title: The Heart Failure Revascularisation Trial (HEART).
abstract: OBJECTIVE
  Revascularization is frequently advocated to improve ventricular function and prognosis for patients with heart failure due to coronary artery disease, especially when there is evidence of extensive myocardial viability.
  
  
  RESULTS
  Patients with heart failure, coronary artery disease, and a left ventricular (LV) ejection fraction < 35%, who had a substantial volume of viable myocardium with contractile dysfunction assessed by any standard imaging technique, were randomly assigned to a strategy of conservative management vs. angiography with the intent of percutaneous or surgical revascularization. Patients requiring revascularization for angina or too frail for surgery were excluded. Only 138 of the planned 800 patients were enrolled because of withdrawal of funding due to slow recruitment. Also, a larger trial (The Surgical Treatment for Ischemic Heart Failure Trial) addressing a similar question became available, which investigators were encouraged to join. Of 69 patients assigned to the invasive strategy, 6 refused angiography, 2 died as a result of the diagnostic procedure, 14 were considered unsuitable for revascularization, 2 refused surgery, and 45 had revascularization. After a median follow-up of 59 (inter-quartile range: 33-63) months, there were 51 (37%) deaths; 25 (37%) in those assigned to the conservative strategy, and 26 (38%) in those assigned to the invasive strategy, 13 (29%) of whom had been revascularized.
  
  
  CONCLUSIONS
  A conservative management strategy may not be inferior to one of coronary arteriography with the intent to revascularize in patients with heart failure, LV systolic dysfunction, and extensive myocardial viability. However, this study was underpowered and, further, larger trials are required to settle this issue. Clinical trials Registration No: ISRCTN86284615.
authors.affiliation: Department of Cardiology, Castle Hill Hospital, University of Hull, Kingston upon Hull HU16 5JQ, UK.
authors.forename: John G F
authors.initials: JG
authors.lastname: Cleland
authors.forename: Melanie
authors.initials: M
authors.lastname: Calvert
authors.forename: Nick
authors.initials: N
authors.lastname: Freemantle
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Arrow
authors.forename: Stephen G
authors.initials: SG
authors.lastname: Ball
authors.forename: Robert S
authors.initials: RS
authors.lastname: Bonser
authors.forename: Sudipta
authors.initials: S
authors.lastname: Chattopadhyay
authors.forename: Michael S
authors.initials: MS
authors.lastname: Norell
authors.forename: Dudley J
authors.initials: DJ
authors.lastname: Pennell
authors.forename: Roxy
authors.initials: R
authors.lastname: Senior
mesh_terms: D000368:Aged; D000787:Angina Pectoris / Q000000981:diagnostic imaging / Q000601:surgery; D017130:Angioplasty / Q000379:methods / Q000401:mortality; D017023:Coronary Angiography / Q000379:methods; D001026:Coronary Artery Bypass / Q000379:methods / Q000401:mortality; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000009:adverse effects / Q000379:methods*; D018579:Patient Selection; D018570:Risk Assessment; D015996:Survival Rate; D016896:Treatment Outcome