Effect of Revascularization on Long-Term Survival in Patients With Ischemic Left Ventricular Dysfunction and a Wide Range of Viability

Sawada, Stephen; Dasgupta, Saumyadip; Nguyen, James; Lane, Kathleen A.; Gradus‐Pizlo, Irmina; Mahenthiran, Jothiharan; Feigenbaum, Harvey

doi:10.1016/j.amjcard.2010.03.014

Cited by 24 publications

(16 citation statements)

References 18 publications

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“…8,10-33 This finding may reflect, in part, the low rates of death among patients with viable myocardium who were assigned to receive medical therapy (approximately 7% per year) in this study, as compared with previously reported rates (which exceeded 15% per year in many studies). Adherence to guidelines-recommended therapies was high in our trial, whereas data on medical therapy are lacking in many previous retrospective analyses.…”

Section: Discussionmentioning

confidence: 44%

“…7-9 The assessment of myocardial viability with the use of single-photon-emission computed tomography (SPECT) or low-dose dobutamine echocardiography is commonly performed to predict improvement in left ventricular function after CABG, and numerous studies have suggested that the identification of viable myocardium with the use of such methods also predicts improved survival after CABG. 8,10-33 However, previous studies that have suggested an association between myocardial viability and outcome have been retrospective in nature, and it is uncertain in most of these studies whether the decision to perform CABG may have been driven by the results of the tests, whether adjustment for key baseline variables was adequate, and whether patients who did not undergo CABG received aggressive medical therapy for heart failure. 34 In this substudy, we report the outcome of patients who were randomly assigned to receive medical therapy alone or medical therapy plus CABG in the hypothesis 1 component of STICH study and who also underwent assessment of myocardial viability.…”

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confidence: 99%

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Myocardial Viability and Survival in Ischemic Left Ventricular Dysfunction

et al. 2011

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BACKGROUND The assessment of myocardial viability has been used to identify patients with coronary artery disease and left ventricular dysfunction in whom coronary-artery bypass grafting (CABG) will provide a survival benefit. However, the efficacy of this approach is uncertain. METHODS In a substudy of patients with coronary artery disease and left ventricular dysfunction who were enrolled in a randomized trial of medical therapy with or without CABG, we used single-photon-emission computed tomography (SPECT), dobutamine echocardiography, or both to assess myocardial viability on the basis of pre-specified thresholds. RESULTS Among the 1212 patients enrolled in the randomized trial, 601 underwent assessment of myocardial viability. Of these patients, we randomly assigned 298 to receive medical therapy plus CABG and 303 to receive medical therapy alone. A total of 178 of 487 patients with viable myocardium (37%) and 58 of 114 patients without viable myocardium (51%) died (hazard ratio for death among patients with viable myocardium, 0.64; 95% confidence interval [CI], 0.48 to 0.86; P = 0.003). However, after adjustment for other baseline variables, this association with mortality was not significant (P = 0.21). There was no significant interaction between viability status and treatment assignment with respect to mortality (P = 0.53). CONCLUSIONS The presence of viable myocardium was associated with a greater likelihood of survival in patients with coronary artery disease and left ventricular dysfunction, but this relationship was not significant after adjustment for other baseline variables. The assessment of myocardial viability did not identify patients with a differential survival benefit from CABG, as compared with medical therapy alone. (Funded by the National Heart, Lung, and Blood Institute; STICH ClinicalTrials.gov number, NCT00023595.)

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Section: Discussionmentioning

confidence: 44%

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confidence: 99%

Myocardial Viability and Survival in Ischemic Left Ventricular Dysfunction

et al. 2011

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“…[52][53][54][55][56][57][58] To test this hypothesis further in patients with CAD and severe LV dysfunction, the STICH viability study was conducted by Bonow et al 59 A total of 601 patients underwent myocardial viability assessment using single-photon emission computed tomography (SPECT) or low-dose dobutamine echocardiography. In patients undergoing SPECT, viability was defined as those with ≥11 viable segments on the basis of tracer activity, and in patients undergoing dobutamine echocardiography, viability was defined as ≥5 segments with abnormal resting function with manifest contractile reserve on dobutamine infusion.…”

Section: Myocardial Viability Inducible Ischemia or Anatomic Variabmentioning

confidence: 99%

Surgical Revascularization for Ischemic Cardiomyopathy in the Post-STICH Era

Khera¹,

Panza²

2015

Cardiology in Review

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Coronary artery disease (CAD) accounts for significant morbidity and mortality in the United States and most developed countries. Patients with heart failure secondary to CAD have demonstrable poorer outcomes compared with those patients with heart failure because of other causes. Even when the causative relationship between CAD and systolic dysfunction can be unequivocally established, the controversy of revascularization in patients with ischemic cardiomyopathy continues to challenge clinicians. The potential benefit of revascularization has to be weighed against the higher operative and postoperative mortality of coronary artery bypass graft surgery in patients with very low ejection fraction and the possible futility of a high-risk intervention in certain patients. This review focuses on the role of surgical revascularization in patients with ischemic cardiomyopathy in light of data emerging from the original Surgical Treatment for Ischemic Heart Failure trial and its substudies, with an emphasis on the clinical implications for patient selection.

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“…Although surgical risk in patients with poor left ventricular ejection fraction (LVEF) is relatively higher, these patients could benefit greatly from CABG [1]. Previous studies have linked improvement in cardiac function or survival after CABG to the presence of dysfunctional but viable myocardium [2], [3], [4], [5]. In 2011, however, the Surgical Treatment for Ischemic Heart Failure (STICH) trial [6] demonstrated that the assessment of myocardial viability did not identify patients with a differential survival benefit from surgical revascularization, as compared with medical therapy alone.…”

Section: Introductionmentioning

confidence: 99%

Myocardial Scar Identified by Magnetic Resonance Imaging Can Predict Left Ventricular Functional Improvement after Coronary Artery Bypass Grafting

Yang

Sun

et al. 2013

PLoS ONE

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BackgroundPrevious studies have shown that viable myocardium predicts recovery of left ventricular (LV) dysfunction after revascularization. Our aim was to evaluate the prognostic value of myocardial scar assessed by late gadolinium-enhanced cardiovascular magnetic resonance imaging (LGE-CMR) on functional recovery in patients undergoing coronary artery bypass grafting (CABG).MethodsFrom November 2009 to September 2012, 63 patients with reduced left ventricular ejection fraction (LVEF) referred for first-time isolated CABG were prospectively enrolled, 52 were included in final analysis. LV functional parameters and scar tissue were assessed by LGE-CMR at baseline and 6 months after surgery. Patency of grafts was evaluated by computed tomography angiography (CTA) 6 months post-CABG. Predictors for global functional recovery were analyzed.ResultsThe baseline LVEF was 32.7±9.2%, which improved to 41.6±11.0% 6 months later and 32/52 patients improved LVEF by ≥5%. Multivariate logistic regression analysis showed that the most significant negative predictor for global functional recovery was the number of scar segments (Odds ratio 2.864, 95% Confidence Interval 1.172–6.996, p = 0.021). Receiver-Operator-Characteristic (ROC) analysis demonstrated that ≤4 scar segments predicted global functional recovery with a sensitivity and specificity of 85.0% and 87.5%, respectively (AUC = 0.91, p<0.001). Comparison of ROC curves also indicated that scar tissue was superior to viable myocardium in predicting cardiac functional recovery (p<0.001).ConclusionsOur findings indicated that scar tissue on LGE-CMR is an independent negative predictor of cardiac functional recovery in patients with impaired LV function undergoing CABG. These observations may be helpful for clinicians and cardiovascular surgeons to determine which patients are most likely to benefit from surgical revascularization.

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Effect of Revascularization on Long-Term Survival in Patients With Ischemic Left Ventricular Dysfunction and a Wide Range of Viability

Cited by 24 publications

References 18 publications

Myocardial Viability and Survival in Ischemic Left Ventricular Dysfunction

Myocardial Viability and Survival in Ischemic Left Ventricular Dysfunction

Surgical Revascularization for Ischemic Cardiomyopathy in the Post-STICH Era

Myocardial Scar Identified by Magnetic Resonance Imaging Can Predict Left Ventricular Functional Improvement after Coronary Artery Bypass Grafting

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