Severity of Remodeling, Myocardial Viability, and Survival in Ischemic LV Dysfunction After Surgical Revascularization.
Severity of Remodeling, Myocardial Viability, and Survival in Ischemic LV Dysfunction After Surgical Revascularization.
复制标题
DOI：
10.1016/j.jcmg.2015.03.013
复制
发表时间：
2015-10
期刊：
影响因子：
--
通讯作者：
STICH Trial Investigators
中科院分区：
文献类型：
--
作者：
Bonow RO;Castelvecchio S;Panza JA;Berman DS;Velazquez EJ;Michler RE;She L;Holly TA;Desvigne-Nickens P;Kosevic D;Rajda M;Chrzanowski L;Deja M;Lee KL;White H;Oh JK;Doenst T;Hill JA;Rouleau JL;Menicanti L;STICH Trial Investigators
The objectives of this study were to test the hypothesis that end-systolic volume (ESV), as a marker of severity of left ventricular (LV) remodeling, influences the relationship between myocardial viability and survival in patients with coronary artery disease and LV systolic dysfunction. Retrospective studies of ischemic LV dysfunction suggest that severity of LV remodeling determines whether myocardial viability predicts improved survival with surgical (CABG) compared to medical (MED) therapy, with CABG only benefitting patients with viable myocardium who have smaller ESV. However, this has not been tested prospectively. Interactions of ESV index (ESVI), myocardial viability and treatment with respect to survival were assessed in patients in the prospective randomized STICH trial of CABG vs MED who underwent viability assessment (n=601, age 61±9 years, ejection fraction ≤35%), median follow-up 5.1 years. Median ESVI was 84 ml/m2. Viability was assessed by SPECT or dobutamine echocardiography using prespecified criteria. Mortality was highest among patients with larger ESVI and non-viability (P<0.001), but no interaction was observed between ESVI, viability status, and treatment assignment (P=0.491). Specifically, the effect of CABG versus MED in patients with viable myocardium and ESVI ≤84 ml/m2 (HR 0.85, 95% CI 0.56,1.29) was no different than in patients with viability and ESVI >84 ml/m2 (HR 0.87, 95% CI 0.57,1.31). Other ESVI thresholds yielded similar results, including ESVI ≤60 ml/m2 (HR 0.87, 95% CI 0.44,1.74). ESVI and viability assessed as continuous rather than dichotomous variables yielded similar results (P=0.562). Among patients with ischemic cardiomyopathy, those with greater LVESVI and no substantial viability have worse prognosis. However, the effect of CABG relative to MED is not differentially influenced by the combination of these two factors. Lower ESVI does not identify patients in whom myocardial viability predicts better outcome with CABG relative to MED.
