Complete Percutaneous Revascularization for Multivessel Disease in Patients With Impaired Left Ventricular Function

Objectives The aim of this study was to investigate the effect of complete, incomplete, and unsuccessful revascularization by percutaneous coronary intervention (PCI) on left ventricular ejection fraction (EF) in patients with multivessel disease and impaired left ventricular function and assess the diagnostic accuracy of cardiac magnetic resonance imaging (MRI) for improvement in EF. Background The effect of PCI for multivessel coronary artery disease on long-term myocardial function and the predictive value of cardiac MRI on global function are incompletely investigated. Methods Cardiac MRI was performed in patients with multivessel disease before and 6 months after complete revascularization (n = 34) or incomplete revascularization (n = 22) or in patients without successful revascularization (n = 15). For the prediction of recovery of EF, wall thickening was quantified on cine images at rest and during 5- and 10-mu g/kg/min dobutamine. The transmural extent of infarction was quantified on delayed enhancement cardiac MRI. Results The EF improved significantly after complete revascularization (46 +/- 12% to 51 +/- 13%; p < 0.0001) but did not change after incomplete (49 +/- 11% to 49 +/- 10%; p = 0.88) or unsuccessful revascularization (49 13% to 47 13%; p = 0.11). Sensitivity, specificity, positive and negative predictive value for the prediction of improvement in EF of >4% after PCI were 100%, 75%, 74%, and 100%, respectively, for dobutamine-cardiac MRI and 70%, 77%, 70%, and 77%, respectively, for delayed enhancement-cardiac MRI. Conclusions Complete revascularization for multivessel coronary artery disease improves EF, whereas EF did not change in patients after incomplete or unsuccessful revascularization. Improvement in EF can be predicted by performing cardiac MRI before PCI. (J Am Coll Cardiol Intv 2010;3:392-400) (C) 2010 by the American College of Cardiology Foundation