OBJECTIVES: The objectives of this study were to test the hypothesis that end-systolic volume ( @entity5778 ), as a marker of severity of left ventricular (LV) remodeling, influences the relationship between @entity296 and survival in @entity1 with @entity1002 . BACKGROUND: Retrospective studies of @entity1002 suggest that the severity of LV remodeling determines whether @entity296 predicts improved survival with surgical compared with medical therapy, with coronary artery bypass grafting (CABG) only benefitting @entity1 with viable myocardium who have smaller @entity5778 . However, this has not been tested prospectively. METHODS: Interactions of end-systolic volume index (ESVI), @entity296 , and treatment with respect to survival were assessed in @entity1 in the prospective randomized STICH (Comparison of Surgical and Medical Treatment for @entity712 and @entity453 ) trial of CABG versus medical therapy who underwent viability assessment (n  = 601; age 61    9 years; ejection fraction   <=35%), with a median follow-up of 5.1 years. Median ESVI was 84 ml/m(2). Viability was assessed by single-photon emission computed tomography or @entity452 echocardiography using pre-specified criteria. RESULTS: Mortality was highest among @entity1 with larger ESVI and nonviability (p  < 0.001), but no interaction was observed between ESVI, viability status, and treatment assignment (p  = 0.491). Specifically, the effect of CABG versus medical therapy in @entity1 with viable myocardium and ESVI   <=84 ml/m(2) (hazard ratio [HR]: 0.85; 95% confidence interval [CI]: 0.56 to 1.29) was no different than in @entity1 with viability and ESVI >84 ml/m(2) (HR: 0.87; 95% CI: 0.57 to 1.31). Other ESVI thresholds yielded similar results, including ESVI   <=60 ml/m(2) (HR: 0.87; 95% CI: 0.44 to 1.74). ESVI and viability assessed as continuous rather than dichotomous variables yielded similar results (p  = 0.562). CONCLUSIONS: Among @entity1 with @entity296 , those with greater LV ESVI and no substantial viability had worse prognosis. However, the effect of CABG relative to medical therapy was not differentially influenced by the combination of these 2 factors. Lower ESVI did not identify @entity1 in whom @entity296 predicted better outcome with CABG relative to medical therapy. (Comparison of Surgical and Medical Treatment for @entity712 and @entity453 [STICH]; NCT00023595).

Severity of Remodeling, XXXX , and Survival in Ischemic LV Dysfunction After Surgical Revascularization.

@entity1 :: ('9606', 'Species') :: ['patients'] @entity712 :: ('MESH:D006333', 'Disease') :: ['Congestive Heart Failure'] @entity296 :: ('MESH:D009202', 'Disease') :: ['ischemic cardiomyopathy', 'myocardial viability'] @entity452 :: ('MESH:D004280', 'Chemical') :: ['dobutamine'] @entity5778 :: ('1127767', 'Species') :: ['ESV'] @entity453 :: ('MESH:D003324', 'Disease') :: ['Coronary Artery Disease'] @entity1002 :: ('MESH:D018487', 'Disease') :: ['coronary artery disease and LV systolic dysfunction', 'ischemic LV dysfunction']
@entity296 :: (MESH:D009202,Disease) :: ['Myocardial Viability']
