Objective assessment of "cardioprotective" efficacy as a prognostic guide to management of mildly symptomatic revascularizable XXXX .

@entity1 @entity453 @entity63
OBJECTIVES: The concept of "cardioprotection" based on ejection fraction was tested to see whether @entity1 with @entity453 in whom medical treatment fails to be cardioprotective can be distinguished from those in whom it is safe to continue such treatment. BACKGROUND: Ejection fraction is of fundamental prognostic importance. Its modification by anti- @entity63 medication may allow assessment of cardioprotection from adverse outcome. METHODS: Exercise ejection fraction and the change in ejection fraction from rest to exercise were measured by radionuclide ventriculography with and without background medication in 102 mildly symptomatic @entity1 with @entity453 suitable for revascularization but initially treated medically. RESULTS: Over 20 months, 23 @entity1 experienced an adverse event. With medication, exercise ejection fraction increased in @entity1 with and without events. By contrast, the ejection fraction response to exercise improved significantly in the event-free group only; the group with events had a persistent decrease in ejection fraction. By Cox analysis, the ejection fraction response to exercise performed with medication made the most significant independent contribution to event-free survival. Comparison of areas under receiver operating characteristic curves suggested that this index is the most useful clinical measure of cardioprotection. CONCLUSIONS: An exercise-induced decrease in ejection fraction despite anti- @entity63 medication implies failure of cardioprotection and a greater short-term risk of adverse outcome and crossover to revascularization in @entity1 initially treated medically. Conversely, a preserved left ventricular performance confers a satisfactory prognosis while continuing with that treatment. Thus, the effect of medication on the ejection fraction response to exercise--a reasonable estimate of its cardioprotective efficacy--may influence the choice of continuing with such treatment or performing early revascularization.
