Predictive Value of Dobutamine Stress Echocardiography–Derived Myocardial Viability in Patients with Ischemic Cardiomyopathy

Background: The primary validation of myocardial via-bility testing lies in its capacity to anticipate functional my-ocardial recovery after revascularization. While contractile improvement in stunned myocardium may occur as early as a few hours and up to several days post- revascularizationfunc-tional recovery in myocardium with chronic hibernation may be delayed for few months. Aim of Study: The aim of this study is toassess the pre-dictive significance of Dobutamine Stress Echocardiography (DSE)–based determination of myocardial viabilityin relation to clinical outcomes in patients presenting with ischemic car-diomyopathy (ICM). Patients and Methods: This prospective study enrolled 60 patients diagnosed with ischemic cardiomyopathy (ICM) and left ventricular systolic dysfunction, as evidenced by an ejec-tion fraction (EF) ≤40%, each of whom underwent evaluation of myocardial viability using DSE before revascularization. Results: A significant improvement in New York Heart As-sociation (NYHA) functional class, as determined statistically was noted, in most of the patients transitioning from Class III at baseline to Class II or lower during follow-up. Similarly, Canadian Cardiovascular Society (CCS) angina classification showed significant improvement, with most patients achieving Class I status by six months. The six-minute walk test (6MWT) distance also demonstrated significant enhancement over time, increasing from a baseline mean of 351.5±35.65 meters to higher values at both 3- and 6-month follow-up assessments. Non-viable myocardial segments were predominantly identi-fied in the left anterior descending (LAD) artery territory in 75% of cases, followed by combined involvement of the LAD and right coronary artery (RCA) in 6.7%. A robust inverse cor-relation was noted between the extent of non-viable myocardi-um and the magnitude of improvement in left ventricular ejec-tion fraction (LVEF), with statistical significance (p<0.001). Conclusion: The results underscore the outcome-predict-ing capacity of myocardial viability particularly as evaluated by DSE in forecasting improvements in clinical outcomes among patients with ICM.