Ischemic cardiomyopathy: Medical versus surgical treatment

Faulkner, Scott; Stoney, William S.; Alford, William C.; Thomas, Chantal; Burrus, George R.; Frist, Robert A.; Page, Harry L.

doi:10.1016/s0022-5223(19)41417-7

Cited by 56 publications

(7 citation statements)

References 19 publications

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“…Although evidence-based medical therapy remains the foundation for treatment of all patients with LV systolic dysfunction, CABG provides the potential for incremental survival benefit, particularly among the highest-risk patients with multivessel disease and the most severely remodeled ventricles. The results of the prospective STICH trial 26 support those of many earlier nonrandomized studies, [13][14][15][16][17] showing that the longer-term survival benefit in patients who undergo CABG compared with medical therapy alone tends to offset the short-term perioperative mortality risk. Decisions to proceed with CABG in the highest-risk patients need to be made judiciously and are best deliberated with coordinated input from a dedicated multidisciplinary heart team.…”

Section: Discussionsupporting

confidence: 65%

“…Numerous early studies of CABG versus medical therapy in patients with LV dysfunction uniformly suggested that CABG results in improved survival, with enhanced survival rates compared with medical management, ranging from 10% to 50%. [13][14][15][16][17] However, these nonrandomized studies were predominately retrospective and predate the use of modern evidence-based medical therapies for LV dysfunction; many predate the use of internal mammary grafts.…”

mentioning

confidence: 99%

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Indications for revascularization in patients with left ventricular dysfunction: Evidence and uncertainties

Bonow¹

2014

The Journal of Thoracic and Cardiovascular Surgery

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Section: Discussionsupporting

confidence: 65%

mentioning

confidence: 99%

Indications for revascularization in patients with left ventricular dysfunction: Evidence and uncertainties

Bonow¹

2014

The Journal of Thoracic and Cardiovascular Surgery

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“…Surgical revascularization: Hibernating myocardium with a potentially reversible contractile function upon myocardial reperfusion is a common manifestation of ischemic HF, thus the selection of CAD patients that would benefit from revascularization is important [6]. Three early observational studies conducted in the mid-1970s reported CABG had a 10 to > 50% reduction in mortality compared to medical therapy in CAD patients with LV systolic dysfunction [114][115][116]. However, the three studies were conducted before the development of beta-blockers and ACE-I/ARBs nor provided sufficient data for comparison of treatment efficacy with the current optimal medical therapy.…”

Section: Interventional Therapiesmentioning

confidence: 99%

Ischemic heart failure: A review of clinical status and meta-analysis of diagnosis and clinical management methods

Albakri¹

2018

Clin Med Invest

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Ischemic heart failure (IHF) is a life-threatening cardiac condition characterized by systolic dysfunction and reduced cardiac output. It results from an imbalance between myocardial oxygen demand and supply. If left untreated, the condition could lead to disability and death. Medical or revascularization therapy potentially restores cardiac function and improves survival, thus the selection of patients who will benefit from vascularization remains an important clinical target. However, for years, research on IHF therapies lagged behind as the focus was more on functional status of the heart than on etiology. Recently, increased research has provided greater insight into myocardial viability and contributed to new strategies for identifying patients for vascularization. In this review, we aggregate published evidence on IHF definition, etiology, pathophysiology, clinical presentation, diagnosis and clinical management of IHF. The objective is to improve clinical understanding and management of IHF.

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“…Operative mortality rises further with evidence of symptomatic heart failure, up to 14.3% [21]. However, despite this fact, the long‐term prognosis of revascularized patients with severe LV dysfunction has been repeatedly found to be better than that in patients with comparable LV dysfunction treated only medically [18,22,23]. The more severe the LV dysfunction, the greater the benefit of revascularization compared to medical therapy [22,23].…”

Section: Discussionmentioning

confidence: 99%

Prognosis of patients with chronic coronary artery disease and severe left ventricular dysfunction. The importance of myocardial viability

Meluzı́n

Černý²,

Špinarová

et al. 2003

European J of Heart Fail

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Background and aim: The choice of optimal treatment strategy in patients with coronary artery disease (CAD) and severe left ventricular (LV) dysfunction is often difficult. The aim of this study was to compare long-term results of patients with chronic CAD, severe heart failure and a defined scope of myocardial viability treated with coronary revascularization, heart transplantation, or kept on medical therapy. Methods: From 1993 to 2000, viability evaluation using low-dose dobutamine echocardiography was performed in 124 patients with CAD and LV ejection fraction F30%. The dysfunctional myocardial segments were defined as viable if they exhibited improvement in their thickening at any dose of dobutamine or worsening without initial improvement. The patients were divided into five groups and followed up for a mean period of 27"23 months. Group A consisted of 39 patients with viability (at least two dysfunctional but viable segments) who were revascularized. Group B consisted of 29 patients with viability treated medically. Groups C (ns23) and D (ns22) comprised patients with non-viable dysfunctional myocardial segments who were revascularized or kept on medical therapy, respectively. Eleven patients referred for heart transplantation after dobutamine echocardiography and 62 patients with ischemic cardiomyopathy transplanted in the same time interval were included in the group of transplanted patients (Group E). Results: The Kaplan-Meier survival analysis demonstrated a significantly better survival of group A patients as compared with group B patients (P-0.05). The prognostic benefit of revascularization in patients with viability was not manifested until 3 years after the procedure. At 5 years, survival in groups A, B, C, D and E was 89, 60, 67, 50 and 78%, respectively. Conclusion: In patients with CAD, severe LV dysfunction, and the evidence of viability in dysfunctional myocardium, coronary revascularization improves survival. At least 3-years follow-up is necessary to objectively assess the prognostic effect of coronary revascularization.

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Ischemic cardiomyopathy: Medical versus surgical treatment

Cited by 56 publications

References 19 publications

Indications for revascularization in patients with left ventricular dysfunction: Evidence and uncertainties

Indications for revascularization in patients with left ventricular dysfunction: Evidence and uncertainties

Ischemic heart failure: A review of clinical status and meta-analysis of diagnosis and clinical management methods

Prognosis of patients with chronic coronary artery disease and severe left ventricular dysfunction. The importance of myocardial viability

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