Relative efficacy of medical therapy and revascularization for improving exercise capacity in patients with chronic left ventricular dysfunction☆,☆☆,★,★★
Section snippets
Study design and patient selection
Over a 24-month period we studied 52 patients (43 male, age 53 ± 14 years) with significant LV systolic impairment (LV ejection fraction [LVEF] 25% ± 7%). Patients entered the study at the time of metabolic exercise testing, which was ordered to evaluate their functional capacity. On the basis of clinical grounds and coronary artery anatomy, 20 patients underwent revascularization by coronary bypass grafting, and these formed group A. A further 16 patients with ischemic cardiomyopathy who were
Clinical characteristics
The clinical and echocardiographic parameters for all three groups are shown in Table I.
Empty Cell Group A (revascularization) Group B (medical therapy) Group C (control) p Value (group A vs others) No. patients 20 16 16 Male (%) 18 (90) 15 (94) 10 (63) NS Age (yr) 64 ± 11 50 ± 6 44 ± 12 <0.001 Diabetes (%) 10 (50) 4 (25) 2 (13) 0.04 Chest pain (%) 7 (35) 2 (13) 2 (13) NS LVEF (%) 26 ± 5 25 ± 7 23 ± 8 NS ACE inhibitors (%) 14 (70) 14 (88) 15 (94) NS Digoxin (%) 11 (55) 14 (88) 15 (94) <0.001 β/Calcium
Discussion
The results of this study indicate that the revascularization of selected patients after myocardial infarction is associated with improved LV systolic function and exercise capacity. In contrast, patients who had maximization of medical therapy alone did not improve significantly. Comparison with a control group of patients already receiving maximal therapy confirms that this change was not related to the “learning” effect of sequential exercise tests.
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Cited by (0)
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From the Department of Cardiology, Cleveland Clinic Foundation.
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Supported in part by a grant in aid from the American Heart Association.
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Reprint requests: T. Marwick, MD, PhD, Department of Cardiology, F15, Cleveland Clinic Foundation, 9500 Euclid Ave., Cleveland, OH 44195.
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