Viable myocardium: comparative evaluation of surgical and pharmacological treatment of patients with ischemic heart disease, post-infarct cardiosclerosis and chronic cardiac failure

AIM: To compare surgical and drug therapies of viable myocardium in IHD patients with left ventricular dysfunction (LVD), to show how to choose between them basing on the presence or absence of viable myocardium in the dyssenergy zones in such patients. MATERIAL AND METHODS: The study enrolled 55 IHD patients with postinfarction cardiosclerosis, left ventricular ejection fraction under 35%, circulatory disorder class I-III (NYHA classification). Coronary artery bypass operation (CABO) was made in 24 patients, 31 patients received drugs. The examination included dobutamin echo-CG, perfusion myocardial scintigraphy. Viability of the myocardium was assessed before and 6 months after the treatment. RESULTS: The patients were divided by the treatment and number of segments of viable myocardium: group 1--patients with viable myocardium subjected to CABO, group 2--patients with non-viable myocardium subjected to CABO, group 3--patients with viable myocardium treated with drugs, group 4--patients with non-viable myocardium treated with drugs. The greatest rise in LV EF, reduction of the end diastolic volume, end systolic volume of the left ventricle and functional class was observed in group 1. In group 2 these parameters changed less than in group 3. Patients of groups 2 and 4 were similar by parameters of LV global contractility. CONCLUSION: Improvement of central hemodynamics and functional class was the greatest in IHD patients after CABO having viable myocardium. If myocardium is not viable surgical treatment has no advantage over conservative in improvement of the pump cardiac function and is inferior to pharmacological treatment in effect on myocardium function in patients with viable myocardium in dyssynergia zones.