The impact of viability assessment using cardiac MRI and echocardiogram on the outcome of revascularization in patients with multi-vessels coronary artery disease and moderate to severe ischemic cardiomyopathy.

Apr 17, 2023

Experts: Atif Alzahrani,Hani Mufti,Anas Alswat,Bsaim Altirkistani,Mohammed Aljehani,Ahmed Jazzar,Fahad Alutaibi,Amir Abushouk,Jamilah Al Rahimi,Wail Al Kashkari,Mohammed Althobaiti

To investigate the influence of viability assessment in the management of patients with ischemic cardiomyopathy (ICM).
This retrospective cohort study included all patients with ICM with moderate to severely reduced left ventricular ejection fraction (LVEF) who underwent viability assessment using cardiac magnetic resonance imaging (MRI) and echocardiogram as modalities of imaging. In addition, LVEF, modality of choice, and treatment plans were all extracted as main variables from the electronic database. One hundred 6 patients who met the inclusion criteria from December 2014 to December 2019 were included.
Posttreatment LVEF improved by 5% in the viable group compared to the nonviable group (=0.016). Regardless of the treatment received, 6 (8.8%) patients in the viable group died due to cardiac causes after an 18-month follow-up period; in contrast, 7 (18.4%) patients died due to cardiac causes in the nonviable group. However, despite that difference, this was not statistically significant (=0.153). Medical therapy alone was observed in 32 (84.2%) patients in the nonviable group compared to 32 (47.1%) in the viable group (<0.001). Although the reduction in hospitalization for cardiac reasons was not statistically significant, the viable arm had 50% fewer hospitalizations than the nonviable arm (=0.051).
Patients with viable myocardium had better outcomes in which LVEF significantly improved posttreatment. Additionally, there was a reduction in the number of hospitalizations for cardiac reasons in the viable group compared to the nonviable group, even though the difference was not statistically significant. However, further studies with a larger number of patients are needed to determine a definite conclusion.

Copyright: © Saudi Medical Journal.

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ABOUT THE EXPERTS

Atif Alzahrani,Hani Mufti,Anas Alswat,Bsaim Altirkistani,Mohammed Aljehani,Ahmed Jazzar,Fahad Alutaibi,Amir Abushouk,Jamilah Al Rahimi,Wail Al Kashkari,Mohammed Althobaiti

Atif Alzahrani

From King Faisal Cardiac Center (Alzahrani, Mufti, Al Rahimi, Al Kashkari), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah; from the Department of Radiology (Althobaiti), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, from King Abdullah International Medical Research Center, (Alzahrani, Mufti, Alswat, Altirkistani, Aljehani, Jazzar, Alutaibi, Abushouk, Rahimi, Kashkari, Althobaiti), Jeddah, Kingdom of Saudi Arabia; from the College of Medicine (Alzahrani, Mufti, Alsawat, Altirkistani, Aljehani, Jazzar, Alutaibi, Abushouk, Al Rahimi, Al Kashkari, Althobaiti), King Saud Bin Aldulaziz University for Health Sciences, Jeddah, Kingdom of Saudi Arabia.

Hani Mufti

From King Faisal Cardiac Center (Alzahrani, Mufti, Al Rahimi, Al Kashkari), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah; from the Department of Radiology (Althobaiti), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, from King Abdullah International Medical Research Center, (Alzahrani, Mufti, Alswat, Altirkistani, Aljehani, Jazzar, Alutaibi, Abushouk, Rahimi, Kashkari, Althobaiti), Jeddah, Kingdom of Saudi Arabia; from the College of Medicine (Alzahrani, Mufti, Alsawat, Altirkistani, Aljehani, Jazzar, Alutaibi, Abushouk, Al Rahimi, Al Kashkari, Althobaiti), King Saud Bin Aldulaziz University for Health Sciences, Jeddah, Kingdom of Saudi Arabia.

Anas Alswat

From King Faisal Cardiac Center (Alzahrani, Mufti, Al Rahimi, Al Kashkari), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah; from the Department of Radiology (Althobaiti), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, from King Abdullah International Medical Research Center, (Alzahrani, Mufti, Alswat, Altirkistani, Aljehani, Jazzar, Alutaibi, Abushouk, Rahimi, Kashkari, Althobaiti), Jeddah, Kingdom of Saudi Arabia; from the College of Medicine (Alzahrani, Mufti, Alsawat, Altirkistani, Aljehani, Jazzar, Alutaibi, Abushouk, Al Rahimi, Al Kashkari, Althobaiti), King Saud Bin Aldulaziz University for Health Sciences, Jeddah, Kingdom of Saudi Arabia.

Bsaim Altirkistani

From King Faisal Cardiac Center (Alzahrani, Mufti, Al Rahimi, Al Kashkari), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah; from the Department of Radiology (Althobaiti), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, from King Abdullah International Medical Research Center, (Alzahrani, Mufti, Alswat, Altirkistani, Aljehani, Jazzar, Alutaibi, Abushouk, Rahimi, Kashkari, Althobaiti), Jeddah, Kingdom of Saudi Arabia; from the College of Medicine (Alzahrani, Mufti, Alsawat, Altirkistani, Aljehani, Jazzar, Alutaibi, Abushouk, Al Rahimi, Al Kashkari, Althobaiti), King Saud Bin Aldulaziz University for Health Sciences, Jeddah, Kingdom of Saudi Arabia.

Mohammed Aljehani

From King Faisal Cardiac Center (Alzahrani, Mufti, Al Rahimi, Al Kashkari), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah; from the Department of Radiology (Althobaiti), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, from King Abdullah International Medical Research Center, (Alzahrani, Mufti, Alswat, Altirkistani, Aljehani, Jazzar, Alutaibi, Abushouk, Rahimi, Kashkari, Althobaiti), Jeddah, Kingdom of Saudi Arabia; from the College of Medicine (Alzahrani, Mufti, Alsawat, Altirkistani, Aljehani, Jazzar, Alutaibi, Abushouk, Al Rahimi, Al Kashkari, Althobaiti), King Saud Bin Aldulaziz University for Health Sciences, Jeddah, Kingdom of Saudi Arabia.

Ahmed Jazzar

From King Faisal Cardiac Center (Alzahrani, Mufti, Al Rahimi, Al Kashkari), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah; from the Department of Radiology (Althobaiti), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, from King Abdullah International Medical Research Center, (Alzahrani, Mufti, Alswat, Altirkistani, Aljehani, Jazzar, Alutaibi, Abushouk, Rahimi, Kashkari, Althobaiti), Jeddah, Kingdom of Saudi Arabia; from the College of Medicine (Alzahrani, Mufti, Alsawat, Altirkistani, Aljehani, Jazzar, Alutaibi, Abushouk, Al Rahimi, Al Kashkari, Althobaiti), King Saud Bin Aldulaziz University for Health Sciences, Jeddah, Kingdom of Saudi Arabia.

Fahad Alutaibi

From King Faisal Cardiac Center (Alzahrani, Mufti, Al Rahimi, Al Kashkari), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah; from the Department of Radiology (Althobaiti), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, from King Abdullah International Medical Research Center, (Alzahrani, Mufti, Alswat, Altirkistani, Aljehani, Jazzar, Alutaibi, Abushouk, Rahimi, Kashkari, Althobaiti), Jeddah, Kingdom of Saudi Arabia; from the College of Medicine (Alzahrani, Mufti, Alsawat, Altirkistani, Aljehani, Jazzar, Alutaibi, Abushouk, Al Rahimi, Al Kashkari, Althobaiti), King Saud Bin Aldulaziz University for Health Sciences, Jeddah, Kingdom of Saudi Arabia.

Amir Abushouk

From King Faisal Cardiac Center (Alzahrani, Mufti, Al Rahimi, Al Kashkari), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah; from the Department of Radiology (Althobaiti), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, from King Abdullah International Medical Research Center, (Alzahrani, Mufti, Alswat, Altirkistani, Aljehani, Jazzar, Alutaibi, Abushouk, Rahimi, Kashkari, Althobaiti), Jeddah, Kingdom of Saudi Arabia; from the College of Medicine (Alzahrani, Mufti, Alsawat, Altirkistani, Aljehani, Jazzar, Alutaibi, Abushouk, Al Rahimi, Al Kashkari, Althobaiti), King Saud Bin Aldulaziz University for Health Sciences, Jeddah, Kingdom of Saudi Arabia.

Jamilah Al Rahimi

From King Faisal Cardiac Center (Alzahrani, Mufti, Al Rahimi, Al Kashkari), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah; from the Department of Radiology (Althobaiti), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, from King Abdullah International Medical Research Center, (Alzahrani, Mufti, Alswat, Altirkistani, Aljehani, Jazzar, Alutaibi, Abushouk, Rahimi, Kashkari, Althobaiti), Jeddah, Kingdom of Saudi Arabia; from the College of Medicine (Alzahrani, Mufti, Alsawat, Altirkistani, Aljehani, Jazzar, Alutaibi, Abushouk, Al Rahimi, Al Kashkari, Althobaiti), King Saud Bin Aldulaziz University for Health Sciences, Jeddah, Kingdom of Saudi Arabia.

Wail Al Kashkari

From King Faisal Cardiac Center (Alzahrani, Mufti, Al Rahimi, Al Kashkari), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah; from the Department of Radiology (Althobaiti), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, from King Abdullah International Medical Research Center, (Alzahrani, Mufti, Alswat, Altirkistani, Aljehani, Jazzar, Alutaibi, Abushouk, Rahimi, Kashkari, Althobaiti), Jeddah, Kingdom of Saudi Arabia; from the College of Medicine (Alzahrani, Mufti, Alsawat, Altirkistani, Aljehani, Jazzar, Alutaibi, Abushouk, Al Rahimi, Al Kashkari, Althobaiti), King Saud Bin Aldulaziz University for Health Sciences, Jeddah, Kingdom of Saudi Arabia.

Mohammed Althobaiti

From King Faisal Cardiac Center (Alzahrani, Mufti, Al Rahimi, Al Kashkari), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah; from the Department of Radiology (Althobaiti), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, from King Abdullah International Medical Research Center, (Alzahrani, Mufti, Alswat, Altirkistani, Aljehani, Jazzar, Alutaibi, Abushouk, Rahimi, Kashkari, Althobaiti), Jeddah, Kingdom of Saudi Arabia; from the College of Medicine (Alzahrani, Mufti, Alsawat, Altirkistani, Aljehani, Jazzar, Alutaibi, Abushouk, Al Rahimi, Al Kashkari, Althobaiti), King Saud Bin Aldulaziz University for Health Sciences, Jeddah, Kingdom of Saudi Arabia.