Pii: S1010-7940(02)00359-7

Objectives: To evaluate the impact of viability/ischemia before revascularization on improvement in systolic performance, reverse remodeling, symptoms and long-term prognosis post-revascularization. Methods: Fifty patients underwent thallium-201 imaging before revascularization to assess stress-induced ischemia and viability (‘jeopardized myocardium’). Left ventricular (LV) ejection fraction (EF), LV end-systolic volume index (LVESVI) and LV end-diastolic volume index (LVEDVI) were determined before and 3 months postrevascularization. Graft/vessel patency was controlled by repeat angiography. Long-term follow-up data (New York Heart Association (NYHA) class, hard events) were acquired up to 3 years. Results: Patients with $5 jeopardized segments on thallium-201 imaging demonstrated improvement of LVEF at 3 months (from 35 ^ 6 to 43 ^ 6%, P , 0:001), with reverse remodeling (LVESVI decreased from 68 ^ 16 to 52 ^ 14 ml/m, P , 0:001; LVEDVI decreased from 103 ^ 21 to 91 ^ 18 ml/m, P , 0:001), and improved in NYHA class with excellent long-term prognosis (0% event rate). Conversely, patients with ,5 jeopardized segments failed to improve in LVEF (34 ^ 4 vs. 33 ^ 7%, NS), and exhibited ongoing remodeling (LVESVI increased from 70 ^ 14 to 78 ^ 23 ml/m, P , 0:001; LVEDVI increased from 106 ^ 19 to 116 ^ 25 ml/m, P , 0:001), without improvement in NYHA class, and worse long-term prognosis (29% event rate). Conclusion: Patients with jeopardized myocardium benefit from revascularization with improvement in LVEF, reverse remodeling, improvement in NYHA class and favorable long-term prognosis. q 2002 Elsevier Science B.V. All rights reserved.