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Regional left ventricular function does not predict survival in ischaemic cardiomyopathy after cardiac surgery.

Publication ,  Journal Article
Prior, DL; Stevens, SR; Holly, TA; Krejca, M; Paraforos, A; Pohost, GM; Byrd, K; Kukulski, T; Jones, RH; Desvigne-Nickens, P; Varadarajan, P ...
Published in: Heart
September 2017

OBJECTIVES: To define the prognostic contribution of global and regional left ventricular (LV) function measurements in patients with ischaemic cardiomyopathy randomised to coronary artery bypass graft surgery (CABG) with (n=501) or without (n=499) surgical ventricular reconstruction (SVR). METHODS: Novel multivariable methods to analyse global and regional LV systolic function were used to better formulate prediction models for long-term mortality following CABG with or without SVR in the entire cohort of 1000 randomised SVR hypothesis patients. Key clinical variables were included in the analysis. Regional function was classified according to the discreteness of anteroapical hypokinesia and akinesia into those most likely to benefit from SVR, those least likely and those felt to have intermediate likelihood of benefit from SVR. RESULTS: The most prognostic clinical variables identified in multivariable models include creatinine, LV end-systolic volume index (ESVI), age and NYHA (New York Heart Association) class. Addition of LV ejection fraction, LV end-diastolic volume index and regional function assessment did not contribute additional power to the model. Subgroup analysis based on regional function did not identify a cohort in which SVR improved mortality. CONCLUSIONS: ESVI is the single parameter of LV function most predictive of mortality in patients with LV systolic dysfunction following CABG with or without SVR in multivariable models that include all key clinical and LV systolic function parameters. Assessment of regional cardiac function does not enhance prediction of mortality nor identify a subgroup for which SVR improves mortality. These results do not support elective addition of LV reconstruction surgery in patients undergoing CABG. TRIAL REGISTRATION NUMBER: NCT00023595.

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Published In

Heart

DOI

EISSN

1468-201X

Publication Date

September 2017

Volume

103

Issue

17

Start / End Page

1359 / 1367

Location

England

Related Subject Headings

  • Ventricular Remodeling
  • Ventricular Function, Left
  • United States
  • Survival Rate
  • Prognosis
  • Postoperative Period
  • Myocardial Ischemia
  • Middle Aged
  • Male
  • Humans
 

Citation

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Prior, D. L., Stevens, S. R., Holly, T. A., Krejca, M., Paraforos, A., Pohost, G. M., … STICH Trial Investigators, . (2017). Regional left ventricular function does not predict survival in ischaemic cardiomyopathy after cardiac surgery. Heart, 103(17), 1359–1367. https://doi.org/10.1136/heartjnl-2016-310693
Prior, David L., Susanna R. Stevens, Thomas A. Holly, Michal Krejca, Alexandros Paraforos, Gerald M. Pohost, Krysti Byrd, et al. “Regional left ventricular function does not predict survival in ischaemic cardiomyopathy after cardiac surgery.Heart 103, no. 17 (September 2017): 1359–67. https://doi.org/10.1136/heartjnl-2016-310693.
Prior DL, Stevens SR, Holly TA, Krejca M, Paraforos A, Pohost GM, et al. Regional left ventricular function does not predict survival in ischaemic cardiomyopathy after cardiac surgery. Heart. 2017 Sep;103(17):1359–67.
Prior, David L., et al. “Regional left ventricular function does not predict survival in ischaemic cardiomyopathy after cardiac surgery.Heart, vol. 103, no. 17, Sept. 2017, pp. 1359–67. Pubmed, doi:10.1136/heartjnl-2016-310693.
Prior DL, Stevens SR, Holly TA, Krejca M, Paraforos A, Pohost GM, Byrd K, Kukulski T, Jones RH, Desvigne-Nickens P, Varadarajan P, Amanullah A, Lin G, Al-Khalidi HR, Aldea G, Santambrogio C, Bochenek A, Berman DS, STICH Trial Investigators. Regional left ventricular function does not predict survival in ischaemic cardiomyopathy after cardiac surgery. Heart. 2017 Sep;103(17):1359–1367.

Published In

Heart

DOI

EISSN

1468-201X

Publication Date

September 2017

Volume

103

Issue

17

Start / End Page

1359 / 1367

Location

England

Related Subject Headings

  • Ventricular Remodeling
  • Ventricular Function, Left
  • United States
  • Survival Rate
  • Prognosis
  • Postoperative Period
  • Myocardial Ischemia
  • Middle Aged
  • Male
  • Humans