title: Myocardial viability and impact of surgical ventricular reconstruction on outcomes of patients with severe left ventricular dysfunction undergoing coronary artery bypass surgery: results of the Surgical Treatment for Ischemic Heart Failure trial.
abstract: OBJECTIVE
  In the Surgical Treatment for Ischemic Heart Failure trial, surgical ventricular reconstruction plus coronary artery bypass surgery was not associated with a reduction in the rate of death or cardiac hospitalization compared with bypass alone. We hypothesized that the absence of viable myocardium identifies patients with coronary artery disease and left ventricular dysfunction who have a greater benefit with coronary artery bypass graft surgery and surgical ventricular reconstruction compared with bypass alone.
  
  
  METHODS
  Myocardial viability was assessed by single photon computed tomography in 267 of the 1000 patients randomized to bypass or bypass plus surgical ventricular reconstruction in the Surgical Treatment for Ischemic Heart Failure. Myocardial viability was assessed on a per patient basis and regionally according to prespecified criteria.
  
  
  RESULTS
  At 3 years, there was no difference in mortality or the combined outcome of death or cardiac hospitalization between those with and without viability, and there was no significant interaction between the type of surgery and the global viability status with respect to mortality or death plus cardiac hospitalization. Furthermore, there was no difference in mortality or death plus cardiac hospitalization between those with and without anterior wall or apical scar, and no significant interaction between the presence of scar in these regions and the type of surgery with respect to mortality.
  
  
  CONCLUSIONS
  In patients with coronary artery disease and severe regional left ventricular dysfunction, assessment of myocardial viability does not identify patients who will derive a mortality benefit from adding surgical ventricular reconstruction to coronary artery bypass graft surgery.
authors.affiliation: Northwestern University, Chicago, Ill. Electronic address: t-holly@northwestern.edu.
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Holly
authors.affiliation: Northwestern University, Chicago, Ill.
authors.forename: Robert O
authors.initials: RO
authors.lastname: Bonow
authors.affiliation: University of Western Ontario, London, Ontario, Canada.
authors.forename: J Malcolm O
authors.initials: JM
authors.lastname: Arnold
authors.affiliation: Mayo Clinic, Rochester, Minn.
authors.forename: Jae K
authors.initials: JK
authors.lastname: Oh
authors.affiliation: Loma Linda University, Loma Linda, Calif.
authors.forename: Padmini
authors.initials: P
authors.lastname: Varadarajan
authors.affiliation: University of Southern California, Los Angeles, Calif.
authors.forename: Gerald M
authors.initials: GM
authors.lastname: Pohost
authors.affiliation: Ottawa Heart Institute, Ottawa, Ontario, Canada.
authors.forename: Haissam
authors.initials: H
authors.lastname: Haddad
authors.affiliation: Duke University, Durham, NC.
authors.forename: Robert H
authors.initials: RH
authors.lastname: Jones
authors.affiliation: Duke University, Durham, NC.
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Velazquez
authors.affiliation: Department of Nuclear Medicine PUM, Szczecin, Poland.
authors.forename: Bozena
authors.initials: B
authors.lastname: Birkenfeld
authors.affiliation: MedStar Washington Hospital Center, Washington, DC.
authors.forename: Federico M
authors.initials: FM
authors.lastname: Asch
authors.affiliation: Medical University of Silesia, Katowice, Poland.
authors.forename: Marcin
authors.initials: M
authors.lastname: Malinowski
authors.affiliation: Instituto Dante Pazzanese de Cardiologia, Sao Paulo, Brazil.
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Barretto
authors.affiliation: Instituto de Cardiologia, Porto Alegre, Brazil.
authors.forename: Renato A K
authors.initials: RA
authors.lastname: Kalil
authors.affiliation: Cedars-Sinai Medical Center, Los Angeles, Calif.
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Berman
authors.affiliation: Duke University, Durham, NC.
authors.forename: Jie-Lena
authors.initials: JL
authors.lastname: Sun
authors.affiliation: Duke University, Durham, NC.
authors.forename: Kerry L
authors.initials: KL
authors.lastname: Lee
authors.affiliation: Westchester Medical Center, Valhalla, NY.
authors.forename: Julio A
authors.initials: JA
authors.lastname: Panza
mesh_terms: D000368:Aged; D009202:Cardiomyopathies / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000401:mortality; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology*; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000401:mortality; D012720:Severity of Illness Index; D013997:Time Factors; D014022:Tissue Survival; D015899:Tomography, Emission-Computed, Single-Photon; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D016277:Ventricular Function, Left