Coronary Revascularization Outcomes, Based on Viability Assessment Using CMR in Ischemic Cardiomyopathy Patients

Background: The beneficial effects of revascularization in patients with ischemic heart failure (IHF) and viable myocardium are well established, but trials using older viability criteria (dobutamine stress echocardiography , DSE and single-photon emission computed tomography SPECT also had conflicting results (Surgical Treatment for Ischemic Heart Failure [STICH] trial and Heart Failure Revascularization Trial [HEART]). The short-term impact of 'gold standard' viability assessment (cardiac magnetic resonance CMR with late gadolinium enhancement LGE) on clinical outcomes is not well known. Objectives : We sought to assess the outcomes of CMR-DT on short-term MACE, change in LVEF, and QoL in patients with IHF. Methods In this single-center prospective cohort study, 64 patients with ischemic cardiomyopathy and left ventricular ejection fraction ≤40% underwent viability assessment by CMR-LGE. Patients with viable myocardium-having a trans-murality of less than 50%-underwent revascularization (Group I, n = 29), and those exhibiting non-viable myocardium-a trans-murality of more than 70%-received optimal medical therapy (OMT; Group II, n = 35). Six months of follow-up were completed by all the patients. Results Baseline CMR findings were significantly worse in patients with non-viable myocardium including lower LVEF , higher left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), and T1 relaxation times . The change in LVEF at 6 months was significantly higher in the revascularization group than the OMT group . The revascularization group had significantly fewer recurrent hospitalizations Conclusions CMR-directed patient management with revascularization performed in the setting of viable myocardium led to better outcome.