Background The Surgical Treatment for Ischemic Heart Failure (STICH) randomized trial was designed to identify an optimal management strategy for patients with ischemic cardiomyopathy. Baseline echocardiographic (Echo) examination was required for all patients. Aims The primary aim of this report is to describe the baseline STICH Echo Core Lab data. The secondary aim is to provide recommendations regarding how Echo should be used in clinical practice and research based on the experience gained from Echo in STICH. Method Between September 2002 and January 2006, 2,136 patients with an ejection fraction (EF) ≤ 35% and coronary artery disease amenable to coronary artery bypass grafting were enrolled. Echo was acquired by 122 clinical enrolling sites and measurements were performed by the Echo Core Lab after a certification process for all clinical sites. Results Echo was available for analysis in 2,006 (93.9%) patients; 1734 (86.4%) were men and mean (SD) age was 60.9 (9.5) years. Mean left ventricular (LV) end-systolic volume index measureable in 72.8% was 84.0 (30.9) mL/m2, and EF was 28.9 (8.3) % with 18.5% of patients having EF >35%. Single plane measurement of LV and left atrial volume was similar to their volume by biplane measurement (r= 0.97 and 0.92, respectively). Mitral regurgitation severity by visual assessment was associated with a wide range of effective regurgitant orifice area (ERO), while ERO ≥ 0.2 cm2 indicated at least moderate mitral regurgitation by visual assessment. . Deceleration time (DT) of mitral inflow velocity had a weak correlation with EF (r=0.25), but was inversely related to estimated pulmonary artery systolic pressure (r = −0.49). Conclusion In STICH patients with ischemic cardiomyopathy, Core Lab analysis of baseline Echo demonstrated a wide spectrum of LV shape, function, and hemodynamics as well as feasibility and limitations of obtaining essential Echo measurements. It is critical that utilization of Echo parameters in clinical practice and research needs to balance the strengths and weaknesses of the technique.

Perivascular tissue of ITA releases potent, soluble, nitric oxide and prostacyclin-independent anticontractile factor. The pleural adipose tissue does not influence ITA reactivity to vasoconstrictors. Preservation of perivascular tissue may protect against vasospasm of ITA graft in clinical settings.

Background Whether right ventricular (RV) dysfunction affects clinical outcome after CABG with or without SVR is still unknown. Thus, the aim of the study was to assess the impact of RV dysfunction on clinical outcome in patients with ischemic cardiomyopathy undergoing coronary artery bypass grafting (CABG) with or without surgical ventricular reconstruction (SVR). Methods and Results Of 1,000 STICH patients with coronary artery disease (CAD), left ventricular (LV) ejection fraction (EF) ≤35% and anterior dysfunction randomized to undergo CABG or CABG + SVR, baseline RV function could be assessed by echocardiography in 866 patients. Patients were followed for a median of 48 months. All-cause mortality or cardiovascular hospitalization was the primary endpoint, and all-cause mortality alone was a secondary endpoint. RV dysfunction was mild in 102 (12%) patients and moderate or severe in 78 (9%) patients. Moderate to severe RV dysfunction was associated with larger LV, lower EF, more severe mitral regurgitation, higher filling pressure, and higher pulmonary artery systolic pressure (all p<0.0001) compared to normal or mildly reduced RV function. A significant interaction between RV dysfunction and treatment allocation was observed. Patients with moderate or severe RV dysfunction who received CABG + SVR had significantly worse outcomes compared to patients who received CABG alone on both the primary (HR=1.86; CI=1.06–3.26; p=0.028) and the secondary endpoint (HR=3.37; CI=1.36–8.37; p=0.005). After adjusting for all other prognostic clinical factors, the interaction remained significant with respect to all-cause mortality (p=0.022). Conclusion Adding SVR to CABG may worsen long-term survival in ischemic cardiomyopathy patients with moderate to severe RV dysfunction, which reflects advanced LV remodeling.

URL: https://www.clinicaltrials.gov. Unique identifier: NCT00023595.

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