scholarly journals Genetic Variants Are Not Associated with Outcome in Patients with Coronary Artery Disease and Left Ventricular Dysfunction: Results of the Genetic Substudy of the Surgical Treatment for Ischemic Heart Failure (STICH) Trials

Cardiology ◽  
2015 ◽  
Vol 130 (2) ◽  
pp. 69-81 ◽  
Author(s):  
Arthur M. Feldman ◽  
Lilin She ◽  
Dennis M. McNamara ◽  
Douglas L. Mann ◽  
Michael R. Bristow ◽  
...  
Keyword(s):  
Heart Failure ◽  
Coronary Artery ◽  
Surgical Treatment ◽  
Genetic Variants ◽  
Receptor Gene ◽  
Left Ventricular ◽  
Ischemic Heart ◽  
Ischemic Heart Failure ◽  
Increased Risk ◽  
Left Ventricular Reconstruction

Objectives and Background: We evaluated the ability of 23 genetic variants to provide prognostic information in patients enrolled in the Genetic Substudy of the Surgical Treatment for Ischemic Heart Failure (STICH) trials. Methods: Patients assigned to STICH Hypothesis 1 were randomized to medical therapy with or without coronary artery bypass grafting (CABG). Those assigned to STICH Hypothesis 2 were randomized to CABG or CABG with left ventricular reconstruction. Results: In patients assigned to STICH Hypothesis 2 (n = 714), no genetic variant met the prespecified Bonferroni-adjusted threshold for statistical significance (p < 0.002); however, several variants met nominal prognostic significance: variants in the β2-adrenergic receptor gene (β2-AR Gln27Glu) and in the A1-adenosine receptor gene (A1-717 T/G) were associated with an increased risk of a subject dying or being hospitalized for a cardiac problem (p = 0.027 and 0.031, respectively). These relationships remained nominally significant even after multivariable adjustment for prognostic clinical variables. However, none of the 23 genetic variants influenced all-cause mortality or the combination of death or cardiovascular hospitalization in the STICH Hypothesis 1 population (n = 532) by either univariate or multivariable analysis. Conclusion: We were unable to identify the predictive genotypes in optimally treated patients in these two ischemic heart failure populations.

Abstract 19474: Clinical Characteristics and Outcomes of Patients With and Without Diabetes in the Surgical Treatment for Ischemic Heart Failure (STICH) trial

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Michael R MacDonald ◽  
Lilin She ◽  
Torsten Doenst ◽  
Philip Binkley ◽  
Jean Rouleau ◽  
...  
Keyword(s):  
Heart Failure ◽  
Renal Function ◽  
Surgical Treatment ◽  
Clinical Outcomes ◽  
Left Ventricular ◽  
Ischemic Heart ◽  
Volume Index ◽  
Left Ventricular Ejection ◽  
Ischemic Heart Failure ◽  
Stich Trial

Introduction: Diabetes mellitus (DM), coronary artery disease (CAD) and heart failure commonly coexist. Hypothesis 1 of the Surgical Treatment for Ischemic Heart Failure (STICH) trial enrolled 1212 patients with a left ventricular ejection fraction (LVEF) of 35% or less and CAD amenable to CABG. Patients were randomised to CABG and optimal medical therapy (OMT) or OMT alone. Hypothesis: We assessed the hypothesis that patients with DM enrolled in the STICH trial would have greater benefit of CABG than patients without DM. Methods: We compared the characteristics and clinical outcomes of patients with and without DM randomized to CABG and OMT or OMT alone. Cox-proportional hazards analyses were used to assess treatment effect. Results: Diabetes was present in 40.3%. At baseline, patients with DM had more triple vessel CAD (66% v 57%, p<0.001), higher LVEF [median 29% (IQR:22,35) vs 27% (IQR:22,33), p=0.015] and smaller left ventricular end diastolic volume index [median 105 ml/m2 (IQR:85, 128) vs 117 ml/m2 (IQR:93, 146) (p<0.001)]. Among patients with DM, there was a higher proportion of females, higher BMI on average, worse renal function, and more hypertension. Patients with DM undergoing CABG spent longer on cardio-pulmonary bypass [median 97 (IQR:71,126) vs 87 (IQR:65, 115) minutes, p=0.029], and were more likely to develop perioperative AF (23% vs 11%, p<0.001) and worsening renal function (9% vs 4%, p=0.021). Patients with DM on OMT had similar outcomes as those on OMT without diabetes (Table 1). A statistically significant or near statistically significant improvement in clinical outcomes with CABG compared to OMT was documented in patients without DM, but not in patients with DM. However, there was no significant interaction between DM and treatment group on formal statistical testing. Conclusions: Patients with and without DM enrolled in the STICH trial had similar outcomes at 5 years, and CABG did not exert greater benefit in patients with DM.

scholarly journals Long-Term Results of Hybrid Left Ventricular Reconstruction in the Treatment of Ischemic Cardiomyopathy

2021 ◽  
Author(s):  
Jan Naar ◽  
Ivo Skalský ◽  
Andreas Krűger ◽  
Filip Málek ◽  
Kevin Van Bladel ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ischemic Cardiomyopathy ◽  
Left Ventricular ◽  
Ischemic Heart ◽  
Volume Index ◽  
Long Term Results ◽  
Ischemic Heart Failure ◽  
Left Ventricular Reconstruction ◽  
Anchoring System

AbstractThe evidence supporting surgical aneurysmectomy in ischemic heart failure is inconsistent. The aim of the study was to describe long-term effect of minimally invasive hybrid transcatheter and minithoracotomy left ventricular (LV) reconstruction in patients with ischemic cardiomyopathy. Twenty-three subjects with transmural anterior wall scarring, LV ejection fraction 15–45%, and New York Heart Association class ≥ II were intervened using Revivent TC anchoring system. LV end-systolic volume index was reduced from 73.2 ± 27 ml at baseline to 51.5 ± 22 ml after 6 months (p < 0.001), 49.9 ± 20 ml after 2 years (p < 0.001), and 56.1 ± 16 ml after 5 years (p = 0.047). NYHA class improved significantly at 5 years compared to baseline. Six-min walk test distance increased at 2 years compared to the 6-month visit. Hybrid LV reconstruction using the anchoring system provides significant and durable LV volume reduction during 5-year follow-up in preselected patients with ischemic heart failure. Graphical abstract

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