© 2005 European Society of Cardiology
Benefits of coronary revascularisation in diabetic and non-diabetic patients with ischaemic cardiomyopathy: Role of myocardial viability
a Department of Cardiology Thoraxcenter Room Ba 300, Erasmus MC, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
b Department of Cardiology, The Catholic University Rome, Italy
c Department of Cardiology, Leiden University Medical Center Leiden, The Netherlands
* Corresponding author. Tel.: +31 10 4639222; fax: +31 10 4364957. E-mail address: d.poldermans{at}erasmusmc.nl
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Abstract |
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Background: Diabetes mellitus in patients with coronary artery disease is associated with poor outcome. In this study, the relation between myocardial viability, diabetes, coronary revascularisation and outcome was evaluated.
Methods: 129 patients (31 diabetic, 98 non-diabetic) with ischaemic cardiomyopathy underwent dobutamine stress echocardiography to assess myocardial viability. Patients with 
4 viable segments were defined as viable and patients with <<4 viable segments as nonviable. Left ventricular ejection fraction (LVEF) was assessed before and 9–12 months post-revascularisation. At the same time-points, LV volumes were measured to evaluate LV remodelling. Finally, cardiac events were noted during 5-year follow-up.
Results: The extent of viable myocardium was comparable between diabetic and non-diabetic patients. After revascularisation, LVEF increased 5% in 44% of diabetic and in 40% of non-diabetic patients. LVEF only improved in patients with viable myocardium. Ongoing LV remodelling occurred in 36% and 35% of diabetic and non-diabetic patients respectively, and was related to non-viability, whereas viability protected against ongoing LV remodelling, both in diabetic and non-diabetic patients. Viability was the only predictor of survival after revascularisation.
Conclusions: Diabetic, viable patients with ischaemic LV dysfunction exhibit improvement in LVEF post-revascularisation with prevention of ongoing LV remodelling, similar to non-diabetic patients. Myocardial viability was also the only predictor of long-term outcome.
Key Words: Diabetes mellitus • Coronary artery disease • Myocardial viability • Coronary revascularisation • Ischaemic cardiomyopathy
Received March 27, 2005; Revised June 4, 2005; Accepted July 26, 2005
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