151
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Severe ischemic cardiomyopathy with mechanical complications: Still a surgical disease. Int J Cardiol 2017; 241:103-108. [DOI: 10.1016/j.ijcard.2017.03.133] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Accepted: 03/28/2017] [Indexed: 11/19/2022]
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152
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Nijenhuis VJ, Sanchis L, van der Heyden JAS, Klein P, Rensing BJWM, Latib A, Maisano F, Ten Berg JM, Agostoni P, Swaans MJ. The last frontier: transcatheter devices for percutaneous or minimally invasive treatment of chronic heart failure. Neth Heart J 2017; 25:536-544. [PMID: 28741245 PMCID: PMC5612866 DOI: 10.1007/s12471-017-1018-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Heart failure has a high prevalence in the general population. Morbidity and mortality of heart failure patients remain high, despite improvements in drug therapy, implantable cardioverter-defibrillators and cardiac resynchronisation therapy. New transcatheter implantable devices have been developed to improve the treatment of heart failure. There has been a rapid development of minimally invasive or transcatheter devices used in the treatment of heart failure associated with aortic and mitral valve disease and these devices are being incorporated into routine clinical practice at a fast rate. Several other new transcatheter structural heart interventions for chronic heart failure aimed at a variety of pathophysiologic approaches are currently being developed. In this review, we focus on devices used in the treatment of chronic heart failure by means of left ventricular remodelling, left atrial pressure reduction, tricuspid regurgitation reduction and neuromodulation. The clinical evaluations of these devices are early-stage evaluations of initial feasibility and safety studies and additional clinical evidence needs to be gathered in appropriately designed clinical trials.
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Affiliation(s)
- V J Nijenhuis
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands.
| | - L Sanchis
- Cardiovascular Institute, Hospital Clinic, Barcelona, Spain
| | | | - P Klein
- Department of Cardio-Thoracic Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - B J W M Rensing
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - A Latib
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
- Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy
| | - F Maisano
- University Heart Centre, University Hospital Zurich, Zurich, Switzerland
| | - J M Ten Berg
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - P Agostoni
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - M J Swaans
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
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153
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Abstract
More than 5 million Americans suffer from heart failure and more than 250,000 die annually. Cardiac surgery, as applied to advanced heart failure, has evolved significantly in the past 50 years. Current therapeutic interventions are focused on the appropriate assessment of myocardial dysfunction as a means to select the right patient for the appropriate procedure using state-of-the-art myocardial viability testing and metabolic testing to determine candidacy for conventional interventions, mechanical devices, or transplant. Advances in mechanical circulatory support with more efficient and less morbid ventricular assist devises offer the potential to change the trajectory of this growing epidemiologic dilemma.
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Affiliation(s)
- Robert S D Higgins
- Department of Surgery, Johns Hopkins Medicine, 720 Rutland Avenue, Room 759, Baltimore, MD 21205, USA.
| | - Ahmet Kilic
- Heart Transplantation and Mechanical Circulatory Support, Advanced Heart Failure Program, Clinical and Academic Affairs, Division of Cardiac Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Daniel G Tang
- Division of Cardiothoracic Surgery, Virginia Commonwealth University, MCV Campus, West Hospital, 7th Floor, South Wing, 1200 East Broad Street, PO Box 980068, Richmond, VA 23298-0068, USA
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154
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Adhyapak SM, Parachuri VR. Tailoring therapy for ischemic cardiomyopathy: is Laplace's law enough? Ther Adv Cardiovasc Dis 2017; 11:231-234. [PMID: 28689451 DOI: 10.1177/1753944717718719] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The burden of heart failure has long plagued the productive years of the population, with therapeutic advances in the timely treatment of ischemic heart disease decreasing its associated mortality. Angiotensin-converting enzyme inhibitors and β-blockers have impacted heart failure therapeutics in a revolutionary way. The importance of blockade of the renin-angiotensin system and adrenergic stimulation are fully accepted concepts that apply in young and old, symptomatic and asymptomatic, borderline low and very low Ejection Fraction (EF), left ventricular failure and biventricular failure. Despite several interventions, both pharmaceutical and device based for the treatment of ensuing heart failure, the incidence is increasing in large proportions. Newer molecules like sacubitril show more promise. Despite these novel therapies, several patients relentlessly progress to a stage of advanced heart failure. The use of left-ventricular-assist devices has variable clinical benefit, with some patients progressing to heart transplantation.
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Affiliation(s)
- Srilakshmi M Adhyapak
- Department of Cardiology, St. John's Medical College Hospital, Sarjapura Road, Bangalore 560034, India
| | - V Rao Parachuri
- Department of Cardiac Surgery, Narayana Hrudayalaya Institute of Medical Sciences, Bangalore, India
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155
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Drakos SG. Combining Left Ventricular Volume Reduction Techniques With Cell Therapies: Quo Vadis? Hellenic J Cardiol 2017. [PMID: 28648474 DOI: 10.1016/j.hjc.2017.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- Stavros G Drakos
- Division of Cardiovascular Medicine, University of Utah School of Medicine & 3rd Department of Cardiology, National Kapodestrian University of Athens School of Medicine, USA.
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156
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Castelvecchio S, Careri G, Ambrogi F, Camporeale A, Menicanti L, Secchi F, Lombardi M. Myocardial scar location as detected by cardiac magnetic resonance is associated with the outcome in heart failure patients undergoing surgical ventricular reconstruction. Eur J Cardiothorac Surg 2017. [DOI: 10.1093/ejcts/ezx197] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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157
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Abstract
Heart failure (HF) with abnormal left ventricular (LV) ejection fraction should be identified and treated. Treat hypertension with diuretics, angiotensin-converting enzyme (ACE) inhibitors, and β-blockers. Treat myocardial ischemia with nitrates and β-blockers. Treat volume overload and HF with diuretics. Treat HF with ACE inhibitors and β-blockers. Sacubitril/valsartan may be used instead of an ACE inhibitor or ARB in chronic symptomatic HF and abnormal LV ejection fraction. Add isosorbide dinitrate/hydralazine in African Americans with class II to IV HF treated with diuretics, ACE inhibitors, and β-blockers. Exercise training is recommended. Indications for implantable cardioverter-defibrillator and cardiac resynchronization therapy are discussed.
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Affiliation(s)
- Wilbert S Aronow
- Division of Cardiology, Department of Medicine, Westchester Medical Center, New York Medical College, Macy Pavilion, Room 141, Valhalla, NY 10595, USA.
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158
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Bertrand PB, Schwammenthal E, Levine RA, Vandervoort PM. Exercise Dynamics in Secondary Mitral Regurgitation: Pathophysiology and Therapeutic Implications. Circulation 2017; 135:297-314. [PMID: 28093494 DOI: 10.1161/circulationaha.116.025260] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Secondary mitral valve regurgitation (MR) remains a challenging problem in the diagnostic workup and treatment of patients with heart failure. Although secondary MR is characteristically dynamic in nature and sensitive to changes in ventricular geometry and loading, current therapy is mainly focused on resting conditions. An exercise-induced increase in secondary MR, however, is associated with impaired exercise capacity and increased mortality. In an era where a multitude of percutaneous solutions are emerging for the treatment of patients with heart failure, it becomes important to address the dynamic component of secondary MR during exercise as well. A critical reappraisal of the underlying disease mechanisms, in particular the dynamic component during exercise, is of timely importance. This review summarizes the pathophysiological mechanisms involved in the dynamic deterioration of secondary MR during exercise, its functional and prognostic impact, and the way current treatment options affect the dynamic lesion and exercise hemodynamics in general.
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Affiliation(s)
- Philippe B Bertrand
- From Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium (P.B.B., P.M.V.); Faculty of Medicine and Life Sciences, Hasselt University, Belgium (P.B.B., P.M.V.); Heart Center, Sheba Medical Center, Tel Hashomer, Israel (E.S.); and Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston (R.A.L.).
| | - Ehud Schwammenthal
- From Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium (P.B.B., P.M.V.); Faculty of Medicine and Life Sciences, Hasselt University, Belgium (P.B.B., P.M.V.); Heart Center, Sheba Medical Center, Tel Hashomer, Israel (E.S.); and Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston (R.A.L.)
| | - Robert A Levine
- From Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium (P.B.B., P.M.V.); Faculty of Medicine and Life Sciences, Hasselt University, Belgium (P.B.B., P.M.V.); Heart Center, Sheba Medical Center, Tel Hashomer, Israel (E.S.); and Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston (R.A.L.)
| | - Pieter M Vandervoort
- From Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium (P.B.B., P.M.V.); Faculty of Medicine and Life Sciences, Hasselt University, Belgium (P.B.B., P.M.V.); Heart Center, Sheba Medical Center, Tel Hashomer, Israel (E.S.); and Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston (R.A.L.)
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159
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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. Regional left ventricular function does not predict survival in ischaemic cardiomyopathy after cardiac surgery. Heart 2017; 103:1359-1367. [PMID: 28446548 DOI: 10.1136/heartjnl-2016-310693] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 02/08/2017] [Accepted: 02/12/2017] [Indexed: 11/03/2022] Open
Abstract
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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Affiliation(s)
- David L Prior
- Department of Medicine, St. Vincent's Hospital, University of Melbourne, Melbourne, Australia
| | - Susanna R Stevens
- Duke Clinical Research Institute (SRS,RHJ,HRA) and Department of Surgery Cardiothoracic (RHJ), Duke University School of Medicine, Durham, North Carolina, USA
| | - Thomas A Holly
- Department of Medicine-Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Michal Krejca
- 1st Cardiac Surgery Department, Medical University of Silesia, Katowice, Poland
| | | | - Gerald M Pohost
- Department of Medicine-Cardiology, University of Southern California, Los Angeles, California, USA
| | - Krysti Byrd
- Duke Clinical Research Institute (SRS,RHJ,HRA) and Department of Surgery Cardiothoracic (RHJ), Duke University School of Medicine, Durham, North Carolina, USA
| | - Tomasz Kukulski
- Department of Cardiology, SMDZ in Zabrze, Medical University of Silesia, Katowice, Silesian Center for Heart Diseases, Zabrze, Poland
| | - Robert H Jones
- Duke Clinical Research Institute (SRS,RHJ,HRA) and Department of Surgery Cardiothoracic (RHJ), Duke University School of Medicine, Durham, North Carolina, USA
| | - Patrice Desvigne-Nickens
- National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Padmini Varadarajan
- Department of Medicine-Cardiology, Loma Linda University Medical Center, Loma Linda, California, USA
| | - Aman Amanullah
- Department of Medicine-Cardiology, Albert Einstein Medical Center, Philadelphia, Pennsylvania, USA
| | - Grace Lin
- Department of Medicine-Cardiology, Mayo Clinic, Rochester, New York, USA
| | - Hussein R Al-Khalidi
- Duke Clinical Research Institute (SRS,RHJ,HRA) and Department of Surgery Cardiothoracic (RHJ), Duke University School of Medicine, Durham, North Carolina, USA
| | - Gabriel Aldea
- Department of Surgery-Cardiothoracic, University of Washington Medical Center, Seattle, Washington, USA
| | | | - Andrzej Bochenek
- 1st Cardiac Surgery Department, Medical University of Silesia, Katowice, Poland
| | - Daniel S Berman
- Department of Medicine-Nuclear Cardiology, Cedars-Sinai Medical Center, Los Angeles, California, USA
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160
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Improvements in Left Ventricular Diastolic Mechanics After Parachute Device Implantation in Patients With Ischemia Heart Failure: A Cardiac Computerized Tomographic Study. J Card Fail 2017; 23:455-463. [PMID: 28435004 DOI: 10.1016/j.cardfail.2017.04.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 04/07/2017] [Accepted: 04/18/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND Percutaneous ventricular restoration therapy with the use of a left ventricle (LV)-partitioning Parachute device has emerged as a clinical treatment option for LV apical aneurysm after extensive anterior myocardial infarction (AMI). We assessed changes of diastolic mechanics and functional improvements following LV Parachute device implantation by means of cardiac computerized tomography (CCT). METHODS AND RESULTS CCT data were obtained from 28 patients before and after LV Parachute device implantation. Diastolic functional indices were determined by means of quantitative CCT assessment: 1) transmitral velocities in early (E) and late (A) diastole and ratio (E/A); 2) early diastolic mitral septal tissue velocity (Ea) and E/Ea; and 3) vortex formation time (VFT). Functional improvements were assessed with the use of New York Heart Association (NYHA) functional classification. Among the study patients, there were no significant differences in all transmitral velocities and E/A, though there was significantly increased Ea, reduced E/Ea, and greater VFT 6 months after LV Parachute device implantation. Finally, the improvement of diastolic functional indices after Parachute treatment correlated with observed clinical functional alterations (Δ E/Ea and Δ NYHA functional class:, r = 0.563; P = .002; Δ VFT and Δ NYHA functional class: r = -0.507; P = .006). CONCLUSIONS LV Parachute device implantation therapy in heart failure caused by AMI and LV apical aneurysm formation showed improvements in several diastolic functional mechanics according to CCT-based measures.
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161
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Effect of preoperative left ventricular diastolic dysfunction on mid-term outcomes after surgical ventricular restoration for ischemic cardiomyopathy. Gen Thorac Cardiovasc Surg 2017; 65:381-387. [DOI: 10.1007/s11748-017-0773-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 03/26/2017] [Indexed: 10/19/2022]
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162
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Preoperative right ventricular dysfunction should not preclude surgical ventricular restoration. J Thorac Cardiovasc Surg 2017; 153:853-854. [DOI: 10.1016/j.jtcvs.2016.11.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 11/17/2016] [Indexed: 11/19/2022]
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163
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Rao MP, Al-Khatib SM, Pokorney SD, She L, Romanov A, Nicolau JC, Lee KL, Carson P, Selzman CH, Stepinska J, Cleland JGF, Tungsubutra W, Desvigne-Nickens PM, Sueta CA, Siepe M, Lang I, Feldman AM, Yii M, Rouleau JL, Velazquez EJ. Sudden Cardiac Death in Patients With Ischemic Heart Failure Undergoing Coronary Artery Bypass Grafting: Results From the STICH Randomized Clinical Trial (Surgical Treatment for Ischemic Heart Failure). Circulation 2017; 135:1136-1144. [PMID: 28154006 PMCID: PMC5516272 DOI: 10.1161/circulationaha.116.026075] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 01/25/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND The risk of sudden cardiac death (SCD) in patients with heart failure after coronary artery bypass graft surgery (CABG) has not been examined in a contemporary clinical trial of surgical revascularization. This analysis describes the incidence, timing, and clinical predictors of SCD after CABG. METHODS Patients enrolled in the STICH trial (Surgical Treatment of Ischemic Heart Failure) who underwent CABG with or without surgical ventricular reconstruction were included. We excluded patients with prior implantable cardioverter-defibrillator and those randomized only to medical therapy. The primary outcome was SCD as adjudicated by a blinded committee. A Cox model was used to examine and identify predictors of SCD. The Fine and Gray method was used to estimate the incidence of SCD accounting for the competing risk of other deaths. RESULTS Over a median follow-up of 46 months, 113 of 1411 patients who received CABG without (n = 934) or with (n = 477) surgical ventricular reconstruction had SCD; 311 died of other causes. The mean left ventricular ejection fraction at enrollment was 28±9%. The 5-year cumulative incidence of SCD was 8.5%. Patients who had SCD and those who did not die were younger and had fewer comorbid conditions than did those who died of causes other than SCD. In the first 30 days after CABG, SCD (n=5) accounted for 7% of all deaths. The numerically greatest monthly rate of SCD was in the 31- to 90-day time period. In a multivariable analysis including baseline demographics, risk factors, coronary anatomy, and left ventricular function, end-systolic volume index and B-type natriuretic peptide were most strongly associated with SCD. CONCLUSIONS The monthly risk of SCD shortly after CABG among patients with a low left ventricular ejection fraction is highest between the first and third months, suggesting that risk stratification for SCD should occur early in the postoperative period, particularly in patients with increased preoperative end-systolic volume index or B-type natriuretic peptide. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT0002359.
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Affiliation(s)
- Meena P Rao
- From Duke Clinical Research Institute (M.P.R., S.M.A.-K., S.D.P., L.S., K.L.L., E.J.V.) and Departments of Biostatistics and Bioinformatics (K.L.L.) and Medicine (S.M.A.-K., E.J.V.), Duke University School of Medicine, Durham, NC; State Research Institute of Circulation Pathology, Novosibirsk, Russia (A.R.); Heart Institute, University of São Paulo Medical School, Brazil (J.C.N.); Washington DC Veterans Affairs Medical Center (P.C.); Division of Cardiothoracic Surgery, University of Utah, Salt Lake City (C.H.S.); Institute of Cardiology, Warsaw, Poland (J.S.); National Heart and Lung Institute, Royal Brompton & Harefield Hospitals, Imperial College, London, UK (J.G.F.C.); Siriraj Hospital, Mahidol University, Bangkok, Thailand (W.T.); Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (P.M.D.-N.); University of North Carolina at Chapel Hill (C.A.S.); University Heart Center Freiburg-Bad Krozingen, Germany (M.S.); Medical University of Vienna, Austria (I.L.); Department of Medicine, Temple University School of Medicine, Philadelphia, PA (A.M.F.); St. Vincent's Hospital, University of Melbourne, Fitzroy, Australia (M.Y.); and Department of Medicine, Montreal Heart Institute, University of Montreal, Quebec, Canada (J.L.R.)
| | - Sana M Al-Khatib
- From Duke Clinical Research Institute (M.P.R., S.M.A.-K., S.D.P., L.S., K.L.L., E.J.V.) and Departments of Biostatistics and Bioinformatics (K.L.L.) and Medicine (S.M.A.-K., E.J.V.), Duke University School of Medicine, Durham, NC; State Research Institute of Circulation Pathology, Novosibirsk, Russia (A.R.); Heart Institute, University of São Paulo Medical School, Brazil (J.C.N.); Washington DC Veterans Affairs Medical Center (P.C.); Division of Cardiothoracic Surgery, University of Utah, Salt Lake City (C.H.S.); Institute of Cardiology, Warsaw, Poland (J.S.); National Heart and Lung Institute, Royal Brompton & Harefield Hospitals, Imperial College, London, UK (J.G.F.C.); Siriraj Hospital, Mahidol University, Bangkok, Thailand (W.T.); Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (P.M.D.-N.); University of North Carolina at Chapel Hill (C.A.S.); University Heart Center Freiburg-Bad Krozingen, Germany (M.S.); Medical University of Vienna, Austria (I.L.); Department of Medicine, Temple University School of Medicine, Philadelphia, PA (A.M.F.); St. Vincent's Hospital, University of Melbourne, Fitzroy, Australia (M.Y.); and Department of Medicine, Montreal Heart Institute, University of Montreal, Quebec, Canada (J.L.R.)
| | - Sean D Pokorney
- From Duke Clinical Research Institute (M.P.R., S.M.A.-K., S.D.P., L.S., K.L.L., E.J.V.) and Departments of Biostatistics and Bioinformatics (K.L.L.) and Medicine (S.M.A.-K., E.J.V.), Duke University School of Medicine, Durham, NC; State Research Institute of Circulation Pathology, Novosibirsk, Russia (A.R.); Heart Institute, University of São Paulo Medical School, Brazil (J.C.N.); Washington DC Veterans Affairs Medical Center (P.C.); Division of Cardiothoracic Surgery, University of Utah, Salt Lake City (C.H.S.); Institute of Cardiology, Warsaw, Poland (J.S.); National Heart and Lung Institute, Royal Brompton & Harefield Hospitals, Imperial College, London, UK (J.G.F.C.); Siriraj Hospital, Mahidol University, Bangkok, Thailand (W.T.); Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (P.M.D.-N.); University of North Carolina at Chapel Hill (C.A.S.); University Heart Center Freiburg-Bad Krozingen, Germany (M.S.); Medical University of Vienna, Austria (I.L.); Department of Medicine, Temple University School of Medicine, Philadelphia, PA (A.M.F.); St. Vincent's Hospital, University of Melbourne, Fitzroy, Australia (M.Y.); and Department of Medicine, Montreal Heart Institute, University of Montreal, Quebec, Canada (J.L.R.)
| | - Lilin She
- From Duke Clinical Research Institute (M.P.R., S.M.A.-K., S.D.P., L.S., K.L.L., E.J.V.) and Departments of Biostatistics and Bioinformatics (K.L.L.) and Medicine (S.M.A.-K., E.J.V.), Duke University School of Medicine, Durham, NC; State Research Institute of Circulation Pathology, Novosibirsk, Russia (A.R.); Heart Institute, University of São Paulo Medical School, Brazil (J.C.N.); Washington DC Veterans Affairs Medical Center (P.C.); Division of Cardiothoracic Surgery, University of Utah, Salt Lake City (C.H.S.); Institute of Cardiology, Warsaw, Poland (J.S.); National Heart and Lung Institute, Royal Brompton & Harefield Hospitals, Imperial College, London, UK (J.G.F.C.); Siriraj Hospital, Mahidol University, Bangkok, Thailand (W.T.); Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (P.M.D.-N.); University of North Carolina at Chapel Hill (C.A.S.); University Heart Center Freiburg-Bad Krozingen, Germany (M.S.); Medical University of Vienna, Austria (I.L.); Department of Medicine, Temple University School of Medicine, Philadelphia, PA (A.M.F.); St. Vincent's Hospital, University of Melbourne, Fitzroy, Australia (M.Y.); and Department of Medicine, Montreal Heart Institute, University of Montreal, Quebec, Canada (J.L.R.)
| | - Alexander Romanov
- From Duke Clinical Research Institute (M.P.R., S.M.A.-K., S.D.P., L.S., K.L.L., E.J.V.) and Departments of Biostatistics and Bioinformatics (K.L.L.) and Medicine (S.M.A.-K., E.J.V.), Duke University School of Medicine, Durham, NC; State Research Institute of Circulation Pathology, Novosibirsk, Russia (A.R.); Heart Institute, University of São Paulo Medical School, Brazil (J.C.N.); Washington DC Veterans Affairs Medical Center (P.C.); Division of Cardiothoracic Surgery, University of Utah, Salt Lake City (C.H.S.); Institute of Cardiology, Warsaw, Poland (J.S.); National Heart and Lung Institute, Royal Brompton & Harefield Hospitals, Imperial College, London, UK (J.G.F.C.); Siriraj Hospital, Mahidol University, Bangkok, Thailand (W.T.); Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (P.M.D.-N.); University of North Carolina at Chapel Hill (C.A.S.); University Heart Center Freiburg-Bad Krozingen, Germany (M.S.); Medical University of Vienna, Austria (I.L.); Department of Medicine, Temple University School of Medicine, Philadelphia, PA (A.M.F.); St. Vincent's Hospital, University of Melbourne, Fitzroy, Australia (M.Y.); and Department of Medicine, Montreal Heart Institute, University of Montreal, Quebec, Canada (J.L.R.)
| | - Jose C Nicolau
- From Duke Clinical Research Institute (M.P.R., S.M.A.-K., S.D.P., L.S., K.L.L., E.J.V.) and Departments of Biostatistics and Bioinformatics (K.L.L.) and Medicine (S.M.A.-K., E.J.V.), Duke University School of Medicine, Durham, NC; State Research Institute of Circulation Pathology, Novosibirsk, Russia (A.R.); Heart Institute, University of São Paulo Medical School, Brazil (J.C.N.); Washington DC Veterans Affairs Medical Center (P.C.); Division of Cardiothoracic Surgery, University of Utah, Salt Lake City (C.H.S.); Institute of Cardiology, Warsaw, Poland (J.S.); National Heart and Lung Institute, Royal Brompton & Harefield Hospitals, Imperial College, London, UK (J.G.F.C.); Siriraj Hospital, Mahidol University, Bangkok, Thailand (W.T.); Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (P.M.D.-N.); University of North Carolina at Chapel Hill (C.A.S.); University Heart Center Freiburg-Bad Krozingen, Germany (M.S.); Medical University of Vienna, Austria (I.L.); Department of Medicine, Temple University School of Medicine, Philadelphia, PA (A.M.F.); St. Vincent's Hospital, University of Melbourne, Fitzroy, Australia (M.Y.); and Department of Medicine, Montreal Heart Institute, University of Montreal, Quebec, Canada (J.L.R.)
| | - Kerry L Lee
- From Duke Clinical Research Institute (M.P.R., S.M.A.-K., S.D.P., L.S., K.L.L., E.J.V.) and Departments of Biostatistics and Bioinformatics (K.L.L.) and Medicine (S.M.A.-K., E.J.V.), Duke University School of Medicine, Durham, NC; State Research Institute of Circulation Pathology, Novosibirsk, Russia (A.R.); Heart Institute, University of São Paulo Medical School, Brazil (J.C.N.); Washington DC Veterans Affairs Medical Center (P.C.); Division of Cardiothoracic Surgery, University of Utah, Salt Lake City (C.H.S.); Institute of Cardiology, Warsaw, Poland (J.S.); National Heart and Lung Institute, Royal Brompton & Harefield Hospitals, Imperial College, London, UK (J.G.F.C.); Siriraj Hospital, Mahidol University, Bangkok, Thailand (W.T.); Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (P.M.D.-N.); University of North Carolina at Chapel Hill (C.A.S.); University Heart Center Freiburg-Bad Krozingen, Germany (M.S.); Medical University of Vienna, Austria (I.L.); Department of Medicine, Temple University School of Medicine, Philadelphia, PA (A.M.F.); St. Vincent's Hospital, University of Melbourne, Fitzroy, Australia (M.Y.); and Department of Medicine, Montreal Heart Institute, University of Montreal, Quebec, Canada (J.L.R.)
| | - Peter Carson
- From Duke Clinical Research Institute (M.P.R., S.M.A.-K., S.D.P., L.S., K.L.L., E.J.V.) and Departments of Biostatistics and Bioinformatics (K.L.L.) and Medicine (S.M.A.-K., E.J.V.), Duke University School of Medicine, Durham, NC; State Research Institute of Circulation Pathology, Novosibirsk, Russia (A.R.); Heart Institute, University of São Paulo Medical School, Brazil (J.C.N.); Washington DC Veterans Affairs Medical Center (P.C.); Division of Cardiothoracic Surgery, University of Utah, Salt Lake City (C.H.S.); Institute of Cardiology, Warsaw, Poland (J.S.); National Heart and Lung Institute, Royal Brompton & Harefield Hospitals, Imperial College, London, UK (J.G.F.C.); Siriraj Hospital, Mahidol University, Bangkok, Thailand (W.T.); Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (P.M.D.-N.); University of North Carolina at Chapel Hill (C.A.S.); University Heart Center Freiburg-Bad Krozingen, Germany (M.S.); Medical University of Vienna, Austria (I.L.); Department of Medicine, Temple University School of Medicine, Philadelphia, PA (A.M.F.); St. Vincent's Hospital, University of Melbourne, Fitzroy, Australia (M.Y.); and Department of Medicine, Montreal Heart Institute, University of Montreal, Quebec, Canada (J.L.R.)
| | - Craig H Selzman
- From Duke Clinical Research Institute (M.P.R., S.M.A.-K., S.D.P., L.S., K.L.L., E.J.V.) and Departments of Biostatistics and Bioinformatics (K.L.L.) and Medicine (S.M.A.-K., E.J.V.), Duke University School of Medicine, Durham, NC; State Research Institute of Circulation Pathology, Novosibirsk, Russia (A.R.); Heart Institute, University of São Paulo Medical School, Brazil (J.C.N.); Washington DC Veterans Affairs Medical Center (P.C.); Division of Cardiothoracic Surgery, University of Utah, Salt Lake City (C.H.S.); Institute of Cardiology, Warsaw, Poland (J.S.); National Heart and Lung Institute, Royal Brompton & Harefield Hospitals, Imperial College, London, UK (J.G.F.C.); Siriraj Hospital, Mahidol University, Bangkok, Thailand (W.T.); Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (P.M.D.-N.); University of North Carolina at Chapel Hill (C.A.S.); University Heart Center Freiburg-Bad Krozingen, Germany (M.S.); Medical University of Vienna, Austria (I.L.); Department of Medicine, Temple University School of Medicine, Philadelphia, PA (A.M.F.); St. Vincent's Hospital, University of Melbourne, Fitzroy, Australia (M.Y.); and Department of Medicine, Montreal Heart Institute, University of Montreal, Quebec, Canada (J.L.R.)
| | - Janina Stepinska
- From Duke Clinical Research Institute (M.P.R., S.M.A.-K., S.D.P., L.S., K.L.L., E.J.V.) and Departments of Biostatistics and Bioinformatics (K.L.L.) and Medicine (S.M.A.-K., E.J.V.), Duke University School of Medicine, Durham, NC; State Research Institute of Circulation Pathology, Novosibirsk, Russia (A.R.); Heart Institute, University of São Paulo Medical School, Brazil (J.C.N.); Washington DC Veterans Affairs Medical Center (P.C.); Division of Cardiothoracic Surgery, University of Utah, Salt Lake City (C.H.S.); Institute of Cardiology, Warsaw, Poland (J.S.); National Heart and Lung Institute, Royal Brompton & Harefield Hospitals, Imperial College, London, UK (J.G.F.C.); Siriraj Hospital, Mahidol University, Bangkok, Thailand (W.T.); Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (P.M.D.-N.); University of North Carolina at Chapel Hill (C.A.S.); University Heart Center Freiburg-Bad Krozingen, Germany (M.S.); Medical University of Vienna, Austria (I.L.); Department of Medicine, Temple University School of Medicine, Philadelphia, PA (A.M.F.); St. Vincent's Hospital, University of Melbourne, Fitzroy, Australia (M.Y.); and Department of Medicine, Montreal Heart Institute, University of Montreal, Quebec, Canada (J.L.R.)
| | - John G F Cleland
- From Duke Clinical Research Institute (M.P.R., S.M.A.-K., S.D.P., L.S., K.L.L., E.J.V.) and Departments of Biostatistics and Bioinformatics (K.L.L.) and Medicine (S.M.A.-K., E.J.V.), Duke University School of Medicine, Durham, NC; State Research Institute of Circulation Pathology, Novosibirsk, Russia (A.R.); Heart Institute, University of São Paulo Medical School, Brazil (J.C.N.); Washington DC Veterans Affairs Medical Center (P.C.); Division of Cardiothoracic Surgery, University of Utah, Salt Lake City (C.H.S.); Institute of Cardiology, Warsaw, Poland (J.S.); National Heart and Lung Institute, Royal Brompton & Harefield Hospitals, Imperial College, London, UK (J.G.F.C.); Siriraj Hospital, Mahidol University, Bangkok, Thailand (W.T.); Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (P.M.D.-N.); University of North Carolina at Chapel Hill (C.A.S.); University Heart Center Freiburg-Bad Krozingen, Germany (M.S.); Medical University of Vienna, Austria (I.L.); Department of Medicine, Temple University School of Medicine, Philadelphia, PA (A.M.F.); St. Vincent's Hospital, University of Melbourne, Fitzroy, Australia (M.Y.); and Department of Medicine, Montreal Heart Institute, University of Montreal, Quebec, Canada (J.L.R.)
| | - Wiwun Tungsubutra
- From Duke Clinical Research Institute (M.P.R., S.M.A.-K., S.D.P., L.S., K.L.L., E.J.V.) and Departments of Biostatistics and Bioinformatics (K.L.L.) and Medicine (S.M.A.-K., E.J.V.), Duke University School of Medicine, Durham, NC; State Research Institute of Circulation Pathology, Novosibirsk, Russia (A.R.); Heart Institute, University of São Paulo Medical School, Brazil (J.C.N.); Washington DC Veterans Affairs Medical Center (P.C.); Division of Cardiothoracic Surgery, University of Utah, Salt Lake City (C.H.S.); Institute of Cardiology, Warsaw, Poland (J.S.); National Heart and Lung Institute, Royal Brompton & Harefield Hospitals, Imperial College, London, UK (J.G.F.C.); Siriraj Hospital, Mahidol University, Bangkok, Thailand (W.T.); Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (P.M.D.-N.); University of North Carolina at Chapel Hill (C.A.S.); University Heart Center Freiburg-Bad Krozingen, Germany (M.S.); Medical University of Vienna, Austria (I.L.); Department of Medicine, Temple University School of Medicine, Philadelphia, PA (A.M.F.); St. Vincent's Hospital, University of Melbourne, Fitzroy, Australia (M.Y.); and Department of Medicine, Montreal Heart Institute, University of Montreal, Quebec, Canada (J.L.R.)
| | - Patrice M Desvigne-Nickens
- From Duke Clinical Research Institute (M.P.R., S.M.A.-K., S.D.P., L.S., K.L.L., E.J.V.) and Departments of Biostatistics and Bioinformatics (K.L.L.) and Medicine (S.M.A.-K., E.J.V.), Duke University School of Medicine, Durham, NC; State Research Institute of Circulation Pathology, Novosibirsk, Russia (A.R.); Heart Institute, University of São Paulo Medical School, Brazil (J.C.N.); Washington DC Veterans Affairs Medical Center (P.C.); Division of Cardiothoracic Surgery, University of Utah, Salt Lake City (C.H.S.); Institute of Cardiology, Warsaw, Poland (J.S.); National Heart and Lung Institute, Royal Brompton & Harefield Hospitals, Imperial College, London, UK (J.G.F.C.); Siriraj Hospital, Mahidol University, Bangkok, Thailand (W.T.); Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (P.M.D.-N.); University of North Carolina at Chapel Hill (C.A.S.); University Heart Center Freiburg-Bad Krozingen, Germany (M.S.); Medical University of Vienna, Austria (I.L.); Department of Medicine, Temple University School of Medicine, Philadelphia, PA (A.M.F.); St. Vincent's Hospital, University of Melbourne, Fitzroy, Australia (M.Y.); and Department of Medicine, Montreal Heart Institute, University of Montreal, Quebec, Canada (J.L.R.)
| | - Carla A Sueta
- From Duke Clinical Research Institute (M.P.R., S.M.A.-K., S.D.P., L.S., K.L.L., E.J.V.) and Departments of Biostatistics and Bioinformatics (K.L.L.) and Medicine (S.M.A.-K., E.J.V.), Duke University School of Medicine, Durham, NC; State Research Institute of Circulation Pathology, Novosibirsk, Russia (A.R.); Heart Institute, University of São Paulo Medical School, Brazil (J.C.N.); Washington DC Veterans Affairs Medical Center (P.C.); Division of Cardiothoracic Surgery, University of Utah, Salt Lake City (C.H.S.); Institute of Cardiology, Warsaw, Poland (J.S.); National Heart and Lung Institute, Royal Brompton & Harefield Hospitals, Imperial College, London, UK (J.G.F.C.); Siriraj Hospital, Mahidol University, Bangkok, Thailand (W.T.); Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (P.M.D.-N.); University of North Carolina at Chapel Hill (C.A.S.); University Heart Center Freiburg-Bad Krozingen, Germany (M.S.); Medical University of Vienna, Austria (I.L.); Department of Medicine, Temple University School of Medicine, Philadelphia, PA (A.M.F.); St. Vincent's Hospital, University of Melbourne, Fitzroy, Australia (M.Y.); and Department of Medicine, Montreal Heart Institute, University of Montreal, Quebec, Canada (J.L.R.)
| | - Matthias Siepe
- From Duke Clinical Research Institute (M.P.R., S.M.A.-K., S.D.P., L.S., K.L.L., E.J.V.) and Departments of Biostatistics and Bioinformatics (K.L.L.) and Medicine (S.M.A.-K., E.J.V.), Duke University School of Medicine, Durham, NC; State Research Institute of Circulation Pathology, Novosibirsk, Russia (A.R.); Heart Institute, University of São Paulo Medical School, Brazil (J.C.N.); Washington DC Veterans Affairs Medical Center (P.C.); Division of Cardiothoracic Surgery, University of Utah, Salt Lake City (C.H.S.); Institute of Cardiology, Warsaw, Poland (J.S.); National Heart and Lung Institute, Royal Brompton & Harefield Hospitals, Imperial College, London, UK (J.G.F.C.); Siriraj Hospital, Mahidol University, Bangkok, Thailand (W.T.); Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (P.M.D.-N.); University of North Carolina at Chapel Hill (C.A.S.); University Heart Center Freiburg-Bad Krozingen, Germany (M.S.); Medical University of Vienna, Austria (I.L.); Department of Medicine, Temple University School of Medicine, Philadelphia, PA (A.M.F.); St. Vincent's Hospital, University of Melbourne, Fitzroy, Australia (M.Y.); and Department of Medicine, Montreal Heart Institute, University of Montreal, Quebec, Canada (J.L.R.)
| | - Irene Lang
- From Duke Clinical Research Institute (M.P.R., S.M.A.-K., S.D.P., L.S., K.L.L., E.J.V.) and Departments of Biostatistics and Bioinformatics (K.L.L.) and Medicine (S.M.A.-K., E.J.V.), Duke University School of Medicine, Durham, NC; State Research Institute of Circulation Pathology, Novosibirsk, Russia (A.R.); Heart Institute, University of São Paulo Medical School, Brazil (J.C.N.); Washington DC Veterans Affairs Medical Center (P.C.); Division of Cardiothoracic Surgery, University of Utah, Salt Lake City (C.H.S.); Institute of Cardiology, Warsaw, Poland (J.S.); National Heart and Lung Institute, Royal Brompton & Harefield Hospitals, Imperial College, London, UK (J.G.F.C.); Siriraj Hospital, Mahidol University, Bangkok, Thailand (W.T.); Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (P.M.D.-N.); University of North Carolina at Chapel Hill (C.A.S.); University Heart Center Freiburg-Bad Krozingen, Germany (M.S.); Medical University of Vienna, Austria (I.L.); Department of Medicine, Temple University School of Medicine, Philadelphia, PA (A.M.F.); St. Vincent's Hospital, University of Melbourne, Fitzroy, Australia (M.Y.); and Department of Medicine, Montreal Heart Institute, University of Montreal, Quebec, Canada (J.L.R.)
| | - Arthur M Feldman
- From Duke Clinical Research Institute (M.P.R., S.M.A.-K., S.D.P., L.S., K.L.L., E.J.V.) and Departments of Biostatistics and Bioinformatics (K.L.L.) and Medicine (S.M.A.-K., E.J.V.), Duke University School of Medicine, Durham, NC; State Research Institute of Circulation Pathology, Novosibirsk, Russia (A.R.); Heart Institute, University of São Paulo Medical School, Brazil (J.C.N.); Washington DC Veterans Affairs Medical Center (P.C.); Division of Cardiothoracic Surgery, University of Utah, Salt Lake City (C.H.S.); Institute of Cardiology, Warsaw, Poland (J.S.); National Heart and Lung Institute, Royal Brompton & Harefield Hospitals, Imperial College, London, UK (J.G.F.C.); Siriraj Hospital, Mahidol University, Bangkok, Thailand (W.T.); Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (P.M.D.-N.); University of North Carolina at Chapel Hill (C.A.S.); University Heart Center Freiburg-Bad Krozingen, Germany (M.S.); Medical University of Vienna, Austria (I.L.); Department of Medicine, Temple University School of Medicine, Philadelphia, PA (A.M.F.); St. Vincent's Hospital, University of Melbourne, Fitzroy, Australia (M.Y.); and Department of Medicine, Montreal Heart Institute, University of Montreal, Quebec, Canada (J.L.R.)
| | - Michael Yii
- From Duke Clinical Research Institute (M.P.R., S.M.A.-K., S.D.P., L.S., K.L.L., E.J.V.) and Departments of Biostatistics and Bioinformatics (K.L.L.) and Medicine (S.M.A.-K., E.J.V.), Duke University School of Medicine, Durham, NC; State Research Institute of Circulation Pathology, Novosibirsk, Russia (A.R.); Heart Institute, University of São Paulo Medical School, Brazil (J.C.N.); Washington DC Veterans Affairs Medical Center (P.C.); Division of Cardiothoracic Surgery, University of Utah, Salt Lake City (C.H.S.); Institute of Cardiology, Warsaw, Poland (J.S.); National Heart and Lung Institute, Royal Brompton & Harefield Hospitals, Imperial College, London, UK (J.G.F.C.); Siriraj Hospital, Mahidol University, Bangkok, Thailand (W.T.); Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (P.M.D.-N.); University of North Carolina at Chapel Hill (C.A.S.); University Heart Center Freiburg-Bad Krozingen, Germany (M.S.); Medical University of Vienna, Austria (I.L.); Department of Medicine, Temple University School of Medicine, Philadelphia, PA (A.M.F.); St. Vincent's Hospital, University of Melbourne, Fitzroy, Australia (M.Y.); and Department of Medicine, Montreal Heart Institute, University of Montreal, Quebec, Canada (J.L.R.)
| | - Jean L Rouleau
- From Duke Clinical Research Institute (M.P.R., S.M.A.-K., S.D.P., L.S., K.L.L., E.J.V.) and Departments of Biostatistics and Bioinformatics (K.L.L.) and Medicine (S.M.A.-K., E.J.V.), Duke University School of Medicine, Durham, NC; State Research Institute of Circulation Pathology, Novosibirsk, Russia (A.R.); Heart Institute, University of São Paulo Medical School, Brazil (J.C.N.); Washington DC Veterans Affairs Medical Center (P.C.); Division of Cardiothoracic Surgery, University of Utah, Salt Lake City (C.H.S.); Institute of Cardiology, Warsaw, Poland (J.S.); National Heart and Lung Institute, Royal Brompton & Harefield Hospitals, Imperial College, London, UK (J.G.F.C.); Siriraj Hospital, Mahidol University, Bangkok, Thailand (W.T.); Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (P.M.D.-N.); University of North Carolina at Chapel Hill (C.A.S.); University Heart Center Freiburg-Bad Krozingen, Germany (M.S.); Medical University of Vienna, Austria (I.L.); Department of Medicine, Temple University School of Medicine, Philadelphia, PA (A.M.F.); St. Vincent's Hospital, University of Melbourne, Fitzroy, Australia (M.Y.); and Department of Medicine, Montreal Heart Institute, University of Montreal, Quebec, Canada (J.L.R.)
| | - Eric J Velazquez
- From Duke Clinical Research Institute (M.P.R., S.M.A.-K., S.D.P., L.S., K.L.L., E.J.V.) and Departments of Biostatistics and Bioinformatics (K.L.L.) and Medicine (S.M.A.-K., E.J.V.), Duke University School of Medicine, Durham, NC; State Research Institute of Circulation Pathology, Novosibirsk, Russia (A.R.); Heart Institute, University of São Paulo Medical School, Brazil (J.C.N.); Washington DC Veterans Affairs Medical Center (P.C.); Division of Cardiothoracic Surgery, University of Utah, Salt Lake City (C.H.S.); Institute of Cardiology, Warsaw, Poland (J.S.); National Heart and Lung Institute, Royal Brompton & Harefield Hospitals, Imperial College, London, UK (J.G.F.C.); Siriraj Hospital, Mahidol University, Bangkok, Thailand (W.T.); Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (P.M.D.-N.); University of North Carolina at Chapel Hill (C.A.S.); University Heart Center Freiburg-Bad Krozingen, Germany (M.S.); Medical University of Vienna, Austria (I.L.); Department of Medicine, Temple University School of Medicine, Philadelphia, PA (A.M.F.); St. Vincent's Hospital, University of Melbourne, Fitzroy, Australia (M.Y.); and Department of Medicine, Montreal Heart Institute, University of Montreal, Quebec, Canada (J.L.R.).
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High-risk cardiac surgery as an alternative to transplant or mechanical support in patients with end-stage heart failure. J Thorac Cardiovasc Surg 2017; 154:517-525. [PMID: 28495061 DOI: 10.1016/j.jtcvs.2017.03.040] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 01/31/2017] [Accepted: 03/04/2017] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Although the results of cardiac surgery in patients with poor left ventricular function have been widely published, the outcomes in patients with end-stage heart failure who meet criteria for advanced therapies are not well investigated. As access to transplantation and ventricular assist device therapy remains limited, we explored the possibility of conventional surgery as an alternative option for highly selected patients with end-stage heart failure. METHODS We identified patients with left ventricular ejection fraction <20% and VO2 max <14 mL/min/m2, who were initially referred for advanced therapies but were instead offered a conventional procedure from 2002 to 2012. We examined the short- and midterm outcomes and compared survival with that after our advanced therapies in the same era. RESULTS A total of 133 patients were identified; 68 were deemed to be transplant-eligible, whereas 65 were transplant-ineligible. Seventy-nine percent were in New York Heart Association class III/IV. In-hospital mortality was 12%. Actuarial survival at 5 and 10 years was 72% ± 4% and 39% ± 8%, respectively. Nonischemic etiology was identified as a predictor of late mortality. In the propensity-adjusted model, our transplant-eligible patients had comparable long-term survival to our transplantation patients (HR 1.48 [95% confidence interval, 0.66-3.2], P = .34), whereas the survival in our transplant-ineligible subset was comparable to the survival after our left ventricular assist device therapy (HR 0.49 [95% confidence interval, 0.16-1.50], P = .21). CONCLUSIONS Despite high perioperative risk, the midterm survival after conventional surgery in patients eligible for advanced therapies seems to be acceptable and may be an alternative option for highly selected patients with end-stage heart failure.
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165
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Central Sleep Apnea in Heart Failure. J Am Coll Cardiol 2017; 69:1588-1591. [DOI: 10.1016/j.jacc.2017.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 02/01/2017] [Accepted: 02/01/2017] [Indexed: 11/20/2022]
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Isomura T, Fukada Y, Miyazaki T, Yoshida M, Morisaki A, Endo M. Posterior ventricular restoration treatment for heart failure: a review, past, present and future aspects. Gen Thorac Cardiovasc Surg 2017; 65:137-143. [PMID: 28161770 DOI: 10.1007/s11748-017-0750-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 01/06/2017] [Indexed: 11/30/2022]
Abstract
Congestive heart failure (CHF) is one of the major causes of death and occurs in more than 15,000,000 patients worldwide. The incidence is expected to increase in parallel with the aging population. Most current therapies for CHF are medications, and biventricular pacing implantation as appropriated by cardiologists, or surgical interventions. The heart transplantation for indicated patients is still gold standard surgery although the 10-year survival rate is approximately 60% based on the worldwide data. However, the cardiac transplantation remains epidemiologically insignificant because of donor pool limitations. New strategies for treating CHF are needed. In addition to conventional cardiac surgery, surgical ventricular restoration was reported as a promising surgical therapy in 1990s. After the first report of partial left ventriculectomy in which posterior wall was widely resected for dilated heart, many controversial clinical and animal research studies have been reported. In this review, the principles of posterior cardiac restoration therapy will be discussed. An overview of posterior cardiac restoration, structure, and torsion are presented. By understanding the structure of cardiac muscle, shape, and torsion of left ventricle for surgical restoration, the procedure can be performed based on appropriate indication and this knowledge can be used to optimize and improve its efficacy. The use of mechanical support devices has recently become commonplace in many centers, and the use of implantable ventricular assist devices as destination therapy will increase. Surgeons will be able to select several options of the treatment for CHF by understanding the advantages and disadvantages of those surgical treatments.
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Affiliation(s)
- Tadashi Isomura
- Cardiovascular Surgery, Tokyo Heart Center, 5-4-12, Kita-shinagawa, Shinagawa, Tokyo, 141-0001, Japan.
| | - Yasuhisa Fukada
- Cardiovascular Surgery, Tokyo Heart Center, 5-4-12, Kita-shinagawa, Shinagawa, Tokyo, 141-0001, Japan
| | - Takuya Miyazaki
- Cardiovascular Surgery, Tokyo Heart Center, 5-4-12, Kita-shinagawa, Shinagawa, Tokyo, 141-0001, Japan
| | - Minoru Yoshida
- Cardiovascular Surgery, Tokyo Heart Center, 5-4-12, Kita-shinagawa, Shinagawa, Tokyo, 141-0001, Japan
| | - Akimasa Morisaki
- Cardiovascular Surgery, Tokyo Heart Center, 5-4-12, Kita-shinagawa, Shinagawa, Tokyo, 141-0001, Japan
| | - Masahiro Endo
- Cardiovascular Surgery, Tokyo Heart Center, 5-4-12, Kita-shinagawa, Shinagawa, Tokyo, 141-0001, Japan
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Patterson T, Schreuder J, Burkhoff D, Vanderheyden M, Rajani R, Toth G, Redwood SR, Bartunek J. Percutaneous Ventricular Restoration Using the Parachute Device: The Parachute III Pressure-Volume Loop Sub-study. STRUCTURAL HEART 2017. [DOI: 10.1080/24748706.2017.1329574] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Bonios MJ, Anastasiou-Nana M, Perrea DN, Malliaras K. A combined cellular and surgical ventricular reconstruction therapeutic approach produces attenuation of remodeling in infarcted rats. Hellenic J Cardiol 2016; 58:135-142. [PMID: 27923685 DOI: 10.1016/j.hjc.2016.11.036] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 11/18/2016] [Accepted: 11/22/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Left ventricular reconstruction (LVR) has been shown to provide transient benefits to the LV structure and function of infarcted hearts; however, long-term results have been disappointing as LVR-induced benefits are typically not sustained. We hypothesized that administration of cardiosphere-derived cells (CDCs), which promote myocardial repair and regeneration, may result in long-term preservation of the beneficial effects of LVR in ischemic cardiomyopathy. METHODS Wistar Kyoto rats underwent myocardial infarction (MI) and two weeks later were randomized into 3 groups: in Group 1 (n=9), LVR was performed by plication of the infarcted apex and CDCs were injected in the infarct border zone (IBZ); group 2 animals (n=9) underwent LVR and received vehicle solution in the IBZ; and Group 3 animals (n=10) were injected with vehicle solution in the IBZ without undergoing LVR. Echocardiograms were performed at baseline, 4 days post-apex plication, and at 3 months post-MI. RESULTS At baseline, all animal groups had a comparable LVEF, LV end-diastolic volume (EDV) and LV end-systolic volume (ESV). Four days post-LV apex plication, Group 1 and Group 2 animals exhibited comparable significant improvement in EF and comparable significant reduction in LVEDV and LVESV. Three months post-MI, Group 1 animals had a decreased LVEDV, decreased LVESV, less impaired CS, increased peak systolic torsion and increased EF compared to animals in Groups 2 and 3. CONCLUSION In infarcted rat hearts, intramyocardial delivery of CDCs in conjunction with LVR resulted in significant and sustained amelioration of LV remodeling and improvement in LV function compared to LVR alone.
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Affiliation(s)
- Michael J Bonios
- 3(rd) Department of Cardiology, University of Athens School of Medicine, Athens, Greece
| | - Maria Anastasiou-Nana
- 3(rd) Department of Cardiology, University of Athens School of Medicine, Athens, Greece
| | - Despina N Perrea
- Laboratory for Experimental Surgery and Surgical Research "N.S. Christeas", University of Athens School of Medicine, Athens, Greece
| | - Konstantinos Malliaras
- 3(rd) Department of Cardiology, University of Athens School of Medicine, Athens, Greece.
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Marui A. Coronary-artery bypass surgery plus medical therapy is associated with longer survival over 10 years than medical therapy alone in patients with ischaemic cardiomyopathy. EVIDENCE-BASED MEDICINE 2016; 22:32. [PMID: 27913564 DOI: 10.1136/ebmed-2016-110478] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Domenech M, Polo-Corrales L, Ramirez-Vick JE, Freytes DO. Tissue Engineering Strategies for Myocardial Regeneration: Acellular Versus Cellular Scaffolds? TISSUE ENGINEERING. PART B, REVIEWS 2016; 22:438-458. [PMID: 27269388 PMCID: PMC5124749 DOI: 10.1089/ten.teb.2015.0523] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 05/24/2016] [Indexed: 01/03/2023]
Abstract
Heart disease remains one of the leading causes of death in industrialized nations with myocardial infarction (MI) contributing to at least one fifth of the reported deaths. The hypoxic environment eventually leads to cellular death and scar tissue formation. The scar tissue that forms is not mechanically functional and often leads to myocardial remodeling and eventual heart failure. Tissue engineering and regenerative medicine principles provide an alternative approach to restoring myocardial function by designing constructs that will restore the mechanical function of the heart. In this review, we will describe the cellular events that take place after an MI and describe current treatments. We will also describe how biomaterials, alone or in combination with a cellular component, have been used to engineer suitable myocardium replacement constructs and how new advanced culture systems will be required to achieve clinical success.
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Affiliation(s)
- Maribella Domenech
- Department of Chemical Engineering, Universidad de Puerto Rico, Mayagüez, Puerto Rico
| | - Lilliana Polo-Corrales
- Department of Chemical Engineering, Universidad de Puerto Rico, Mayagüez, Puerto Rico
- Department of Agroindustrial Engineering, Universidad de Sucre, Sucre, Colombia
| | - Jaime E. Ramirez-Vick
- Department of Chemical Engineering, Universidad de Puerto Rico, Mayagüez, Puerto Rico
- Department of Biomedical, Industrial & Human Factors Engineering, Wright State University, Dayton, Ohio
| | - Donald O. Freytes
- The New York Stem Cell Foundation Research Institute, New York, New York
- Joint Department of Biomedical Engineering, NC State/UNC-Chapel Hill, Raleigh, North Carolina
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171
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Asai H, Shingu Y, Yamakawa T, Niwano H, Wakasa S, Ooka T, Kato H, Tachibana T, Matsui Y. Left-Ventricular Plication Reduces Wall Stress and Cardiomyocyte Hypertrophy in a Rat Model of Ischemic Cardiomyopathy. Eur Surg Res 2016; 58:69-80. [PMID: 27884008 DOI: 10.1159/000452682] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 08/23/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND The indications of left-ventricular plication (LVP) are controversial, although several studies have reported favorable outcomes in heart failure patients. The aim of this study was to assess left-ventricular (LV) wall stress and myocardial remodeling after LVP in a rat model of myocardial infarction (MI). METHODS Sixteen rats underwent LVP by excluding the LV anterior wall scar 4 weeks after ligation of the left anterior descending artery. After 4 weeks, LV wall stress was assessed using transthoracic echocardiography and an LV catheter. Gene expression of the wall stress markers, atrial natriuretic factor (ANF) and brain natriuretic peptide (BNP), were evaluated via reverse transcription polymerase chain reaction. Cardiomyocyte area and myocardial fibrosis were also examined through histological examinations. These parameters were compared to those in 16 rats that underwent coronary artery ligation but not LVP. RESULTS We noted that the LV end-diastolic dimension was smaller (9.9 ± 0.3 vs. 11.2 ± 0.2 mm, p < 0.05) and fractional shortening was greater (25 ± 2 vs. 15 ± 1%, p < 0.05) in LVP rats than in sham rats. Moreover, systolic wall stress was lower in LVP rats (71 ± 7 vs. 111 ± 9 × 103 dyn/cm2, p < 0.05). Myocardial ANF and BNP expression levels were lower in LVP rats (2.6 ± 0.3 vs. 4.4 ± 0.5 and 1.0 ± 0.1 vs. 1.5 ± 0.2 arbitrary units, respectively; p < 0.05). Cardiomyocyte area was significantly decreased in LVP rats (556 ± 15 vs. 670 ± 28 μm2, p = 0.003) and was correlated with LV wall stress (r = 0.669, p = 0.002). The reduction in myocardial fibrosis after LVP was not significant. CONCLUSION LVP reduced LV wall stress and cardiomyocyte hypertrophy in a rat model of MI.
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Affiliation(s)
- Hidetsugu Asai
- Department of Cardiovascular and Thoracic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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172
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Ramakrishna H, Gutsche JT, Patel PA, Evans AS, Weiner M, Morozowich ST, Gordon EK, Riha H, Bracker J, Ghadimi K, Murphy S, Spitz W, MacKay E, Cios TJ, Malhotra AK, Baron E, Shaefi S, Fassl J, Weiss SJ, Silvay G, Augoustides JGT. The Year in Cardiothoracic and Vascular Anesthesia: Selected Highlights From 2016. J Cardiothorac Vasc Anesth 2016; 31:1-13. [PMID: 28041810 DOI: 10.1053/j.jvca.2016.10.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Indexed: 12/11/2022]
Affiliation(s)
| | - Jacob T Gutsche
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Prakash A Patel
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Adam S Evans
- Department of Anesthesiology, Cleveland Clinic Florida, Weston, FL
| | - Menachem Weiner
- Anesthesiology and Critical Care, Icahn School of Medicine, Mount Sinai Hospital, New York, NY
| | | | - Emily K Gordon
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Hynek Riha
- Cardiothoracic Anesthesiology and Intensive Care, Department of Anesthesiology and Intensive Care Medicine, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Joseph Bracker
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Kamrouz Ghadimi
- Cardiothoracic Anesthesiology, Department of Anesthesiology and Critical Care, Duke University, Durham, NC
| | - Sunberri Murphy
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Warren Spitz
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Emily MacKay
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | | | | | - Elvera Baron
- Anesthesiology and Critical Care, Icahn School of Medicine, Mount Sinai Hospital, New York, NY
| | - Shahzad Shaefi
- Cardiothoracic Anesthesiology and Critical Care, Department of Anesthesiology, Harvard Medical School, Boston, MA
| | - Jens Fassl
- Cardiovascular and Thoracic Section, Department of Anesthesia and Intensive Care Medicine, University of Basel, Basel, Switzerland
| | - Stuart J Weiss
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - George Silvay
- Anesthesiology and Critical Care, Icahn School of Medicine, Mount Sinai Hospital, New York, NY
| | - John G T Augoustides
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
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173
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Aronow WS. Current treatment of heart failure with reduction of left ventricular ejection fraction. Expert Rev Clin Pharmacol 2016; 9:1619-1631. [PMID: 27673415 DOI: 10.1080/17512433.2016.1242067] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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174
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Revascularización quirúrgica en pacientes con disfunción ventricular severa. REVISTA COLOMBIANA DE CARDIOLOGÍA 2016. [DOI: 10.1016/j.rccar.2016.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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175
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Janaswamy P, Walters TE, Nazer B, Lee RJ. Current Treatment Strategies for Heart Failure: Role of Device Therapy and LV Reconstruction. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2016; 18:57. [PMID: 27488313 DOI: 10.1007/s11936-016-0479-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OPINION STATEMENT Medical care of heart failure (HF) begins with the determination of the cause of the heart failure and diagnosing potential reversible causes (i.e., coronary heart disease, hyperthyroidism, etc.). Medical therapy includes pharmacological and nonpharmacological strategies that limit and/or reverse the signs and symptoms of HF. Initial behavior modification includes dietary sodium and fluid restriction to avoid weight gain; and encouraging physical activity when appropriate. Optimization of medical therapy is the first line of treatment that includes the use of diuretics, vasodilators (i.e., ACE inhibitors or ARBs), beta blockers, and potentially inotropic agents and anticoagulation depending on the patient's severity of heart failure and LV dysfunction. As heart failure advances despite optimized medical management, cardiac resynchronization therapy (CRT), and implantable cardioverter defibrillators (ICDs) are appropriate device therapies. The development of progressive end-stage HF, despite maximal medical therapy, necessitates the consideration of mechanical circulatory devices such as ventricular assist devices (VADs) either as a bridge to heart transplantation or as destination therapy. Despite the advances in the treatment of heart failure, there is still a large morbidity and mortality associated with HF, thus the need to develop newer strategies for the treatment of HF.
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Affiliation(s)
- Praneeth Janaswamy
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Tomos E Walters
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Babak Nazer
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Randall J Lee
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA. .,Cardiovascular Research Institute, University of California San Francisco, San Francisco, CA, USA. .,Institute for Regeneration Medicine, University of California San Francisco, San Francisco, CA, USA. .,University of California San Francisco, Box 1354, San Francisco, CA, 94143, USA.
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176
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Beyersdorf F. Left ventricular restoration in heart failure: rebirth due to interventional devices? Eur J Cardiothorac Surg 2016; 50:589-592. [PMID: 27401701 DOI: 10.1093/ejcts/ezw249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Affiliation(s)
- Friedhelm Beyersdorf
- Department of Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, Freiburg, Germany
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177
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178
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Yamazaki S, Doi K, Numata S, Itatani K, Kawajiri H, Morimoto K, Manabe K, Ikemoto K, Yaku H. Ventricular volume and myocardial viability, evaluated using cardiac magnetic resonance imaging, affect long-term results after surgical ventricular reconstruction. Eur J Cardiothorac Surg 2016; 50:704-712. [PMID: 27354255 DOI: 10.1093/ejcts/ezw213] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2015] [Revised: 03/14/2016] [Accepted: 04/04/2016] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVES We aimed to investigate the outcomes of surgical ventricular reconstruction (SVR) for ischaemic cardiomyopathy and to identify ideal candidates for this procedure using cardiac magnetic resonance imaging (MRI) studies. METHODS We retrospectively examined 50 patients who underwent SVR and were preoperatively evaluated using cardiac MRI from 2004 to 2014. Cine MRI and gadolinium-enhanced MRI were performed to evaluate left ventricular (LV) volume and scarring. The midterm (median, 2.5 years) risk factors of cardiac death or major adverse cardiac events (MACEs) were analysed. Patients were divided into three groups-those with preoperative indexed LV end-systolic volume (LVESVI) of ≤100 ml/m2 (Group 1), those with LVESVI of >100 and ≤130 ml/m2 (Group 2) and those with LVESVI of >130 ml/m2 (Group 3)-and examined. RESULTS In total, 17 patients exhibited MACEs at follow-up. Kaplan-Meier analysis showed that the 5-year rate of freedom from MACEs was 66%. The Cox hazard model indicated that preoperative LVESVI was the only significant predictor for MACEs (P = 0.006; hazard ratio, 1.02; 95% confidence interval, 1.01-1.04). Moreover, a significant reduction in LVESVI and an increase in LV ejection fraction (LVEF) were observed early after SVR (preoperative versus postoperative: LVESVI, 110 ± 44 vs 68 ± 28 ml/m2, P < 0.001; LVEF, 24.3 ± 10.3 vs 32.0 ± 10.4%, P < 0.001) and at follow-up (LVESVI, 61 ± 28 ml/m2, P < 0.001; LVEF, 36.5 ± 11.5%, P < 0.001). Although no difference was observed between the groups at follow-up, LVEF and LVESVI primarily improved in Group 2. LVEF improvement was significantly greater in Group 2 than in Group 1 (%increase in LVEF: Group 1, 6%; Group 2, 18%; P = 0.008). In patients with a preoperative LVESVI of >130 ml/m2, the number of non-viable segments was a significant risk factor for MACEs. CONCLUSIONS Patients with preoperative LVESVI ranging from 100 to 130 ml/m2 had fairly better outcomes, and the percentage improvement in LVEF and the percentage reduction in LVESVI were more pronounced in these patients. Hence, accurate preoperative assessments of LV volume and viability testing using cardiac MRI studies are essential for better stratification of the SVR procedure.
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Affiliation(s)
- Sachiko Yamazaki
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kiyoshi Doi
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Satoshi Numata
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Keiichi Itatani
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hidetake Kawajiri
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kazuki Morimoto
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kaichiro Manabe
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Koki Ikemoto
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hitoshi Yaku
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
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179
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Affiliation(s)
- James E. Udelson
- From Division of Cardiology and the Cardiovascular Center, Tufts Medical Center, Boston, MA (J.E.U.); and Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston MA (L.W.S.)
| | - Lynne Warner Stevenson
- From Division of Cardiology and the Cardiovascular Center, Tufts Medical Center, Boston, MA (J.E.U.); and Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston MA (L.W.S.)
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180
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Right Ventricular Systolic Dysfunction Assessed by Cardiac Magnetic Resonance Is a Strong Predictor of Cardiovascular Death After Coronary Bypass Grafting. Ann Thorac Surg 2016; 101:2176-84. [DOI: 10.1016/j.athoracsur.2015.11.035] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 10/09/2015] [Accepted: 11/13/2015] [Indexed: 11/30/2022]
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181
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Castelvecchio S, Garatti A, Gagliardotto PV, Menicanti L. Surgical ventricular reconstruction for ischaemic heart failure: state of the art. Eur Heart J Suppl 2016; 18:E8-E14. [DOI: 10.1093/eurheartj/suw028] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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182
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Contijoch FJ, Witschey WRT, McGarvey J, Lee ME, Gorman J, Gorman RC, Pilla JJ. Slice-by-Slice Pressure-Volume Loop Analysis Demonstrates Native Differences in Regional Cardiac Contractility and Response to Inotropic Agents. Ann Thorac Surg 2016; 102:796-802. [PMID: 27112654 DOI: 10.1016/j.athoracsur.2016.02.055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Revised: 02/01/2016] [Accepted: 02/16/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Regional changes in diastolic and systolic properties after myocardial infarction contribute to adverse left ventricular (LV) remodeling. Regional function is currently assessed using load-dependent measures such as slice ejection fraction (sEF), wall motion abnormalities, or strain imaging. However, load-independent measures of cardiac function may be useful in the study of the infarction-induced remodeling. METHODS In this study, we used a recently validated 2-dimensional (2D) real-time magnetic resonance imaging (MRI) technique to evaluate regional variations in load-independent slice-by-slice measures of systolic and diastolic function and compared the values to a load-dependent measure in 11 sheep at rest and during inotropic agent infusion. RESULTS Slice-derived ejection fraction (sEF) was greater in the apex relative to the midventricular and basal regions, and inotropic infusion increased sEF in the base more than in the apex and midventricle. Slice-derived ESPVR (sESPVR) in the apex was significantly lower than in the midventricle and the base, and inotropic infusion increased sESPVR in the apical slices more than in the midventricle. Similarly, slice-derived volume-axis intercept V0 (sV0) was higher in the base relative to the midventricle and apex. sEDPVR did not demonstrate significant regional variations, but inotropic infusion resulted in a small increase in the apex. CONCLUSIONS In conclusion, acquisition of slice-derived load-independent measures demonstrated variations that contradict those observed with load-dependent sEF. The approach may provide advanced slice-based measures of function during the LV remodeling process and aid in the development of therapies.
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Affiliation(s)
- Francisco J Contijoch
- Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Walter R T Witschey
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jeremy McGarvey
- Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Madonna E Lee
- Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Joseph Gorman
- Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Robert C Gorman
- Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - James J Pilla
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania
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Coronary Atherosclerosis: Pathophysiologic Basis for Diagnosis and Management. Prog Cardiovasc Dis 2016; 58:676-92. [PMID: 27091673 DOI: 10.1016/j.pcad.2016.04.003] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 04/13/2016] [Indexed: 12/13/2022]
Abstract
Coronary atherosclerosis is a long lasting and continuously evolving disease with multiple clinical manifestations ranging from asymptomatic to stable angina, acute coronary syndrome (ACS), heart failure (HF) and sudden cardiac death (SCD). Genetic and environmental factors contribute to the development and progression of coronary atherosclerosis. In this review, current knowledge related to the diagnosis and management of coronary atherosclerosis based on pathophysiologic mechanisms will be discussed. In addition to providing state-of-the-art concepts related to coronary atherosclerosis, special consideration will be given on how to apply data from epidemiologic studies and randomized clinical trials to the individual patient. The greatest challenge for the clinician in the twenty-first century is not in absorbing the fast accumulating new knowledge, but rather in applying this knowledge to the individual patient.
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184
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Buckberg GD. Surgical ventricular restoration after flawed STICH trial: results when guidelines followed. Eur J Cardiothorac Surg 2016; 50:702-703. [DOI: 10.1093/ejcts/ezw133] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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185
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Velazquez EJ, Lee KL, Jones RH, Al-Khalidi HR, Hill JA, Panza JA, Michler RE, Bonow RO, Doenst T, Petrie MC, Oh JK, She L, Moore VL, Desvigne-Nickens P, Sopko G, Rouleau JL. Coronary-Artery Bypass Surgery in Patients with Ischemic Cardiomyopathy. N Engl J Med 2016; 374:1511-20. [PMID: 27040723 PMCID: PMC4938005 DOI: 10.1056/nejmoa1602001] [Citation(s) in RCA: 634] [Impact Index Per Article: 79.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND The survival benefit of a strategy of coronary-artery bypass grafting (CABG) added to guideline-directed medical therapy, as compared with medical therapy alone, in patients with coronary artery disease, heart failure, and severe left ventricular systolic dysfunction remains unclear. METHODS From July 2002 to May 2007, a total of 1212 patients with an ejection fraction of 35% or less and coronary artery disease amenable to CABG were randomly assigned to undergo CABG plus medical therapy (CABG group, 610 patients) or medical therapy alone (medical-therapy group, 602 patients). The primary outcome was death from any cause. Major secondary outcomes included death from cardiovascular causes and death from any cause or hospitalization for cardiovascular causes. The median duration of follow-up, including the current extended-follow-up study, was 9.8 years. RESULTS A primary outcome event occurred in 359 patients (58.9%) in the CABG group and in 398 patients (66.1%) in the medical-therapy group (hazard ratio with CABG vs. medical therapy, 0.84; 95% confidence interval [CI], 0.73 to 0.97; P=0.02 by log-rank test). A total of 247 patients (40.5%) in the CABG group and 297 patients (49.3%) in the medical-therapy group died from cardiovascular causes (hazard ratio, 0.79; 95% CI, 0.66 to 0.93; P=0.006 by log-rank test). Death from any cause or hospitalization for cardiovascular causes occurred in 467 patients (76.6%) in the CABG group and in 524 patients (87.0%) in the medical-therapy group (hazard ratio, 0.72; 95% CI, 0.64 to 0.82; P<0.001 by log-rank test). CONCLUSIONS In a cohort of patients with ischemic cardiomyopathy, the rates of death from any cause, death from cardiovascular causes, and death from any cause or hospitalization for cardiovascular causes were significantly lower over 10 years among patients who underwent CABG in addition to receiving medical therapy than among those who received medical therapy alone. (Funded by the National Institutes of Health; STICH [and STICHES] ClinicalTrials.gov number, NCT00023595.).
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Affiliation(s)
- Eric J Velazquez
- From the Division of Cardiology (E.J.V.), Departments of Biostatistics and Bioinformatics (K.L.L., H.R.A.-K.) and Surgery (R.H.J.), and Duke Clinical Research Institute (L.S., V.L.M.), Duke University Medical Center, Durham, NC; the University of Florida, Gainesville (J.A.H.); Westchester Medical Center and New York Medical College, Valhalla (J.A.P.), and Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, New York (R.E.M.); Northwestern University Feinberg School of Medicine, Chicago (R.O.B.); the Department of Cardiothoracic Surgery, University Hospital Jena, Friedrich-Schiller-University of Jena, Jena, Germany (T.D.); Glasgow University and Golden Jubilee National Hospital, Glasgow, United Kingdom (M.C.P.); Mayo Clinic, Rochester, MN (J.K.O.); the Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (P.D.-N., G.S.); and University of Montreal, Montreal Heart Institute, Montreal (J.L.R.)
| | - Kerry L Lee
- From the Division of Cardiology (E.J.V.), Departments of Biostatistics and Bioinformatics (K.L.L., H.R.A.-K.) and Surgery (R.H.J.), and Duke Clinical Research Institute (L.S., V.L.M.), Duke University Medical Center, Durham, NC; the University of Florida, Gainesville (J.A.H.); Westchester Medical Center and New York Medical College, Valhalla (J.A.P.), and Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, New York (R.E.M.); Northwestern University Feinberg School of Medicine, Chicago (R.O.B.); the Department of Cardiothoracic Surgery, University Hospital Jena, Friedrich-Schiller-University of Jena, Jena, Germany (T.D.); Glasgow University and Golden Jubilee National Hospital, Glasgow, United Kingdom (M.C.P.); Mayo Clinic, Rochester, MN (J.K.O.); the Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (P.D.-N., G.S.); and University of Montreal, Montreal Heart Institute, Montreal (J.L.R.)
| | - Robert H Jones
- From the Division of Cardiology (E.J.V.), Departments of Biostatistics and Bioinformatics (K.L.L., H.R.A.-K.) and Surgery (R.H.J.), and Duke Clinical Research Institute (L.S., V.L.M.), Duke University Medical Center, Durham, NC; the University of Florida, Gainesville (J.A.H.); Westchester Medical Center and New York Medical College, Valhalla (J.A.P.), and Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, New York (R.E.M.); Northwestern University Feinberg School of Medicine, Chicago (R.O.B.); the Department of Cardiothoracic Surgery, University Hospital Jena, Friedrich-Schiller-University of Jena, Jena, Germany (T.D.); Glasgow University and Golden Jubilee National Hospital, Glasgow, United Kingdom (M.C.P.); Mayo Clinic, Rochester, MN (J.K.O.); the Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (P.D.-N., G.S.); and University of Montreal, Montreal Heart Institute, Montreal (J.L.R.)
| | - Hussein R Al-Khalidi
- From the Division of Cardiology (E.J.V.), Departments of Biostatistics and Bioinformatics (K.L.L., H.R.A.-K.) and Surgery (R.H.J.), and Duke Clinical Research Institute (L.S., V.L.M.), Duke University Medical Center, Durham, NC; the University of Florida, Gainesville (J.A.H.); Westchester Medical Center and New York Medical College, Valhalla (J.A.P.), and Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, New York (R.E.M.); Northwestern University Feinberg School of Medicine, Chicago (R.O.B.); the Department of Cardiothoracic Surgery, University Hospital Jena, Friedrich-Schiller-University of Jena, Jena, Germany (T.D.); Glasgow University and Golden Jubilee National Hospital, Glasgow, United Kingdom (M.C.P.); Mayo Clinic, Rochester, MN (J.K.O.); the Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (P.D.-N., G.S.); and University of Montreal, Montreal Heart Institute, Montreal (J.L.R.)
| | - James A Hill
- From the Division of Cardiology (E.J.V.), Departments of Biostatistics and Bioinformatics (K.L.L., H.R.A.-K.) and Surgery (R.H.J.), and Duke Clinical Research Institute (L.S., V.L.M.), Duke University Medical Center, Durham, NC; the University of Florida, Gainesville (J.A.H.); Westchester Medical Center and New York Medical College, Valhalla (J.A.P.), and Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, New York (R.E.M.); Northwestern University Feinberg School of Medicine, Chicago (R.O.B.); the Department of Cardiothoracic Surgery, University Hospital Jena, Friedrich-Schiller-University of Jena, Jena, Germany (T.D.); Glasgow University and Golden Jubilee National Hospital, Glasgow, United Kingdom (M.C.P.); Mayo Clinic, Rochester, MN (J.K.O.); the Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (P.D.-N., G.S.); and University of Montreal, Montreal Heart Institute, Montreal (J.L.R.)
| | - Julio A Panza
- From the Division of Cardiology (E.J.V.), Departments of Biostatistics and Bioinformatics (K.L.L., H.R.A.-K.) and Surgery (R.H.J.), and Duke Clinical Research Institute (L.S., V.L.M.), Duke University Medical Center, Durham, NC; the University of Florida, Gainesville (J.A.H.); Westchester Medical Center and New York Medical College, Valhalla (J.A.P.), and Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, New York (R.E.M.); Northwestern University Feinberg School of Medicine, Chicago (R.O.B.); the Department of Cardiothoracic Surgery, University Hospital Jena, Friedrich-Schiller-University of Jena, Jena, Germany (T.D.); Glasgow University and Golden Jubilee National Hospital, Glasgow, United Kingdom (M.C.P.); Mayo Clinic, Rochester, MN (J.K.O.); the Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (P.D.-N., G.S.); and University of Montreal, Montreal Heart Institute, Montreal (J.L.R.)
| | - Robert E Michler
- From the Division of Cardiology (E.J.V.), Departments of Biostatistics and Bioinformatics (K.L.L., H.R.A.-K.) and Surgery (R.H.J.), and Duke Clinical Research Institute (L.S., V.L.M.), Duke University Medical Center, Durham, NC; the University of Florida, Gainesville (J.A.H.); Westchester Medical Center and New York Medical College, Valhalla (J.A.P.), and Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, New York (R.E.M.); Northwestern University Feinberg School of Medicine, Chicago (R.O.B.); the Department of Cardiothoracic Surgery, University Hospital Jena, Friedrich-Schiller-University of Jena, Jena, Germany (T.D.); Glasgow University and Golden Jubilee National Hospital, Glasgow, United Kingdom (M.C.P.); Mayo Clinic, Rochester, MN (J.K.O.); the Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (P.D.-N., G.S.); and University of Montreal, Montreal Heart Institute, Montreal (J.L.R.)
| | - Robert O Bonow
- From the Division of Cardiology (E.J.V.), Departments of Biostatistics and Bioinformatics (K.L.L., H.R.A.-K.) and Surgery (R.H.J.), and Duke Clinical Research Institute (L.S., V.L.M.), Duke University Medical Center, Durham, NC; the University of Florida, Gainesville (J.A.H.); Westchester Medical Center and New York Medical College, Valhalla (J.A.P.), and Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, New York (R.E.M.); Northwestern University Feinberg School of Medicine, Chicago (R.O.B.); the Department of Cardiothoracic Surgery, University Hospital Jena, Friedrich-Schiller-University of Jena, Jena, Germany (T.D.); Glasgow University and Golden Jubilee National Hospital, Glasgow, United Kingdom (M.C.P.); Mayo Clinic, Rochester, MN (J.K.O.); the Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (P.D.-N., G.S.); and University of Montreal, Montreal Heart Institute, Montreal (J.L.R.)
| | - Torsten Doenst
- From the Division of Cardiology (E.J.V.), Departments of Biostatistics and Bioinformatics (K.L.L., H.R.A.-K.) and Surgery (R.H.J.), and Duke Clinical Research Institute (L.S., V.L.M.), Duke University Medical Center, Durham, NC; the University of Florida, Gainesville (J.A.H.); Westchester Medical Center and New York Medical College, Valhalla (J.A.P.), and Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, New York (R.E.M.); Northwestern University Feinberg School of Medicine, Chicago (R.O.B.); the Department of Cardiothoracic Surgery, University Hospital Jena, Friedrich-Schiller-University of Jena, Jena, Germany (T.D.); Glasgow University and Golden Jubilee National Hospital, Glasgow, United Kingdom (M.C.P.); Mayo Clinic, Rochester, MN (J.K.O.); the Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (P.D.-N., G.S.); and University of Montreal, Montreal Heart Institute, Montreal (J.L.R.)
| | - Mark C Petrie
- From the Division of Cardiology (E.J.V.), Departments of Biostatistics and Bioinformatics (K.L.L., H.R.A.-K.) and Surgery (R.H.J.), and Duke Clinical Research Institute (L.S., V.L.M.), Duke University Medical Center, Durham, NC; the University of Florida, Gainesville (J.A.H.); Westchester Medical Center and New York Medical College, Valhalla (J.A.P.), and Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, New York (R.E.M.); Northwestern University Feinberg School of Medicine, Chicago (R.O.B.); the Department of Cardiothoracic Surgery, University Hospital Jena, Friedrich-Schiller-University of Jena, Jena, Germany (T.D.); Glasgow University and Golden Jubilee National Hospital, Glasgow, United Kingdom (M.C.P.); Mayo Clinic, Rochester, MN (J.K.O.); the Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (P.D.-N., G.S.); and University of Montreal, Montreal Heart Institute, Montreal (J.L.R.)
| | - Jae K Oh
- From the Division of Cardiology (E.J.V.), Departments of Biostatistics and Bioinformatics (K.L.L., H.R.A.-K.) and Surgery (R.H.J.), and Duke Clinical Research Institute (L.S., V.L.M.), Duke University Medical Center, Durham, NC; the University of Florida, Gainesville (J.A.H.); Westchester Medical Center and New York Medical College, Valhalla (J.A.P.), and Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, New York (R.E.M.); Northwestern University Feinberg School of Medicine, Chicago (R.O.B.); the Department of Cardiothoracic Surgery, University Hospital Jena, Friedrich-Schiller-University of Jena, Jena, Germany (T.D.); Glasgow University and Golden Jubilee National Hospital, Glasgow, United Kingdom (M.C.P.); Mayo Clinic, Rochester, MN (J.K.O.); the Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (P.D.-N., G.S.); and University of Montreal, Montreal Heart Institute, Montreal (J.L.R.)
| | - Lilin She
- From the Division of Cardiology (E.J.V.), Departments of Biostatistics and Bioinformatics (K.L.L., H.R.A.-K.) and Surgery (R.H.J.), and Duke Clinical Research Institute (L.S., V.L.M.), Duke University Medical Center, Durham, NC; the University of Florida, Gainesville (J.A.H.); Westchester Medical Center and New York Medical College, Valhalla (J.A.P.), and Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, New York (R.E.M.); Northwestern University Feinberg School of Medicine, Chicago (R.O.B.); the Department of Cardiothoracic Surgery, University Hospital Jena, Friedrich-Schiller-University of Jena, Jena, Germany (T.D.); Glasgow University and Golden Jubilee National Hospital, Glasgow, United Kingdom (M.C.P.); Mayo Clinic, Rochester, MN (J.K.O.); the Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (P.D.-N., G.S.); and University of Montreal, Montreal Heart Institute, Montreal (J.L.R.)
| | - Vanessa L Moore
- From the Division of Cardiology (E.J.V.), Departments of Biostatistics and Bioinformatics (K.L.L., H.R.A.-K.) and Surgery (R.H.J.), and Duke Clinical Research Institute (L.S., V.L.M.), Duke University Medical Center, Durham, NC; the University of Florida, Gainesville (J.A.H.); Westchester Medical Center and New York Medical College, Valhalla (J.A.P.), and Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, New York (R.E.M.); Northwestern University Feinberg School of Medicine, Chicago (R.O.B.); the Department of Cardiothoracic Surgery, University Hospital Jena, Friedrich-Schiller-University of Jena, Jena, Germany (T.D.); Glasgow University and Golden Jubilee National Hospital, Glasgow, United Kingdom (M.C.P.); Mayo Clinic, Rochester, MN (J.K.O.); the Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (P.D.-N., G.S.); and University of Montreal, Montreal Heart Institute, Montreal (J.L.R.)
| | - Patrice Desvigne-Nickens
- From the Division of Cardiology (E.J.V.), Departments of Biostatistics and Bioinformatics (K.L.L., H.R.A.-K.) and Surgery (R.H.J.), and Duke Clinical Research Institute (L.S., V.L.M.), Duke University Medical Center, Durham, NC; the University of Florida, Gainesville (J.A.H.); Westchester Medical Center and New York Medical College, Valhalla (J.A.P.), and Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, New York (R.E.M.); Northwestern University Feinberg School of Medicine, Chicago (R.O.B.); the Department of Cardiothoracic Surgery, University Hospital Jena, Friedrich-Schiller-University of Jena, Jena, Germany (T.D.); Glasgow University and Golden Jubilee National Hospital, Glasgow, United Kingdom (M.C.P.); Mayo Clinic, Rochester, MN (J.K.O.); the Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (P.D.-N., G.S.); and University of Montreal, Montreal Heart Institute, Montreal (J.L.R.)
| | - George Sopko
- From the Division of Cardiology (E.J.V.), Departments of Biostatistics and Bioinformatics (K.L.L., H.R.A.-K.) and Surgery (R.H.J.), and Duke Clinical Research Institute (L.S., V.L.M.), Duke University Medical Center, Durham, NC; the University of Florida, Gainesville (J.A.H.); Westchester Medical Center and New York Medical College, Valhalla (J.A.P.), and Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, New York (R.E.M.); Northwestern University Feinberg School of Medicine, Chicago (R.O.B.); the Department of Cardiothoracic Surgery, University Hospital Jena, Friedrich-Schiller-University of Jena, Jena, Germany (T.D.); Glasgow University and Golden Jubilee National Hospital, Glasgow, United Kingdom (M.C.P.); Mayo Clinic, Rochester, MN (J.K.O.); the Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (P.D.-N., G.S.); and University of Montreal, Montreal Heart Institute, Montreal (J.L.R.)
| | - Jean L Rouleau
- From the Division of Cardiology (E.J.V.), Departments of Biostatistics and Bioinformatics (K.L.L., H.R.A.-K.) and Surgery (R.H.J.), and Duke Clinical Research Institute (L.S., V.L.M.), Duke University Medical Center, Durham, NC; the University of Florida, Gainesville (J.A.H.); Westchester Medical Center and New York Medical College, Valhalla (J.A.P.), and Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, New York (R.E.M.); Northwestern University Feinberg School of Medicine, Chicago (R.O.B.); the Department of Cardiothoracic Surgery, University Hospital Jena, Friedrich-Schiller-University of Jena, Jena, Germany (T.D.); Glasgow University and Golden Jubilee National Hospital, Glasgow, United Kingdom (M.C.P.); Mayo Clinic, Rochester, MN (J.K.O.); the Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (P.D.-N., G.S.); and University of Montreal, Montreal Heart Institute, Montreal (J.L.R.)
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186
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Cirillo M, Campana M, Brunelli F, Dalla Tomba M, Mhagna Z, Messina A, Villa E, Natalini G, Troise G. Time series analysis of physiologic left ventricular reconstruction in ischemic cardiomyopathy. J Thorac Cardiovasc Surg 2016; 152:382-91. [PMID: 27167021 DOI: 10.1016/j.jtcvs.2016.03.087] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2015] [Revised: 03/14/2016] [Accepted: 03/17/2016] [Indexed: 01/07/2023]
Abstract
OBJECTIVE The history of left ventricular reconstruction has demonstrated that the full spectrum of recoverable physiologic parameters is essential for a good functional result. We report the long-term outcome of a new surgical technique that arranges myocardial fibers in a near-normal disposition, also recovering left ventricular twisting. METHODS Between May 2006 and October 2013, 29 consecutive patients with previous anterior myocardial infarction and heart failure symptoms underwent physiologic left ventricular reconstruction surgery and coronary revascularization. Patients were examined by means of standard echocardiography and 2-dimensional speckle tracking at 8 time steps until 7 years after surgery. Ten geometric and functional parameters were evaluated at each step and analyzed by the linear mixed model test. RESULTS Hospital mortality was 0%. The mean percentage of indexed end-diastolic and end-systolic volume reduction was 45.7% and 50.9%, respectively. Ejection fraction and all of the volumes were significantly different in the postoperative period with a steady correction during time. Diastolic parameters were not worsened by surgical reconstruction. Ejection fraction and deceleration time showed a significant improvement during time. Left ventricular torsion increased immediately after the surgical correction from 2.8 ± 4.4 degrees to 8.7 ± 3.9 degrees (P = .02) and was still present 4 years after surgery. CONCLUSIONS Surgical conduction of ventricular reconstruction should be standardized to achieve the full spectrum of recoverable physiologic parameters. The renewal of ventricular torsion should be pursued as an adjunctive element of ventricular efficiency, mainly in ventricles that work at a critical level in the Frank-Starling relationship and pressure-volume loop.
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Affiliation(s)
- Marco Cirillo
- Heart Failure Surgery Unit, Poliambulanza Foundation Hospital, Brescia, Italy.
| | - Marco Campana
- Echocardiography Laboratory, Cardiology Unit, Cardiovascular Department, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Federico Brunelli
- Cardiac Surgery Unit, Cardiovascular Department, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Margherita Dalla Tomba
- Cardiac Surgery Unit, Cardiovascular Department, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Zean Mhagna
- Cardiac Surgery Unit, Cardiovascular Department, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Antonio Messina
- Cardiac Surgery Unit, Cardiovascular Department, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Emmanuel Villa
- Cardiac Surgery Unit, Cardiovascular Department, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Giuseppe Natalini
- Intensive Care Unit, Emergency Department, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Giovanni Troise
- Cardiac Surgery Unit, Cardiovascular Department, Poliambulanza Foundation Hospital, Brescia, Italy
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187
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Calafiore AM, Iaco' AL, Kheirallah H, Sheikh AA, Al Sayed H, El Rasheed M, Allam A, Awadi MO, Alfonso JJ, Osman AA, Di Mauro M. Outcome of left ventricular surgical remodelling after the STICH trial. Eur J Cardiothorac Surg 2016; 50:693-701. [PMID: 27072008 DOI: 10.1093/ejcts/ezw103] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 02/13/2016] [Accepted: 02/22/2016] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES After the publication of the Surgical Treatment for Ischaemic Heart Failure (STICH) trial, surgical indications to left ventricular surgical remodelling (LVSR) have become more restrictive. The experience we report reflects the changes in the real world after the publication of STICH trial. METHODS From May 2009 to July 2014, 113 patients underwent LVSR, targeted mainly to the left anterior descending territory (89.4%). Of these, 18 patients (15.9%) were operated on an emergency basis. Early and mid-term outcomes were assessed to identify clinical and echocardiographic risk factors. RESULTS Most patients (90.3%) had chronic ischaemic mitral regurgitation (CIMR) and were in New York Heart Association (NYHA) class III/IV (77.9%). The median ejection fraction (EF) was 26% [95% confidence interval (CI): 26, 28] and scarred areas were akinetic (86.7%) in most cases. Severe left ventricular diastolic dysfunction (LVDD) was found in 33.6% of patients. Mitral valve surgery was performed in 84.1% of patients. Five patients (4.4%) died while in hospital, all from cardiac causes. Risk factors were abnormal bilirubin and emergency status. After a median follow-up of 12 (95% CI: 6, 18) months, 22 patients died, 17 from cardiac causes. Five-year freedom from death any from cause was 73 ± 5%, emergency status and MR Grade 4 being the only risk factors. Five-year freedom from death from any cause and NYHA class III/IV was 61 ± 6%. Severe LVDD and emergency status were risk factors, along with high bilirubin and diabetes mellitus on insulin. Five-year freedom from death from any cause and non-fatal cardiovascular events (rehospitalization, reoperation and stroke) was 55 ± 6%. LVDD and atrial fibrillation were found to be risk factors. After a median follow-up of 31 (95% CI: 19, 38) months, 91 patients underwent postoperative echocardiography. EF increased by 20%, but stroke volume remained unchanged. Postoperatively, patients with severe LVDD had lower EF and higher end-systolic volumes than patients without LVDD. CONCLUSIONS Our findings show that patients, who are candidates for LVSR, have mostly akinetic areas and CIMR requiring surgical correction and are severely symptomatic. Severe LVDD is common and, along with emergency status, is the most important risk factor for early and late outcome.
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Affiliation(s)
- Antonio M Calafiore
- Department of Cardiac Surgery and Cardiology, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Angela L Iaco'
- Department of Cardiac Surgery and Cardiology, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Hatim Kheirallah
- Department of Cardiac Surgery and Cardiology, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Azmat A Sheikh
- Department of Cardiac Surgery and Cardiology, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Hussain Al Sayed
- Department of Cardiac Surgery and Cardiology, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Mohammed El Rasheed
- Department of Cardiac Surgery and Cardiology, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Ahmed Allam
- Department of Cardiac Surgery and Cardiology, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
- Department of Cardiothoracic Surgery, Ain Shams University, Ain Shams, Egypt
| | - Mohammed O Awadi
- Department of Cardiac Surgery and Cardiology, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
- Department of Cardiothoracic Surgery, Benha University, Benha, Egypt
| | - Juan J Alfonso
- Department of Cardiac Surgery and Cardiology, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Ahmed A Osman
- Department of Cardiac Surgery and Cardiology, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
- Department of Critical Care, Cairo University, Cairo, Egypt
| | - Michele Di Mauro
- Department of Cardiac Surgery and Cardiology, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
- Department of Cardiology, L'Aquila University, L'Aquila, Italy
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188
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Heeger C, Frerker C, Hayashi K, Schmidt T, Mathew S, Sohns C, Kaiser L, Metzner A, Kuck K, Ouyang F. Catheter ablation of frequent ventricular tachycardia after interventional left ventricular restoration with the Revivent-Transcatheter(™)-system. Clin Case Rep 2016; 4:339-43. [PMID: 27099723 PMCID: PMC4831379 DOI: 10.1002/ccr3.512] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Revised: 01/01/2016] [Accepted: 01/27/2016] [Indexed: 11/29/2022] Open
Abstract
The Revivent-TC(™)-system is able to restore LV volumes in patients with severe ischemic cardiomyopathy. We are presenting a case report of successful implantation of the Revivent-TC(™)-system, but postprocedural development of sustained VT. This case report is presenting one way to successfully treat patients with postprocedural frequent VT.
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Affiliation(s)
| | | | - Kentaro Hayashi
- Department of CardiologyAsklepios Clinic St. GeorgHamburgGermany
| | - Tobias Schmidt
- Department of CardiologyAsklepios Clinic St. GeorgHamburgGermany
| | - Shibu Mathew
- Department of CardiologyAsklepios Clinic St. GeorgHamburgGermany
| | - Christian Sohns
- Department of CardiologyAsklepios Clinic St. GeorgHamburgGermany
| | - Lukas Kaiser
- Department of CardiologyAsklepios Clinic St. GeorgHamburgGermany
| | - Andreas Metzner
- Department of CardiologyAsklepios Clinic St. GeorgHamburgGermany
| | - Karl‐Heinz Kuck
- Department of CardiologyAsklepios Clinic St. GeorgHamburgGermany
| | - Feifan Ouyang
- Department of CardiologyAsklepios Clinic St. GeorgHamburgGermany
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189
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Cardiovascular Simulation of Heart Failure Pathophysiology and Therapeutics. J Card Fail 2016; 22:303-11. [DOI: 10.1016/j.cardfail.2015.12.012] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2015] [Revised: 11/23/2015] [Accepted: 12/08/2015] [Indexed: 11/19/2022]
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190
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Samsky MD, DeVore AD, Durkin M, Stout JE, Velazquez EJ, Milano CA. Getting to a Man's Heart through His Colon. Tex Heart Inst J 2016; 43:168-70. [PMID: 27127437 DOI: 10.14503/thij-14-4946] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
A 69-year-old man presented with a progressively enlarging pulsatile mass in the left side of his chest. Because of a history of an ischemic cardiomyopathy, he had been randomized in 2003 to undergo coronary artery bypass grafting with a Dor procedure, as part of the Surgical Treatment for Ischemic Heart Failure (STICH) trial. Our patient's imaging studies, including a thoracic computed tomogram and transthoracic echocardiogram, were now of concern for left ventricular pseudoaneurysm. He was taken immediately for surgical exploration. Purulent material, with empyema, extended from the anterior chest wall through the chest cavity into the mediastinum, with communication into the pericardial space. Notably, there was no compromise of the left ventricular cavity, and there was no pseudoaneurysm. The chest was copiously irrigated before closure. The epicardial patch placed 10 years earlier in the STICH trial was not thought to be the nidus of the abscess and was therefore not removed. Three months later, the patient presented again, this time with hemorrhagic shock and bleeding from his left anterior thoracotomy site, which we then re-entered. He was found to have a left ventricular pseudoaneurysm with disruption of the ventricular apex. The epicardial felt-and-Dacron patch, placed 10 years previously during his Dor procedure, was found to be infected with Clostridium difficile and was removed. The left ventricular apex was repaired. Whereas C. difficile bacteremia is rare, the seeding of prosthetic cardiac material with delayed presentation, as in this case, is extraordinarily uncommon.
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191
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Kajita AH, Oliveira MDP, Menezes FR, Franken M, Baraciolli LM, Nicolau JC. Giant and Calcified Post-Infarction True Left Ventricular Aneurysm: What to Do? Arq Bras Cardiol 2016; 106:259-62. [PMID: 27027370 PMCID: PMC4811282 DOI: 10.5935/abc.20150087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2015] [Accepted: 05/11/2015] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | - Marcelo Franken
- Instituto do Coração, Universidade de São Paulo, São Paulo, SP, Brazil
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192
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Kassab GS, An G, Sander EA, Miga MI, Guccione JM, Ji S, Vodovotz Y. Augmenting Surgery via Multi-scale Modeling and Translational Systems Biology in the Era of Precision Medicine: A Multidisciplinary Perspective. Ann Biomed Eng 2016; 44:2611-25. [PMID: 27015816 DOI: 10.1007/s10439-016-1596-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Accepted: 03/18/2016] [Indexed: 12/18/2022]
Abstract
In this era of tremendous technological capabilities and increased focus on improving clinical outcomes, decreasing costs, and increasing precision, there is a need for a more quantitative approach to the field of surgery. Multiscale computational modeling has the potential to bridge the gap to the emerging paradigms of Precision Medicine and Translational Systems Biology, in which quantitative metrics and data guide patient care through improved stratification, diagnosis, and therapy. Achievements by multiple groups have demonstrated the potential for (1) multiscale computational modeling, at a biological level, of diseases treated with surgery and the surgical procedure process at the level of the individual and the population; along with (2) patient-specific, computationally-enabled surgical planning, delivery, and guidance and robotically-augmented manipulation. In this perspective article, we discuss these concepts, and cite emerging examples from the fields of trauma, wound healing, and cardiac surgery.
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Affiliation(s)
- Ghassan S Kassab
- California Medical Innovations Institute, San Diego, CA, 92121, USA
| | - Gary An
- Department of Surgery, University of Chicago, Chicago, IL, 60637, USA
| | - Edward A Sander
- Department of Biomedical Engineering, University of Iowa, Iowa City, IA, 52242, USA
| | - Michael I Miga
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, 37235, USA
| | - Julius M Guccione
- Department of Surgery, University of California, San Francisco, CA, 94143, USA
| | - Songbai Ji
- Thayer School of Engineering, Dartmouth College, Hanover, NH, 03755, USA.,Department of Surgery and of Orthopaedic Surgery, Geisel School of Medicine, Dartmouth College, Hanover, NH, 03755, USA
| | - Yoram Vodovotz
- Department of Surgery, University of Pittsburgh, W944 Starzl Biomedical Sciences Tower, 200 Lothrop St., Pittsburgh, PA, 15213, USA. .,Center for Inflammation and Regenerative Modeling, McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA, 15219, USA.
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193
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Richter D, Vlachopoulos C, Tousoulis D. Scalpels Versus Balloons in Failing Hearts: Case Closed? Angiology 2016; 68:8-9. [PMID: 26969114 DOI: 10.1177/0003319716636310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Charalambos Vlachopoulos
- First Department of Cardiology, Hippokration Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Tousoulis
- First Department of Cardiology, Hippokration Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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194
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The Canadian Cardiovascular Society Heart Failure Companion: Bridging Guidelines to Your Practice. Can J Cardiol 2016; 32:296-310. [DOI: 10.1016/j.cjca.2015.06.019] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Revised: 06/15/2015] [Accepted: 06/15/2015] [Indexed: 01/09/2023] Open
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195
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Starling RC. Augmenting outcomes in advanced heart failure: a lot to learn. Eur J Heart Fail 2016; 18:326-7. [DOI: 10.1002/ejhf.488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 12/26/2015] [Accepted: 12/27/2015] [Indexed: 11/06/2022] Open
Affiliation(s)
- Randall C. Starling
- Kaufman Center for Heart Failure; Cleveland Clinic Lerner College of Medicine of Case Western Reserve University; 9500 Euclid Avenue Cleveland OH 44195 USA
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Balsam LB, DeAnda A. Returning to the bench with adeno-associated virus 1 SERCA2a gene therapy. J Thorac Cardiovasc Surg 2016; 151:1200-2. [PMID: 26787470 DOI: 10.1016/j.jtcvs.2015.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 12/08/2015] [Indexed: 11/24/2022]
Affiliation(s)
- Leora B Balsam
- Department of Cardiothoracic Surgery, New York University-Langone Medical Center, New York, NY.
| | - Abe DeAnda
- Division of Cardiothoracic Surgery, University of Texas Medical Branch-Galveston, Galveston, Tex
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Rodríguez Masi M, Martín Lores I, Bustos García de Castro A, Cabeza Martínez B, Maroto Castellanos L, Gómez de Diego J, Ferreirós Domínguez J. Preoperative and follow-up cardiac magnetic resonance imaging of candidates for surgical ventricular restoration. RADIOLOGIA 2016. [DOI: 10.1016/j.rxeng.2015.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Berthiaume J, Kirk J, Ranek M, Lyon R, Sheikh F, Jensen B, Hoit B, Butany J, Tolend M, Rao V, Willis M. Pathophysiology of Heart Failure and an Overview of Therapies. Cardiovasc Pathol 2016. [DOI: 10.1016/b978-0-12-420219-1.00008-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
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Wrobel K, Stevens SR, Jones RH, Selzman CH, Lamy A, Beaver TM, Djokovic LT, Wang N, Velazquez EJ, Sopko G, Kron IL, DiMaio JM, Michler RE, Lee KL, Yii M, Leng CY, Zembala M, Rouleau JL, Daly RC, Al-Khalidi HR. Influence of Baseline Characteristics, Operative Conduct, and Postoperative Course on 30-Day Outcomes of Coronary Artery Bypass Grafting Among Patients With Left Ventricular Dysfunction: Results From the Surgical Treatment for Ischemic Heart Failure (STICH) Trial. Circulation 2015; 132:720-30. [PMID: 26304663 DOI: 10.1161/circulationaha.114.014932] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Patients with severe left ventricular dysfunction, ischemic heart failure, and coronary artery disease suitable for coronary artery bypass grafting (CABG) are at higher risk for surgical morbidity and mortality. Paradoxically, those patients with the most severe coronary artery disease and ventricular dysfunction who derive the greatest clinical benefit from CABG are also at the greatest operative risk, which makes decision making regarding whether to proceed to surgery difficult in such patients. To better inform such decision making, we analyzed the Surgical Treatment for Ischemic Heart Failure (STICH) CABG population for detailed information on perioperative risk and outcomes. METHODS AND RESULTS In both STICH trials (hypotheses), 2136 patients with a left ventricular ejection fraction of ≤35% and coronary artery disease were allocated to medical therapy, CABG plus medical therapy, or CABG with surgical ventricular reconstruction. Relationships of baseline characteristics and operative conduct with morbidity and mortality at 30 days were evaluated. There were a total of 1460 patients randomized to and receiving surgery, and 346 (≈25%) of these high-risk patients developed a severe complication within 30 days. Worsening renal insufficiency, cardiac arrest with cardiopulmonary resuscitation, and ventricular arrhythmias were the most frequent complications and those most commonly associated with death. Mortality at 30 days was 5.1% and was generally preceded by a serious complication (65 of 74 deaths). Left ventricular size, renal dysfunction, advanced age, and atrial fibrillation/flutter were significant preoperative predictors of mortality within 30 days. Cardiopulmonary bypass time was the only independent surgical variable predictive of 30-day mortality. CONCLUSIONS CABG can be performed with relatively low 30-day mortality in patients with left ventricular dysfunction. Serious postoperative complications occurred in nearly 1 in 4 patients and were associated with mortality. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00023595.
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Affiliation(s)
- Krzysztof Wrobel
- From Allenort Hospital, Warsaw, Poland and John Paul II Hospital, Krakow, Poland (K.W.); Duke Clinical Research Institute, Durham, NC (S.R.S.); Duke University School of Medicine and Duke Clinical Research Institute, Durham, NC (R.H.J., E.J.V., K.L.L., H.R.A.); University of Utah, Salt Lake City, UT (C.H.S.); Hamilton General Hospital/McMaster University, Hamilton, ON, Canada (A.L.); Shands Hospital at the University of Florida, Gainesville (T.M.B.); Dedinje Cardiovascular Institute, Belgrade, Serbia (L.T.D.); Loma Linda University Medical Center, CA (N.W.); National Institutes of Health/National Heart, Blood, and Lung Institute, Bethesda, MD (G.S.); University of Virginia, Charlottesville (I.L.K.); Baylor University Medical Center, Dallas, TX (J.M.D.); Montefiore Medical Center and Albert Einstein College of Medicine, New York (R.E.M.); St. Vincent's Hospital Melbourne and University of Melbourne, Australia (M.Y.); National Heart Centre Singapore (C.Y.L.); Silesian Center for Heart Diseases in Zabrze, Poland (M.Z.); Montreal Heart Institute, University de Montréal, Canada (J.L.R.); and Mayo Clinic, Rochester, MN (R.C.D.)
| | - Susanna R Stevens
- From Allenort Hospital, Warsaw, Poland and John Paul II Hospital, Krakow, Poland (K.W.); Duke Clinical Research Institute, Durham, NC (S.R.S.); Duke University School of Medicine and Duke Clinical Research Institute, Durham, NC (R.H.J., E.J.V., K.L.L., H.R.A.); University of Utah, Salt Lake City, UT (C.H.S.); Hamilton General Hospital/McMaster University, Hamilton, ON, Canada (A.L.); Shands Hospital at the University of Florida, Gainesville (T.M.B.); Dedinje Cardiovascular Institute, Belgrade, Serbia (L.T.D.); Loma Linda University Medical Center, CA (N.W.); National Institutes of Health/National Heart, Blood, and Lung Institute, Bethesda, MD (G.S.); University of Virginia, Charlottesville (I.L.K.); Baylor University Medical Center, Dallas, TX (J.M.D.); Montefiore Medical Center and Albert Einstein College of Medicine, New York (R.E.M.); St. Vincent's Hospital Melbourne and University of Melbourne, Australia (M.Y.); National Heart Centre Singapore (C.Y.L.); Silesian Center for Heart Diseases in Zabrze, Poland (M.Z.); Montreal Heart Institute, University de Montréal, Canada (J.L.R.); and Mayo Clinic, Rochester, MN (R.C.D.)
| | - Robert H Jones
- From Allenort Hospital, Warsaw, Poland and John Paul II Hospital, Krakow, Poland (K.W.); Duke Clinical Research Institute, Durham, NC (S.R.S.); Duke University School of Medicine and Duke Clinical Research Institute, Durham, NC (R.H.J., E.J.V., K.L.L., H.R.A.); University of Utah, Salt Lake City, UT (C.H.S.); Hamilton General Hospital/McMaster University, Hamilton, ON, Canada (A.L.); Shands Hospital at the University of Florida, Gainesville (T.M.B.); Dedinje Cardiovascular Institute, Belgrade, Serbia (L.T.D.); Loma Linda University Medical Center, CA (N.W.); National Institutes of Health/National Heart, Blood, and Lung Institute, Bethesda, MD (G.S.); University of Virginia, Charlottesville (I.L.K.); Baylor University Medical Center, Dallas, TX (J.M.D.); Montefiore Medical Center and Albert Einstein College of Medicine, New York (R.E.M.); St. Vincent's Hospital Melbourne and University of Melbourne, Australia (M.Y.); National Heart Centre Singapore (C.Y.L.); Silesian Center for Heart Diseases in Zabrze, Poland (M.Z.); Montreal Heart Institute, University de Montréal, Canada (J.L.R.); and Mayo Clinic, Rochester, MN (R.C.D.)
| | - Craig H Selzman
- From Allenort Hospital, Warsaw, Poland and John Paul II Hospital, Krakow, Poland (K.W.); Duke Clinical Research Institute, Durham, NC (S.R.S.); Duke University School of Medicine and Duke Clinical Research Institute, Durham, NC (R.H.J., E.J.V., K.L.L., H.R.A.); University of Utah, Salt Lake City, UT (C.H.S.); Hamilton General Hospital/McMaster University, Hamilton, ON, Canada (A.L.); Shands Hospital at the University of Florida, Gainesville (T.M.B.); Dedinje Cardiovascular Institute, Belgrade, Serbia (L.T.D.); Loma Linda University Medical Center, CA (N.W.); National Institutes of Health/National Heart, Blood, and Lung Institute, Bethesda, MD (G.S.); University of Virginia, Charlottesville (I.L.K.); Baylor University Medical Center, Dallas, TX (J.M.D.); Montefiore Medical Center and Albert Einstein College of Medicine, New York (R.E.M.); St. Vincent's Hospital Melbourne and University of Melbourne, Australia (M.Y.); National Heart Centre Singapore (C.Y.L.); Silesian Center for Heart Diseases in Zabrze, Poland (M.Z.); Montreal Heart Institute, University de Montréal, Canada (J.L.R.); and Mayo Clinic, Rochester, MN (R.C.D.)
| | - Andre Lamy
- From Allenort Hospital, Warsaw, Poland and John Paul II Hospital, Krakow, Poland (K.W.); Duke Clinical Research Institute, Durham, NC (S.R.S.); Duke University School of Medicine and Duke Clinical Research Institute, Durham, NC (R.H.J., E.J.V., K.L.L., H.R.A.); University of Utah, Salt Lake City, UT (C.H.S.); Hamilton General Hospital/McMaster University, Hamilton, ON, Canada (A.L.); Shands Hospital at the University of Florida, Gainesville (T.M.B.); Dedinje Cardiovascular Institute, Belgrade, Serbia (L.T.D.); Loma Linda University Medical Center, CA (N.W.); National Institutes of Health/National Heart, Blood, and Lung Institute, Bethesda, MD (G.S.); University of Virginia, Charlottesville (I.L.K.); Baylor University Medical Center, Dallas, TX (J.M.D.); Montefiore Medical Center and Albert Einstein College of Medicine, New York (R.E.M.); St. Vincent's Hospital Melbourne and University of Melbourne, Australia (M.Y.); National Heart Centre Singapore (C.Y.L.); Silesian Center for Heart Diseases in Zabrze, Poland (M.Z.); Montreal Heart Institute, University de Montréal, Canada (J.L.R.); and Mayo Clinic, Rochester, MN (R.C.D.)
| | - Thomas M Beaver
- From Allenort Hospital, Warsaw, Poland and John Paul II Hospital, Krakow, Poland (K.W.); Duke Clinical Research Institute, Durham, NC (S.R.S.); Duke University School of Medicine and Duke Clinical Research Institute, Durham, NC (R.H.J., E.J.V., K.L.L., H.R.A.); University of Utah, Salt Lake City, UT (C.H.S.); Hamilton General Hospital/McMaster University, Hamilton, ON, Canada (A.L.); Shands Hospital at the University of Florida, Gainesville (T.M.B.); Dedinje Cardiovascular Institute, Belgrade, Serbia (L.T.D.); Loma Linda University Medical Center, CA (N.W.); National Institutes of Health/National Heart, Blood, and Lung Institute, Bethesda, MD (G.S.); University of Virginia, Charlottesville (I.L.K.); Baylor University Medical Center, Dallas, TX (J.M.D.); Montefiore Medical Center and Albert Einstein College of Medicine, New York (R.E.M.); St. Vincent's Hospital Melbourne and University of Melbourne, Australia (M.Y.); National Heart Centre Singapore (C.Y.L.); Silesian Center for Heart Diseases in Zabrze, Poland (M.Z.); Montreal Heart Institute, University de Montréal, Canada (J.L.R.); and Mayo Clinic, Rochester, MN (R.C.D.)
| | - Ljubomir T Djokovic
- From Allenort Hospital, Warsaw, Poland and John Paul II Hospital, Krakow, Poland (K.W.); Duke Clinical Research Institute, Durham, NC (S.R.S.); Duke University School of Medicine and Duke Clinical Research Institute, Durham, NC (R.H.J., E.J.V., K.L.L., H.R.A.); University of Utah, Salt Lake City, UT (C.H.S.); Hamilton General Hospital/McMaster University, Hamilton, ON, Canada (A.L.); Shands Hospital at the University of Florida, Gainesville (T.M.B.); Dedinje Cardiovascular Institute, Belgrade, Serbia (L.T.D.); Loma Linda University Medical Center, CA (N.W.); National Institutes of Health/National Heart, Blood, and Lung Institute, Bethesda, MD (G.S.); University of Virginia, Charlottesville (I.L.K.); Baylor University Medical Center, Dallas, TX (J.M.D.); Montefiore Medical Center and Albert Einstein College of Medicine, New York (R.E.M.); St. Vincent's Hospital Melbourne and University of Melbourne, Australia (M.Y.); National Heart Centre Singapore (C.Y.L.); Silesian Center for Heart Diseases in Zabrze, Poland (M.Z.); Montreal Heart Institute, University de Montréal, Canada (J.L.R.); and Mayo Clinic, Rochester, MN (R.C.D.)
| | - Nan Wang
- From Allenort Hospital, Warsaw, Poland and John Paul II Hospital, Krakow, Poland (K.W.); Duke Clinical Research Institute, Durham, NC (S.R.S.); Duke University School of Medicine and Duke Clinical Research Institute, Durham, NC (R.H.J., E.J.V., K.L.L., H.R.A.); University of Utah, Salt Lake City, UT (C.H.S.); Hamilton General Hospital/McMaster University, Hamilton, ON, Canada (A.L.); Shands Hospital at the University of Florida, Gainesville (T.M.B.); Dedinje Cardiovascular Institute, Belgrade, Serbia (L.T.D.); Loma Linda University Medical Center, CA (N.W.); National Institutes of Health/National Heart, Blood, and Lung Institute, Bethesda, MD (G.S.); University of Virginia, Charlottesville (I.L.K.); Baylor University Medical Center, Dallas, TX (J.M.D.); Montefiore Medical Center and Albert Einstein College of Medicine, New York (R.E.M.); St. Vincent's Hospital Melbourne and University of Melbourne, Australia (M.Y.); National Heart Centre Singapore (C.Y.L.); Silesian Center for Heart Diseases in Zabrze, Poland (M.Z.); Montreal Heart Institute, University de Montréal, Canada (J.L.R.); and Mayo Clinic, Rochester, MN (R.C.D.)
| | - Eric J Velazquez
- From Allenort Hospital, Warsaw, Poland and John Paul II Hospital, Krakow, Poland (K.W.); Duke Clinical Research Institute, Durham, NC (S.R.S.); Duke University School of Medicine and Duke Clinical Research Institute, Durham, NC (R.H.J., E.J.V., K.L.L., H.R.A.); University of Utah, Salt Lake City, UT (C.H.S.); Hamilton General Hospital/McMaster University, Hamilton, ON, Canada (A.L.); Shands Hospital at the University of Florida, Gainesville (T.M.B.); Dedinje Cardiovascular Institute, Belgrade, Serbia (L.T.D.); Loma Linda University Medical Center, CA (N.W.); National Institutes of Health/National Heart, Blood, and Lung Institute, Bethesda, MD (G.S.); University of Virginia, Charlottesville (I.L.K.); Baylor University Medical Center, Dallas, TX (J.M.D.); Montefiore Medical Center and Albert Einstein College of Medicine, New York (R.E.M.); St. Vincent's Hospital Melbourne and University of Melbourne, Australia (M.Y.); National Heart Centre Singapore (C.Y.L.); Silesian Center for Heart Diseases in Zabrze, Poland (M.Z.); Montreal Heart Institute, University de Montréal, Canada (J.L.R.); and Mayo Clinic, Rochester, MN (R.C.D.)
| | - George Sopko
- From Allenort Hospital, Warsaw, Poland and John Paul II Hospital, Krakow, Poland (K.W.); Duke Clinical Research Institute, Durham, NC (S.R.S.); Duke University School of Medicine and Duke Clinical Research Institute, Durham, NC (R.H.J., E.J.V., K.L.L., H.R.A.); University of Utah, Salt Lake City, UT (C.H.S.); Hamilton General Hospital/McMaster University, Hamilton, ON, Canada (A.L.); Shands Hospital at the University of Florida, Gainesville (T.M.B.); Dedinje Cardiovascular Institute, Belgrade, Serbia (L.T.D.); Loma Linda University Medical Center, CA (N.W.); National Institutes of Health/National Heart, Blood, and Lung Institute, Bethesda, MD (G.S.); University of Virginia, Charlottesville (I.L.K.); Baylor University Medical Center, Dallas, TX (J.M.D.); Montefiore Medical Center and Albert Einstein College of Medicine, New York (R.E.M.); St. Vincent's Hospital Melbourne and University of Melbourne, Australia (M.Y.); National Heart Centre Singapore (C.Y.L.); Silesian Center for Heart Diseases in Zabrze, Poland (M.Z.); Montreal Heart Institute, University de Montréal, Canada (J.L.R.); and Mayo Clinic, Rochester, MN (R.C.D.)
| | - Irving L Kron
- From Allenort Hospital, Warsaw, Poland and John Paul II Hospital, Krakow, Poland (K.W.); Duke Clinical Research Institute, Durham, NC (S.R.S.); Duke University School of Medicine and Duke Clinical Research Institute, Durham, NC (R.H.J., E.J.V., K.L.L., H.R.A.); University of Utah, Salt Lake City, UT (C.H.S.); Hamilton General Hospital/McMaster University, Hamilton, ON, Canada (A.L.); Shands Hospital at the University of Florida, Gainesville (T.M.B.); Dedinje Cardiovascular Institute, Belgrade, Serbia (L.T.D.); Loma Linda University Medical Center, CA (N.W.); National Institutes of Health/National Heart, Blood, and Lung Institute, Bethesda, MD (G.S.); University of Virginia, Charlottesville (I.L.K.); Baylor University Medical Center, Dallas, TX (J.M.D.); Montefiore Medical Center and Albert Einstein College of Medicine, New York (R.E.M.); St. Vincent's Hospital Melbourne and University of Melbourne, Australia (M.Y.); National Heart Centre Singapore (C.Y.L.); Silesian Center for Heart Diseases in Zabrze, Poland (M.Z.); Montreal Heart Institute, University de Montréal, Canada (J.L.R.); and Mayo Clinic, Rochester, MN (R.C.D.)
| | - J Michael DiMaio
- From Allenort Hospital, Warsaw, Poland and John Paul II Hospital, Krakow, Poland (K.W.); Duke Clinical Research Institute, Durham, NC (S.R.S.); Duke University School of Medicine and Duke Clinical Research Institute, Durham, NC (R.H.J., E.J.V., K.L.L., H.R.A.); University of Utah, Salt Lake City, UT (C.H.S.); Hamilton General Hospital/McMaster University, Hamilton, ON, Canada (A.L.); Shands Hospital at the University of Florida, Gainesville (T.M.B.); Dedinje Cardiovascular Institute, Belgrade, Serbia (L.T.D.); Loma Linda University Medical Center, CA (N.W.); National Institutes of Health/National Heart, Blood, and Lung Institute, Bethesda, MD (G.S.); University of Virginia, Charlottesville (I.L.K.); Baylor University Medical Center, Dallas, TX (J.M.D.); Montefiore Medical Center and Albert Einstein College of Medicine, New York (R.E.M.); St. Vincent's Hospital Melbourne and University of Melbourne, Australia (M.Y.); National Heart Centre Singapore (C.Y.L.); Silesian Center for Heart Diseases in Zabrze, Poland (M.Z.); Montreal Heart Institute, University de Montréal, Canada (J.L.R.); and Mayo Clinic, Rochester, MN (R.C.D.)
| | - Robert E Michler
- From Allenort Hospital, Warsaw, Poland and John Paul II Hospital, Krakow, Poland (K.W.); Duke Clinical Research Institute, Durham, NC (S.R.S.); Duke University School of Medicine and Duke Clinical Research Institute, Durham, NC (R.H.J., E.J.V., K.L.L., H.R.A.); University of Utah, Salt Lake City, UT (C.H.S.); Hamilton General Hospital/McMaster University, Hamilton, ON, Canada (A.L.); Shands Hospital at the University of Florida, Gainesville (T.M.B.); Dedinje Cardiovascular Institute, Belgrade, Serbia (L.T.D.); Loma Linda University Medical Center, CA (N.W.); National Institutes of Health/National Heart, Blood, and Lung Institute, Bethesda, MD (G.S.); University of Virginia, Charlottesville (I.L.K.); Baylor University Medical Center, Dallas, TX (J.M.D.); Montefiore Medical Center and Albert Einstein College of Medicine, New York (R.E.M.); St. Vincent's Hospital Melbourne and University of Melbourne, Australia (M.Y.); National Heart Centre Singapore (C.Y.L.); Silesian Center for Heart Diseases in Zabrze, Poland (M.Z.); Montreal Heart Institute, University de Montréal, Canada (J.L.R.); and Mayo Clinic, Rochester, MN (R.C.D.)
| | - Kerry L Lee
- From Allenort Hospital, Warsaw, Poland and John Paul II Hospital, Krakow, Poland (K.W.); Duke Clinical Research Institute, Durham, NC (S.R.S.); Duke University School of Medicine and Duke Clinical Research Institute, Durham, NC (R.H.J., E.J.V., K.L.L., H.R.A.); University of Utah, Salt Lake City, UT (C.H.S.); Hamilton General Hospital/McMaster University, Hamilton, ON, Canada (A.L.); Shands Hospital at the University of Florida, Gainesville (T.M.B.); Dedinje Cardiovascular Institute, Belgrade, Serbia (L.T.D.); Loma Linda University Medical Center, CA (N.W.); National Institutes of Health/National Heart, Blood, and Lung Institute, Bethesda, MD (G.S.); University of Virginia, Charlottesville (I.L.K.); Baylor University Medical Center, Dallas, TX (J.M.D.); Montefiore Medical Center and Albert Einstein College of Medicine, New York (R.E.M.); St. Vincent's Hospital Melbourne and University of Melbourne, Australia (M.Y.); National Heart Centre Singapore (C.Y.L.); Silesian Center for Heart Diseases in Zabrze, Poland (M.Z.); Montreal Heart Institute, University de Montréal, Canada (J.L.R.); and Mayo Clinic, Rochester, MN (R.C.D.)
| | - Michael Yii
- From Allenort Hospital, Warsaw, Poland and John Paul II Hospital, Krakow, Poland (K.W.); Duke Clinical Research Institute, Durham, NC (S.R.S.); Duke University School of Medicine and Duke Clinical Research Institute, Durham, NC (R.H.J., E.J.V., K.L.L., H.R.A.); University of Utah, Salt Lake City, UT (C.H.S.); Hamilton General Hospital/McMaster University, Hamilton, ON, Canada (A.L.); Shands Hospital at the University of Florida, Gainesville (T.M.B.); Dedinje Cardiovascular Institute, Belgrade, Serbia (L.T.D.); Loma Linda University Medical Center, CA (N.W.); National Institutes of Health/National Heart, Blood, and Lung Institute, Bethesda, MD (G.S.); University of Virginia, Charlottesville (I.L.K.); Baylor University Medical Center, Dallas, TX (J.M.D.); Montefiore Medical Center and Albert Einstein College of Medicine, New York (R.E.M.); St. Vincent's Hospital Melbourne and University of Melbourne, Australia (M.Y.); National Heart Centre Singapore (C.Y.L.); Silesian Center for Heart Diseases in Zabrze, Poland (M.Z.); Montreal Heart Institute, University de Montréal, Canada (J.L.R.); and Mayo Clinic, Rochester, MN (R.C.D.)
| | - Chua Yeow Leng
- From Allenort Hospital, Warsaw, Poland and John Paul II Hospital, Krakow, Poland (K.W.); Duke Clinical Research Institute, Durham, NC (S.R.S.); Duke University School of Medicine and Duke Clinical Research Institute, Durham, NC (R.H.J., E.J.V., K.L.L., H.R.A.); University of Utah, Salt Lake City, UT (C.H.S.); Hamilton General Hospital/McMaster University, Hamilton, ON, Canada (A.L.); Shands Hospital at the University of Florida, Gainesville (T.M.B.); Dedinje Cardiovascular Institute, Belgrade, Serbia (L.T.D.); Loma Linda University Medical Center, CA (N.W.); National Institutes of Health/National Heart, Blood, and Lung Institute, Bethesda, MD (G.S.); University of Virginia, Charlottesville (I.L.K.); Baylor University Medical Center, Dallas, TX (J.M.D.); Montefiore Medical Center and Albert Einstein College of Medicine, New York (R.E.M.); St. Vincent's Hospital Melbourne and University of Melbourne, Australia (M.Y.); National Heart Centre Singapore (C.Y.L.); Silesian Center for Heart Diseases in Zabrze, Poland (M.Z.); Montreal Heart Institute, University de Montréal, Canada (J.L.R.); and Mayo Clinic, Rochester, MN (R.C.D.)
| | - Marian Zembala
- From Allenort Hospital, Warsaw, Poland and John Paul II Hospital, Krakow, Poland (K.W.); Duke Clinical Research Institute, Durham, NC (S.R.S.); Duke University School of Medicine and Duke Clinical Research Institute, Durham, NC (R.H.J., E.J.V., K.L.L., H.R.A.); University of Utah, Salt Lake City, UT (C.H.S.); Hamilton General Hospital/McMaster University, Hamilton, ON, Canada (A.L.); Shands Hospital at the University of Florida, Gainesville (T.M.B.); Dedinje Cardiovascular Institute, Belgrade, Serbia (L.T.D.); Loma Linda University Medical Center, CA (N.W.); National Institutes of Health/National Heart, Blood, and Lung Institute, Bethesda, MD (G.S.); University of Virginia, Charlottesville (I.L.K.); Baylor University Medical Center, Dallas, TX (J.M.D.); Montefiore Medical Center and Albert Einstein College of Medicine, New York (R.E.M.); St. Vincent's Hospital Melbourne and University of Melbourne, Australia (M.Y.); National Heart Centre Singapore (C.Y.L.); Silesian Center for Heart Diseases in Zabrze, Poland (M.Z.); Montreal Heart Institute, University de Montréal, Canada (J.L.R.); and Mayo Clinic, Rochester, MN (R.C.D.)
| | - Jean L Rouleau
- From Allenort Hospital, Warsaw, Poland and John Paul II Hospital, Krakow, Poland (K.W.); Duke Clinical Research Institute, Durham, NC (S.R.S.); Duke University School of Medicine and Duke Clinical Research Institute, Durham, NC (R.H.J., E.J.V., K.L.L., H.R.A.); University of Utah, Salt Lake City, UT (C.H.S.); Hamilton General Hospital/McMaster University, Hamilton, ON, Canada (A.L.); Shands Hospital at the University of Florida, Gainesville (T.M.B.); Dedinje Cardiovascular Institute, Belgrade, Serbia (L.T.D.); Loma Linda University Medical Center, CA (N.W.); National Institutes of Health/National Heart, Blood, and Lung Institute, Bethesda, MD (G.S.); University of Virginia, Charlottesville (I.L.K.); Baylor University Medical Center, Dallas, TX (J.M.D.); Montefiore Medical Center and Albert Einstein College of Medicine, New York (R.E.M.); St. Vincent's Hospital Melbourne and University of Melbourne, Australia (M.Y.); National Heart Centre Singapore (C.Y.L.); Silesian Center for Heart Diseases in Zabrze, Poland (M.Z.); Montreal Heart Institute, University de Montréal, Canada (J.L.R.); and Mayo Clinic, Rochester, MN (R.C.D.)
| | - Richard C Daly
- From Allenort Hospital, Warsaw, Poland and John Paul II Hospital, Krakow, Poland (K.W.); Duke Clinical Research Institute, Durham, NC (S.R.S.); Duke University School of Medicine and Duke Clinical Research Institute, Durham, NC (R.H.J., E.J.V., K.L.L., H.R.A.); University of Utah, Salt Lake City, UT (C.H.S.); Hamilton General Hospital/McMaster University, Hamilton, ON, Canada (A.L.); Shands Hospital at the University of Florida, Gainesville (T.M.B.); Dedinje Cardiovascular Institute, Belgrade, Serbia (L.T.D.); Loma Linda University Medical Center, CA (N.W.); National Institutes of Health/National Heart, Blood, and Lung Institute, Bethesda, MD (G.S.); University of Virginia, Charlottesville (I.L.K.); Baylor University Medical Center, Dallas, TX (J.M.D.); Montefiore Medical Center and Albert Einstein College of Medicine, New York (R.E.M.); St. Vincent's Hospital Melbourne and University of Melbourne, Australia (M.Y.); National Heart Centre Singapore (C.Y.L.); Silesian Center for Heart Diseases in Zabrze, Poland (M.Z.); Montreal Heart Institute, University de Montréal, Canada (J.L.R.); and Mayo Clinic, Rochester, MN (R.C.D.)
| | - Hussein R Al-Khalidi
- From Allenort Hospital, Warsaw, Poland and John Paul II Hospital, Krakow, Poland (K.W.); Duke Clinical Research Institute, Durham, NC (S.R.S.); Duke University School of Medicine and Duke Clinical Research Institute, Durham, NC (R.H.J., E.J.V., K.L.L., H.R.A.); University of Utah, Salt Lake City, UT (C.H.S.); Hamilton General Hospital/McMaster University, Hamilton, ON, Canada (A.L.); Shands Hospital at the University of Florida, Gainesville (T.M.B.); Dedinje Cardiovascular Institute, Belgrade, Serbia (L.T.D.); Loma Linda University Medical Center, CA (N.W.); National Institutes of Health/National Heart, Blood, and Lung Institute, Bethesda, MD (G.S.); University of Virginia, Charlottesville (I.L.K.); Baylor University Medical Center, Dallas, TX (J.M.D.); Montefiore Medical Center and Albert Einstein College of Medicine, New York (R.E.M.); St. Vincent's Hospital Melbourne and University of Melbourne, Australia (M.Y.); National Heart Centre Singapore (C.Y.L.); Silesian Center for Heart Diseases in Zabrze, Poland (M.Z.); Montreal Heart Institute, University de Montréal, Canada (J.L.R.); and Mayo Clinic, Rochester, MN (R.C.D.).
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Jolicœur EM, Dunning A, Castelvecchio S, Dabrowski R, Waclawiw MA, Petrie MC, Stewart R, Jhund PS, Desvigne-Nickens P, Panza JA, Bonow RO, Sun B, San TR, Al-Khalidi HR, Rouleau JL, Velazquez EJ, Cleland JGF. Importance of angina in patients with coronary disease, heart failure, and left ventricular systolic dysfunction: insights from STICH. J Am Coll Cardiol 2015; 66:2092-2100. [PMID: 26541919 PMCID: PMC4655599 DOI: 10.1016/j.jacc.2015.08.882] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 08/14/2015] [Accepted: 08/20/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND Patients with left ventricular (LV) systolic dysfunction, coronary artery disease (CAD), and angina are often thought to have a worse prognosis and a greater prognostic benefit from coronary artery bypass graft (CABG) surgery than those without angina. OBJECTIVES This study investigated: 1) whether angina was associated with a worse prognosis; 2) whether angina identified patients who had a greater survival benefit from CABG; and 3) whether CABG improved angina in patients with LV systolic dysfunction and CAD. METHODS We performed an analysis of the STICH (Surgical Treatment for Ischemic Heart Failure) trial, in which 1,212 patients with an ejection fraction ≤35% and CAD were randomized to CABG or medical therapy. Multivariable Cox and logistic models were used to assess long-term clinical outcomes. RESULTS At baseline, 770 patients (64%) reported angina. Among patients assigned to medical therapy, all-cause mortality was similar in patients with and without angina (hazard ratio [HR]: 1.05; 95% confidence interval [CI]: 0.79 to 1.38). The effect of CABG was similar whether the patient had angina (HR: 0.89; 95% CI: 0.71 to 1.13) or not (HR: 0.68; 95% CI: 0.50 to 0.94; p interaction = 0.14). Patients assigned to CABG were more likely to report improvement in angina than those assigned to medical therapy alone (odds ratio: 0.70; 95% CI: 0.55 to 0.90; p < 0.01). CONCLUSIONS Angina does not predict all-cause mortality in medically treated patients with LV systolic dysfunction and CAD, nor does it identify patients who have a greater survival benefit from CABG. However, CABG does improve angina to a greater extent than medical therapy alone. (Comparison of Surgical and Medical Treatment for Congestive Heart Failure and Coronary Artery Disease [STICH]; NCT00023595).
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Affiliation(s)
- E Marc Jolicœur
- Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | - Allison Dunning
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | | | | | - Myron A Waclawiw
- National Institutes of Health/National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | - Mark C Petrie
- Golden Jubilee National Hospital, Glasgow, United Kingdom
| | | | - Pardeep S Jhund
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
| | | | - Julio A Panza
- Westchester Medical Center and New York Medical College, Valhalla, New York
| | - Robert O Bonow
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Tan Ru San
- National Heart Centre, Singapore, Singapore
| | - Hussein R Al-Khalidi
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Jean L Rouleau
- Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | - Eric J Velazquez
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - John G F Cleland
- National Heart & Lung Institute, Royal Brompton & Harefield Hospitals, Imperial College, London, United Kingdom.
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