Does resting two-dimensional echocardiography identity patients with ischemic cardiomyopathy and low likelihood of functional recovery after coronary revascularization?

Objective: To evaluate the potential of a simple and widely available technique as two-dimensional (2D) echocardiography to identify patients with ischemic cardiomyopathy and low likelihood of functional recovery after coronary revascularization. Methods: Two-dimensional echocardiography and radionuclide ventriculography (RNV) were performed before coronary revascularization in 94 patients with ischemic cardiomyopathy. Left ventricular ejection fraction (LVEF) was measured by RNV. Regional wall motion abnormalities, wall motion score index, end-diastolic wall thickness (EDWT), left ventricular (LV) volumes and LV sphericity index were assessed in the echocardiographic images. RNV was repeated 9-12 months after revascularization to assess LVEF change; an improvement ≥ 5% was considered clinically significant. Results: Nine hundred and ninety-nine segments were severely dysfunctional; 149 out of 999 (15%) had an EDWT ≤ 6 mm. A severe enlargement of the end-diastolic volume index (EDVI) (≥ 100 ml/ml2) and of the end-systolic volume index (≥ 80 ml) was present in 32 (34%) and 21 (22%) patients, respectively. A spherical shape of the LV was observed in 35 (37%) patients. LVEF after revascularization increased in 30 out of 94 patients (32%) from 30 ± 8% to 39 ± 9% (P<0.0001). On multivariate analysis, the EDVI was the only predictor of no recovery in LVEF [odds ratio, 1.06, confidence interval (CI), 1.04-1.1, P<0.0001]. The cut-off value of EDVI ≥ 90 ml/ml2 accurately identified patients that virtually never recover. Post-operatively, LVEF increased in three out of 42 (7%, 95% CI 0-15%) patients with EDVI ≥ 90 ml/ml2 as compared to 27 out of 52 (52%) patients with EDVI < 90 ml/ml2 (P<0.0001). Conclusions: In patients with ischemic cardiomyopathy and severe LV enlargement, improvement of LVEF after revascularization is unlikely to occur. Conversely, in patients with relatively preserved LV size, a higher likelihood of functional recovery may be anticipated.

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